Many of us are taught in residency or medical school in the United States to begin a patient’s case presentation with age, sex, race and chief complaint. A survey of medical students published in 2009 noted that “Students are taught to mention race routinely at 11% of schools and selectively at 63% of schools; this practice is discouraged at 9% of schools and not addressed at 18% of schools. Most respondents noted that resident doctors at their institutions routinely mention race at the beginning of case presentations.”
This month, for obvious reasons, has me thinking whether mentioning race is necessary at the beginning of a patient’s case presentation or note in the patient’s chart. Yes, there are some diseases like hypertension which have different outcomes in blacks, but what if we presented the race towards the end in our section on problem list, assessment and plan? Would that not be a better place for a discussion on developing a treatment plan that is more adapted to the patient’s race? Similar sentiments have been expressed by others who feel that “at our current level of knowledge, patient race is in general not clinically useful in knowing a patient, understanding a patient’s disease, or creating a treatment plan.” Black is skin color. Even with race, we do not do an accurate job of describing race for those who are not black, like Latinos, Asians, people from the Indian subcontinent, etc. For example, in my twenty years of taking care of patients in the US either as a trainee or as an academic faculty member, I have not heard a presentation that mentioned a patient’s Dravidian race. We often confuse race with ethnicity and frequently document/ present Hispanic as race and not as ethnicity. We are lost when it comes to mixed race people. When presented at the beginning of a case presentation, there may be a risk of inviting racial stereotyping and implicit bias towards a patient even before one gets to learn about the patient.
All this to say – our social lives and interpersonal relations have become more complicated over the recent decades. Even though there is greater knowledge and better collective awareness of race, skin color, ethnicity, gender, sexuality, and other differences between people, and their impact on health outcomes, we as physicians have a lot to learn about these differences in order to address them in a sensitive manner. Because competence may not be achievable, the new goal is to practice “cultural humility,” which allows us to acknowledge patients’ authority over their own lived experience. Lastly, this is an excellent review article for those who are interested in learning more about the origin of race as a construct and the impact of structural racism and cultural racism on health. Suffice to say that we are only scratching the surface of this very complex social problem in health care.