Thursday, March 23, 2006

Of Race and Wo/men

Our entire team met today---two sister programs who care for vulnerable populations under 65 and over 65, respectively. Since we share an office, a supervisor, and the same mission with slightly different paperwork and processes, we meet once a month to present cases and hash out organizational and office issues. We also celebrate the month's birthdays with a cake. With 20 employees, each month sees a birthday, with May as the only exception. So we have our cake and eat it too. Monthly.

In presenting my case, I opened by describing my patient, beginning by identifying him as African-American. Similarly, the presenter before me also described her patient as African-American. Following the case presentations, one of our Nurse Practitioners confronted us directly but kindly regarding why we felt the need to let the group know that these two patients were indeed African-American. She pointed out---quite correctly---that we never identify white patients as such when we present them in case conference, those distinctions being used only for "minorities". Ironically, among our patient population, caucasian patients are a vast minority, perhaps 5% of our total caseload, and perhaps 10% of the wider health center where we practice. So why don't we identify them?

Letting this sink in, I immediately realized that her point was incredibly astute, and that we had been called on a subtle but obvious (and unnecessary) "racialization" of our non-white patients. While the clinic is identified as serving a majority Latino population, we agreed as a group that race is only important in a case presentation if the person's race figures prominently vis-a-vis their medical conditions (ie: sickle cell anemia).

Some readers trained in the medical field will possibly react to this story by pointing out that medical/nursing training indoctrinates most of us to present a case thusly: "Mr. B. is an obese, middle-aged Caucasian man with a prior medical history of......" We all agreed that this is part of the larger medical culture, but we also agreed that this culture is actually changing. Within our health center itself, the Medical Director will always question a presenter if the patient's race is included in a case presentation for no apparent reason. We also concurred as a group that within the medical industry, disparities of care do exist which often break down along racial lines, and many studies have shown that people of color often receive different treatment for the same diseases as their Caucasian counterparts. Is this institutionalized racism? It appears to be the case, and there are many providers working to bridge that divide.

Words and labels are powerful tools, and their misuse---or unconscientious use---can be damaging, irksome, or blatantly hurtful. When dealing with human lives which each represent a unique story of family, history, and cultural richness, it is important to define our patients by who they are and by the diseases from which they suffer, not by race, creed, or nationality. Do I need to say if Mr. B. is a Christian or Muslim? Perhaps his cultural beliefs about blood transfusion or organ donation might figure into the conversation due to those beliefs, but if not, let his case stand alone, unaccompanied by unnecessary labels. If we list a patient's race for no reason other than habit, are we simply painting that patient into a box, allowing our audience to pre-judge them based upon a mental/societal stereotype attached to that word, that label?

I learned a great deal from this conversation today, and I took the time to thank my colleague for her honesty and courage. A potential conflict was avoided by a gentle but firm presentation of her concerns, as well as by the open-minded listening practiced by our group as a whole. A learning moment was had by all, and the fruits of that discussion will pay dividends, both professionally and personally.


Kim said...

I make it a point to never use a patient's race when describing them to another nurse or giving report.

For instance: Mr. Smith is a very nice 80 year old gentleman in room 10 who is quite self-sufficient despite a history of CVA a year ago.

Well Mr. Smith may be mixed race African-Korean American,born is Scotland but raised in Finland!
You'd never know it from my report! LOL!

I always state in my faxed report that a patient is "pleasant" or "very nice" or "has a good sense of humor". These are not part of the record, by the way, and the receiving nurse gets a good "first" impression.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

When I write a letter or consult request to a specialist, I too will often say "pleasant" or "lovely" or "kind" when describing my patients. It's a thoughtful practice and I think it reaps subtle rewards.