Can I Check the “Human” Box, please?

CC: ________________________________________________
How does one properly fill this chief complaint (CC) line?

Typically, you may hear something like:
“Mrs. Doe, a 33 y/o Caucasian female presents with A, B, and C….”

After seeing my first patient in homeless clinic,I was told the CC is akin to a teaser of the movie of a patient’s medical history. If that's the case, how much information about an individual should be included in the CC and what should be omitted?

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“Knowing the ethnicity and race sets off red flags,” said a self-proclaimed doctor from the old generation during our lecture on race.

Genetically, we are 99.9% identical and yet we are so different. And yet there is no "human box" we can check to identify ourselves in this manner. We are diverse; especially when we think about race and ethnicity—two nebulous terms that evoke strong reactions.

After a two hour lecture and panel discussion of race in medicine, I am still unclear about how to define each term. I do know they are not synonymous and the significance of race and ethnicity as a medical identifier is up for debate.

I did get one central message. No matter how much we can recognize the existence of biases, the bottom line is that we all have our biases. I have mine and you have yours. And biases play a role in how we deliver health care to our patients.

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I have been told repeatedly that I am being indoctrinated into a new culture. Ideally, we shed our biases when we put on our white coats and interact with our patients. But apparently, this new culture is not color-blind.

As such, we must ask if race and ethnicity belong in the tag-line of the chief complaint or should this information be tossed into the social history?

There are no studies that have actually proven that removing race and ethnicity from the chief complaint removes bias. But how can you really measure a bias (and the removal of a bias)? And to play devil’s advocate, if we are hesitant to include race, then why do we mention age and sex in the CC, since both topics are also polarized and notorious sources of generalizations and stereotypes.

UCSF has developed a new innovative approach to addressing how we describe and use race in delivering medical care. We have been instructed to omit race/ethnicity from the CC. In implementing a new approach to address the race/ethnicity question within a broader social context, UCSF is hoping to create a new norm for history taking and will start by educating us early in our training.

***

It seems simple enough, and yet we have opened Pandora’s Box based on today’s extensive discussion in lecture about the implications of this policy. There was no agreement; just a long discussion with varying perspectives that bounced high and low, side to side, and all over the place.

I have mixed feelings. I can see why it is important to look outside the racial box—we need to focus on the individual, rather than the disorder, race, or ethnicity (and the associated stereotypes).

At the same time, an individual’s race and ethnicity is an unavoidable subject that will come up later on in the interview and sometimes has medical significance especially in disorders that have a genetic component such as sickle cell anemia, Tay-Sachs, and cystic fibrosis. It will be interesting to see how this plays out during my clinical experiences. The discussion has got me thinking about race and asking, "so what now…” I think I can quote myself.

Here is something interesting I learned: South Asians are actually more closely related to Europeans than East Asians. And yet, South Asians are clumped under the “Asian” category. Interesting...

At least, I’ll think twice before I check the next racial box that asks me to identify myself. Instead, I will select “other” and pencil “human.”

My reasoning may just be an oversimplification (but at least I can identify with a group that we are all part of).

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Image Source: "Diversity." http://www.lamission.edu/diversity/images/diversity.jpg