California’s controversial forced implicit bias training promotes distrust and resentment in medical care

Dr. Azadeh Khatibi, whose first name means “freedom,” was born in Iran and immigrated to the U.S. when she was six. She has since embodied the spirit of her name and the American dream, completing a rigorous joint medical degree program at the Universities of California San Francisco and Berkeley and launching a career as an ophthalmology specialist in Los Angeles.

Dr. Khatibi never imagined that she would escape the oppression of her childhood only to face creeping collectivism and unfree speech in America.

In 2019, California lawmakers passed a chilling new mandate known as AB 241. In a purported effort to reduce healthcare disparities based on race, ethnicity, gender, or sexual orientation, the law requires that all continuing medical education (CME) courses involving direct patient care include implicit bias training—regardless of who teaches the course or what is taught.

“Implicit bias” is the idea that medical professionals unconsciously treat patients differently based on their race or other immutable characteristics. Evidence that implicit bias exists is mixed, but California now requires discussion of it in CMEs. Worse, evidence shows that improper implicit bias training can backfire, causing anger, frustration, and resentment among those taking the training.

In practice, this means CME courses on advanced cardiac life support, minimally invasive surgery, or diabetes management, for example, must reserve time in each session to remind everyone that they should be conscious of a patient’s race, ethnicity, gender, and sexual orientation.

All California physicians must log 50 CME hours every two years as a condition of license renewal. Now, CME instructors are forced to teach physicians about the government’s controversial topic of implicit bias, whether it’s relevant to their medical education or not.

Requiring this training forces instructors to espouse views they may find unpersuasive and unsupported by evidence. Implicit bias is far from an established fact, yet the law demands that CME instructors presume all healthcare providers are infected with implicit bias and thus treat patients differently.

Injecting race and other immutable characteristics into every training also risks undermining patient-doctor relationships by encouraging resentment and distrust. Physicians should base medical care on each patient’s individual situation and condition. California’s required “implicit bias” training does the opposite. It teaches doctors to be concerned about race when giving medical advice to their patients. And it tells them that their subconscious, unintentional feelings and thoughts are equally important to their reasoned medical judgment.

Dr. Khatibi has organized and taught CME courses for many years in medicine, including ophthalmology, and, following a serious illness, taught the public mindfulness, wellness, and about the needs of highly gifted and sensitive people. Regardless of its relevance in her CME courses, she must replace some of her instruction with a discussion of implicit bias.

Represented free of charge by PLF, Dr. Khatibi is fighting back with a federal lawsuit to stop California from controlling speech like the Iranian government of her childhood.

Dr. Khatibi is joined in the lawsuit by Dr. Marilyn Singleton, a California anesthesiologist, and Do No Harm, a national medical advocacy organization. Dr. Singleton teaches continuing medical education courses in California and wrote in The Washington Post that the implicit bias requirement spreads the “malignant false assumption that White people are inherently racist.”

Do No Harm embraces the principles of freedom and has previously filed complaints with the Office of Civil Rights and a federal lawsuit against Pfizer’s race-based fellowships. Its members, including Dr. Singleton, have given continuing education courses in the past and wish to do so in the future without being compelled to promote implicit bias.