Implicit Bias:

What is it & Where Does it Come From?

By Alan Sylvestre
For Lane County Medical Society

Perspective is an issue that is in “the eye of the beholder.” People create viewpoints and opinions based on their life experiences.

Factors that play into these are heritage, culture, upbringing, and many others.

For Dr. Kevin Modeste, a double board-certified general surgeon with Northwest Surgical Specialists, his viewpoints have largely been shaped by being a minority physician.

“I think that in the medical community, physicians who are of color, and especially female physicians of color, are looked at differently,” Modeste says. “It feels like you are under a microscope, where everything you do is looked at in a certain light. I think because of implicit bias, patients and some physicians assume incompetence and are always looking for ways to confirm it.”

“This unfortunately is a reality for physicians of color. It is an additional layer of stress that is added on to what can be an incredibly stressful job. It is a boundary that people like me must overcome. We all have found different ways of dealing with it.” Despite at times feeling like an outcast, he has never stopped trying to help his patients and this community.

Becoming a Doctor

Born and raised in Trinidad and Tobago, Dr. Modeste is immensely proud of his cultural heritage. The youngest of six, his mother always wanted one of her children to be in medical school.

“I was very lucky because they had just started a medical school in Trinidad and Tobago,” Dr Modeste says. “It was a very robust clinical experience and working there for 6 years gave me valuable experience.”

Once established as a physician, Dr Modeste came to the US and completed residency and fellowship in Connecticut.

And throughout his career, one constant has always been his love of helping those in need.

“We have this amazing job to help people through some of the toughest times in their life. As a surgeon it feels sometimes like you are walking right next to them. After surgery, I like to help people walk through that journey of trying to get their life back.”

A Not So “Black and White” Issue

Dr. Modeste is a practicing minority physician in a largely white area of the country. According to the U.S. Census Bureau as of 2019, Oregon’s white population was 86.7 percent, with less than three percent identifying as black or African American descent. “It does make for an interesting blend of patients. Some are grateful and some can be blatantly disrespectful, you just have to roll with the punches.” Modeste has had patients and their family members use racial slurs against him.

Early on in his career, he says it used to bother him because “we are all human and it’s hard not to let it get to you sometimes.”

Over time, he has come to realize that people’s views are shaped around a preconceived bias. Research supports that racism is learned early in life, with children assigning socio-cultural traits by race in the toddler years and racist beliefs well ingrained with the beginning of school years.

With such strong implicit bias, many people may have negative feelings about minorities while not believing themselves to be at all racist.

Modeste knows that some people will have attitudes about him just after seeing his skin. Even other physicians may assign stereotypes without taking the time to get to know him as a person or as a fellow doctor. “We all are capable of those feelings, physicians as well. However, when it starts affecting our care of patients, or when it affects our ability to promote ideas or individuals, then it is evidence of systemic racism.”

“For many physicians of color, we face verbal abuse – even physical threats. Sometimes it can be daily. The thing is, it also follows you after you take off your lab coat and move out into society.” Dr Modeste states he has been verbally accosted or followed outside of work, and it takes a lot of restraint not to retaliate.He knows that he will always be viewed as the aggressor.

“I think a lot of white physicians do not understand what it is like to live under that constant pressure and be still asked to perform to perfection.”

Varied Outcomes

Dr. Modeste has seen a varied response from physicians in the community. “In the past I have found support in other physicians of color. Most white physicians did not believe racism is still a problem so sometimes they say you are overreacting or too sensitive. It has made me realize who can be allies in a bad situation and those who will not support you. I have the luck of having a wonderful white physician/surgeon wife who has been with me through residency and my career. She has been with me through it all and is an amazing support and encouragement.”

Dr. Modeste says that sometimes the color of your skin can play a major role in how you are treated by colleagues or staff. And it can dictate the kind of emotional or physical support you can receive if something in the operating room does not go as planned. But through all these instances, one constant has remained the same. Modeste’s love of surgery and his passion for practicing medicine.

As a general surgeon, Modeste has the ability to focus on a wide array of surgical methods. Early in his career, he became very fascinated with roboticassisted surgery.

“At RiverBend, we have three surgical robots. I am proud, along with my partner Dr. Duc Vo, to have helped pioneer advanced general surgery robotic procedures in the Eugene/Springfield area” Modeste says.

According to PeaceHealth’s website, robotic-assisted surgeries are minimally invasive, and have a broad spectrum of advantages that might make this option more beneficial to patients.

Because of the increased precision, a patient might see less pain, less blood loss, less scarring, and shorter recovery times.

And although he might do the same surgery several times, each case is different and Modeste says he enjoys looking at each case as a unique problem that requires a different approach.

“One of the things I love about surgery is that you come in with a problem, and you have to develop a way to fix that problem,” Modeste says.

His fervor for medicine fuels his tenacity to overcome hurdles of diversity barriers in the profession.

“No matter what, I try my hardest to always fight for my patients,” Modeste says.

Impacts of George Floyd & Implied Bias

The death of George Floyd is one of many officer involved shootings that have been brought into question recently.

For Modeste, watching the released video from the George Floyd murder, was a point of revelation.

It was entirely different watching it as a person of color.

“Watching the video, all I could see was myself laying on the ground with my wife and kids looking on totally hopeless to help. It was really upsetting to watch that. But even more upsetting was hearing people trying to justify it,” Modeste says.

“There are going to be some people who watch that video and get sad because it is a sad situation,” Modeste says. “But there are many people who are going to watch it and easily disassociate from it, because they know that will never happen to them or their family members.”

He believes this is because of an implicit bias where people see things based on their version of reality. Culturally, many may not put deep thought into a topic we cannot relate to.

It is easier to see George Floyd’s flaws and that he is somehow responsible for his death than to believe we live in a nation with systemic racism.

Despite seeing so much throughout his career, Modeste has learned to put all this aside and focus on the task at hand. To focus on the patient in the room, no matter what they think of him.

“Sometimes this doubt can cause you to second guess yourself into being a bad doctor,” Modeste says. “But if I had only focused on the bad, I would never be where I am in my career. There is always hope especially looking at all the progress with the discussion about implicit bias and systemic racism. I was proud to hear PeaceHealth, Oregon Medical Group as well as LCMS becoming more involved with these difficult, uncomfortable but necessary conversations.”

His message to anyone, inside and outside of medicine, is to remember that implicit bias is everywhere.

And to also remember there are others around you who could be struggling, whether it appears obvious on the surface or not.

“If you see someone hurting, just reach out,” Modeste says. “They might really need your help.”