Sunday, September 15, 2013

When Is Racial Profiling OK? In the Doctor's Office

When Is Racial Profiling OK? In the Doctor's Office

—Christine. M. Kukka, Project Manager, HBV Advocate 

What two topics are among the most difficult to discuss in this country? Race and sex. What factors can help define if you are at risk for hepatitis B or C? Two big ones are race and sexual history.

While race and sexual history have a huge bearing on our health, these topics often get short shrift in the doctor's office. Because of the discomfort of this conversation (along with economic and cultural barriers to health care), about two-thirds of the estimated 5 million Americans infected with hepatitis B or C don't know they're infected. Their doctors never thought to screen them.

It's challenging to get a true snapshot of a patient's sexual history due to fear of judgment, lack of confidentiality, and the lurking homophobia and sexism that afflicts both providers and patients. It is the rare provider who can tease out information about numbers of past sexual partners and practices and other information that can signal a heightened risk of infection. Throw in cultural, language, class and economic barriers, and the chance of having that discussion disappears.

So if our history of risky behaviors isn't on the table, what is available to spur doctors to order hepatitis tests? The things that a doctor can't misssuch as our age, gender, and race/ethnicity. When it comes to finding the millions of Americans with undiagnosed and untreated hepatitis B and C, race matters and there's plenty of science to back this up.

A far higher percentage of Asian-Americans and Pacific Islanders (one in 12) and African-Americans are infected with the hepatitis B virus than are whites or Hispanic Americans. Vietnamese-American men are over 10 times more likely to have liver cancer due to untreated hepatitis B than their white counterparts.

African Americans are twice as likely to be infected with hepatitis C compared to the general U.S. population. While African Americans represent only 12 percent of the U.S. population, they make up roughly 22 percent of the estimated 3.2 million persons with chronic hepatitis C infection. Moreover, liver disease, often hepatitis B- and C-related, is a leading cause of death among African Americans ages 45-64.

So why don't doctors automatically screen Asian- and African-American patients for hepatitis? Is it a waylaid attempt at political correctness? Or does ordering a test for hepatitis B or C carry with it an unspoken judgment or suspicion of drug use or suspect sexual practices that are often linked to ethnic or racial stereotypes?

It is a fine line doctors straddle here. It is racist to test a patient for a sexually transmitted disease simply because of sexual stereotypes attached to that patient's race or ethnicity. It is not racist to test because the patient belongs to an ethnic group or race with a high rate of a treatable, preventable illness.

One doctor, writing in The New York Times several years ago, admitted, "I always take note of my patient's race. So do many of my colleagues. We do it because certain diseases and treatment responses cluster by ethnicity. Recognizing these patterns can help us diagnose disease more efficiently and prescribe medications more effectively. When it comes to practicing medicine, stereotyping often works."(1)

Race doesn't matter if you're treating a broken leg, but it does matter when you're performing a physical on a patient whose parents immigrated from Africa or Asia.

In the case of hepatitis B and C, doctors should allow race and ethnicity to guide their screening decisions because millions of patients are slipping through the health care system's cracks. Failure to identify a hepatitis B or C infection leads to new infections and new liver cancers.

Hepatitis B and C are complex diseases. Diagnosing a patient with viral hepatitis often leads to complicated treatment decisions, painful disclosures, and immunization of family members. Sometimes, patients just don't want to know, but they need to.

1. "I Am a Racially Profiling Doctor," S. Satel. New York Times. May 5, 2002 Source: http://www.nytimes.com/2002/05/05/magazine/i-am-a-racially-profiling-doctor.html?pagewanted=all&src=pm

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