Patient Race ID
Anand Swaminathan, MD and Alden Landry, MD
- In the 1940s, the Jim Crow laws allowed for “separate but equal” facilities for white people and people of color.
- At the same time, World War II soldiers were returning from overseas and the need for healthcare reform became apparent.
- In 1946, Congress and President Truman passed The Hospital Survey and Construction Act, also known as The Hill-Burton Act.
- This was designed to provide federal grants and loans to improve the nation’s hospital system.
- Agencies weren’t allowed to discriminate when building the hospitals, but they were allowed to build “separate but equal” facilities.
- The sponsoring senators were Burton and Hill, senators from Ohio and Alabama.
- Grady Memorial Hospital in Atlanta is built in two towers, originally one tower for white patients and one for black patients.
- Part of the admitting process required a distinction of skin color, built into the one-liner presentation.
- Separate but equal was dismantled but older generations from Atlanta still refer to Grady as “The Gradies” a nod to its discriminatory history.
- Incorporation of race into the first-line of patient presentations is unnecessary and a remnant of racism in America.
- Adding race to the presentation can lead to unconscious bias when managing the patient, including administering pain medication, placement in the ED.
- Only commenting on the race of non-white patients makes white the default and every other race is categorized as “other.”
- If race is a social construct, it may benefit from a discussion in the social history.
- Often we identify the patient’s race based off our assumptions, not their own identification, but race should be self-identified.
- Discerning racism in medicine is difficult, as sometimes racism is an interpersonal experience that is hard to quantify.
- When looking more broadly, there is data that some of these racial groups may have disparities in door-to-ekg time, pain medication pattern, referral pattern to specialists from the ED.
- These discrepancies may follow patients through their healthcare.
- Attendings should be cognizant of how their trainees present patients and how they themselves present patients.
- We should remove race from one-liners and include self-identified race as part of the social history.
Ayobami Olufadeji, Nicole M. Dubosh, Alden Landry, “Guidelines on the use of race as patient identifiers in clinical presentations,” Journal of the National Medical Association, Volume 113, Issue 4, 2021, Pages 428-430, ISSN 0027-9684, https://doi.org/10.1016/j.jnma.2021.02.005
Mark C. - December 19, 2021 6:53 AM
this is ridiculous...….
Race / Ethnicity / geographic country of origin are all actually associated with numerous medically and socially important issues that can affect patient care directly.
knowing a patient's race / ethnicity / geographic country of origin is important for these and other reasons.
Stop the Woke madness please.
Self identified?? really.
Anand S. - December 29, 2021 6:13 PM
Mark - I hope you're open to discussing this more. There's a great deal of literature in the area.
NEJM just published a wonderful article on the topic that I think would be beneficial for everyone to look at: https://www.nejm.org/doi/full/10.1056/NEJMp2112312?query=TOC&cid=NEJM%20eToc,%20December%2030,%202021%20DM586164_NEJM_Non_Subscriber&bid=752391597
They address the issues you state head on:
"The question at hand is whether mentioning race or ethnicity at the beginning of an oral presentation or chart note enhances or undermines these objectives. Some proponents may argue that this information suggests initial biologic probabilities that are immediately relevant for hypothesis generation, diagnosis, and treatment. For example, proponents may cite genetic examples such as sickle cell disease (far more prevalent among Black Americans than in other U.S. racial or ethnic groups) and hemochromatosis (far more prevalent among White populations than in other racial or ethnic groups). Other proponents may argue that race or ethnicity should be acknowledged immediately even if it has little diagnostic or therapeutic relevance for most patients — that there is a benefit to processing an individual patient’s history and physical findings through the lens of race or ethnicity, given the impact of racism on health.
We believe these arguments are problematic, for reasons that fall into two main categories. First, routine inclusion of race or ethnicity at the beginning of a case presentation reinforces the still-prevalent but mistaken belief that race or ethnicity is a robust surrogate for genetic or innate biologic predisposition to disease.2,3 Racial and ethnic groups are not static, uncontroversial categories; because they are socially constructed, they are fluid and evolve over time. Moreover, commonly used racial and ethnic categories are often confusing mixtures of skin color, geographic location, ancestry, culture, and religion. Although there may be a strong statistical correlation between patient-identified race or ethnicity and a particular clinical diagnosis in a specific geographic area at a given point in time, these rare exceptions — which are often mediated by ancestry4 — should not drive the standard template for case presentations. Moreover, immediately mentioning race or ethnicity may predispose clinicians to premature diagnostic closure, a cognitive error in clinical reasoning. The subliminal effect of classifying a patient by race or ethnicity before hearing or reading about the patient’s illness history and physical findings may result in incorrect inclusion or exclusion of diagnostic hypotheses."