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Saturday, May 12th 2007

Race and Ethnicity Have No Place In Medicine

I was party (that might be an overstatement since I contributed nothing) to a conversation a while back where an attending at my school very passionately laid out her desire to do away with presenting a patient’s race or ethnicity. More than that she hoped to work towards replacing it with the patient’s self identification.

For instance, “The patient is a sixty three year old man who self identifies as an African-American.”

What Does This Guy Self Identify As?

Such would be mostly as a promotion of justice and for the patient’s psyche. For instance, as I understood it, a largely Caucasian individual who had embraced his great-great grandmother’s Native American heritage and self described himself as such would have that reported. No matter his actual genetic risk for alcohol dependency or diabetes or whatever.

This wasn’t merely cocktail talk. I, at least, took away from the group conversation that this was something she was actively working on and that those who were listening in seemed in agreement with. To say I was skeptical is to be polite. At the time however, my feelings were merely reactionary. A roll your eyes type of reaction at another example at the intrusion of political correctness into yet another aspect of life.

But thinking it through, long after the conversation was over, I think this is something akin to (if not exactly) the woo which Orac speaks on so often. The most distressing element of the conversation were the anecdotes thrown about. Along the lines of say, I’ve never met an a family of eastern European Jewish heritage with a history Tay-Sachs.

I have a new favorite quote, that is incredibly relevant here: “The plural of anecdote is not data.”

I wonder what makes some incredibly bright and talented physicians seemingly abandon any notion of investigation in favor of what they just “know” (in this case: that the damage of labeling patients by race must be greater than the clinical significance of their race).

True, not everything in the proposal is completely quantifiable. It would likely be difficult to lay out the impact (if any) that health care providers constantly grouping people by race/ethnicity has. But you can certainly quantify the clinical significance of knowing someone’s race or ethnicity. Indeed it has largely been done.

Putting my personal dismissal of the proposal aside, shouldn’t at the least this be studied before someone makes it their life’s work advocating for it? Don’t advocates of this need to know the true cost – benefit analysis before they claim their sceptre in the name of improving race relations?

The physician advocating for this, while with incredibly noble intentions, was more newspaper feature columnist/op-ed writer on this particular night than physician-scientist.