Incompetency Bias

Like we don’t have enough to worry about, and like California already hasn’t won “Dumbest State of the Year” so many times it will hold the title through 2030 at least.

The LA Times tells us that there is a new push on the in the not-so-Golden State for further training to stamp out bias in the medical field.  “State health researchers” say that despite an overall decrease in maternal mortality, black women are three to four times likely to die giving birth than are whites.  “Instead, they point to evidence of racism and implicit bias in the medical community,” citing a 2016 University of Virginia study purporting to show “Racial bias in pain assessment and treatment recommendations…”  Skimming through this study, I found it to be bizarre in its presumptions.  It claims that racial disparities in pain management will occur either because “physicians recognize black patients’ pain, but do not to treat it, perhaps due to concerns about noncompliance or access to health care. The second possibility is that physicians do not recognize black patients’ pain in the first place, and thus cannot treat it.”  More bizarre to me is that someone would even gin up such a cockamamie study in the first place, only to demonstrate the presumption bias that is the real threat here.

 You know the standard emotional formula:  1) Perceive a potential problem; 2) Find some loony-tune study or “expert” to explain why your presumption is correct; 3) Call in the hand-wringing media; 4) Punish the presumed guilty; 5) Repeat cycle. 

“State Sen. Holly Mitchell (D-Los Angeles) said at a recent Senate Health Committee hearing. ‘Black women are in grave danger because when they say they are in pain … some providers do not believe that and lack the cultural competency to respond appropriately.'”  There, did you catch it?  Our old AAFP-promoted friend and moneymaker, “cultural competency” is back to play.  Now state lawmakers have proposals “that would require training for nurses, doctors and other medical professionals on how to spot implicit bias on the job. The legislation is part of a broader push to tackle the unconscious perceptions and stereotypes that contribute to discrimination and disparities in treatment in the medical field and other industries, and can play a role in instances where life and death hang in the balance.”  

– A training program to help perinatal healthcare providers identify and correct their biases.

– Require hospitals to provide patients with more information on how to file discrimination complaints.

– Doctors, physician assistants and nurses would have to undergo eight hours of implicit bias training and testing within two years of receiving their licenses and every two years thereafter.

And here is the real point today:  physicians have long since become the go-to conduit for any and all political or cultural conflict, and usually are the ones to get whipsawed by the good intentions and arrogance of dull-witted politicians and newspapers more eager to prove their own goodness than solve actual problems.  Yes there are certainly cultural variations – not all of them good ones – throughout our society, and when one sees repeat patients looking for pain meds, yes, a presumption may develop.  But while docs are being told they are prescribing too much narcs, will ridiculous “cultural competency” pushes lead them to prescribe a few extra pain pills based on skin color, to keep they employer happy and to avoid complaints?  And would that not itself be horribly biased?

No, this is once again non-medical types demonstrating society’s deeply ingrained, and worsening mistrust of the medical field, putting unaccountable, idiotic “researchers” in charge, manufacturing crimes with which to punish the innocent, and hampering our ability to properly care for patients using our own judgment. This garbage will become a vote getter, a moneymaker for those selling mandatory seminars and CME’s, and further official confirmation that doctors are at best, ignorant types badly wanting reeducation.  Self-hatred and resentment will be the rewards, and none of this will help patients.

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  5 comments for “Incompetency Bias

  1. PW
    May 21, 2019 at 4:35 pm

    Once again, California leads the way in stupidity.

  2. Thomas David Guastavino
    May 21, 2019 at 2:19 pm

    I hate to say it but we are our own first enemies. Recently Dr Kristy Weber took over as head of the American Academy of Orthopaedic Surgeons and made it her stated goal to stamp out all gender bias in orthopaedics , going so far as to say that all faculty and residents should taken the discredited Harvard Implict Associations test to somehow try and detect “subconscious” bias, whatever that is.

  3. Rick M Singel
    May 21, 2019 at 1:59 pm

    This is why I completely LOATHE the diversity industry. In every aspect of life. The neo-Puritan do-gooders are spreading their vile tentacles everywhere. I recently received a dental journal (yes, I’m a dentist but your issues apply to us too) with a 4 page fold-out cover. 4 couples, one on each full page: gay couple holding hands, lesbian couple, interracial couple, another interracial couple, reversed.
    In a PROFESSIONAL publication. The mainstreaming by apparently ALL media is going 1000mph. I so resent it.
    And now you physicians in CA will be sent, mandatorily, to re-education camp.
    My brain can’t even handle this stuff anymore.
    After reading this piece I am to pissed off to work.

    • Rick M Singel
      May 21, 2019 at 2:01 pm


  4. May 21, 2019 at 1:32 pm

    If you are too busy looking for bias, you will miss the biology. Maybe black women have worse maternal outcomes because they are much more likely to have fibroids, which tend to cause postpartum hemorrhage. Is that the doctor’s fault too? See

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