Written by Clay Smith
These authors think race is best unmentioned early in case presentations. However, some clinicians come down on the opposite side of this debate. Let’s take a look at both sides.
Why does this matter?
Some advocate that race should be mentioned early in case presentations, since there are disease entities that tend to cluster in certain racial groups, such as sickle cell anemia among Black patients and hemochromatosis among White patients. Some argue that by mentioning race early, “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.” On the other hand, these authors think race or ethnicity should not be mentioned early in a case presentation.
“Race” to the top?
Let’s look at the authors’ arguments why it may be best to not mention race early in a case presentation.
- Race is not a good surrogate for genetic predisposition to disease.
- “Racial and ethnic groups are not static, uncontroversial categories; because they are socially constructed, they are fluid and evolve over time.”
- This could result in premature diagnostic closure, a cognitive error.
- This may trigger unhelpful, stereotypical assumptions about a patient’s demographics or cultural beliefs.
- This may allow the listener to consider the case in a more unbiased manner.
- They see benefit to mentioning race and, more importantly – ancestry, discussing this later in the presentation as they are considering the differential diagnosis and testing.
- They acknowledge that there may be times in which mentioning race early is important, such as, “when the category is thought to suggest a specific diagnosis with near certainty.” But they view this as the exception.
- To not mention race early in the case is not to downplay the importance of racial categorization in society and its impact on health. In fact, “clinically relevant and patient-specific socioeconomic considerations, cultural beliefs, and race-related barriers to high-quality health care should be acknowledged and addressed later in the case presentation.”
Here is my take. My preference is to not mention race in the first sentence of a case presentation. That said, though racial categorization may be largely socially constructed, the impact on our patients’ daily lives is very real, and we certainly need to consider how ancestry, religious beliefs, and other social and demographic factors are likely to impact the health of our patients. What I do not think we should do is set up peevish rules about this and censure a student or resident who does mention race early in a case presentation. There are very good reasons some clinicians may choose to do that. Let’s give each other a lot of grace and try to move toward best practices with regard to considering race in medicine.
First Impressions – Should We Include Race or Ethnicity at the Beginning of Clinical Case Presentations? N Engl J Med. 2021 Dec 30;385(27):2497-2499. doi: 10.1056/NEJMp2112312. Epub 2021 Dec 25.