When Science and Race Intersect, Beware Scientific Racism
Grey’s Anatomy got (at least) one thing right about medicine: all patient presentations begin with a one-liner. Something like, “Mr. B is a 56-year-old man with a history of heart disease who presents with chest pain.” The presenter (often me, the trainee) distills the patient’s demographics and medical history into a concise statement that tells the attending everything she needs to know — no more, no less.
During my third year of medical school, I worked with a physician who required the race of the patient to be included in the one-liner. To me, this meant that race was vital information to her medical decision-making. In my brief experience on the wards, this is not common but is also not unheard of.
The physician was a woman of color, easing my initial resistance to her request. But still, I was surprised. Of course, disease prevalence does vary by race. So, from a public health perspective, race can be considered a “risk factor.” Such logic is why we include age of the patient (e.g. chest pain in a 56-year-old man is categorically not the same as chest pain in a 12-year-old girl.) But using public health information to frame individual patients also carries the risk of “anchoring.”
In medical practice, anchoring is a cognitive error where the physician depends too heavily on an initial piece of information (like race) when making a decision. But in medical test-taking, anchoring is actually rewarded. Our board exams are 9 hours long and timed so that we cannot spend more than 90 seconds per question. We are encouraged to find anchors to make a diagnosis quickly, then move on. In the land of multiple choice, the patient’s race is often vital. For example, when I read, “Ms. B is a 33-year-old African American female who presents with a cough,” I immediately consider a rare disease like sarcoidosis only because the patient is Black.
But I have heard many cautionary tales from wizened doctors about how “patients don’t read the textbook.” For example, I heard about a White woman who had a lung disease that went undiagnosed for years because no one thought of sarcoidosis — an epidemiologically “Black” disease. Conversely, I heard about a Black child whose diagnosis was incorrectly presumed to be sickle cell disease, a presumption made on the basis of…