Identity: Knowing How Our Patients Describe Themselves Matters

“The good physician treats the disease; the great physician treats the patient who has the disease.” ~William Osler

Mr. J was reading his printout summary of our clinic visit. “African American? I’m not African American, I’m Pakistani.”

I quickly looked at his summary—it was upsetting to both of us that the only selection besides African American available to select was “other.”

This antiquated notion of “other” lacks clarity, and selecting “other” when filling out forms for today’s diverse patients feels like a barrier to a creating a close relationship. Truly knowing who our patients, their families, and their communities are is always the priority, and this priority shouldn’t be forgotten at the expense of data collection. We shouldn’t conform to placing our patients into racial categories that our patients haven’t advocated for simply because it’s convenient.

Our patients’ diseases are complex, their care is multi-disciplinary, and their outcomes are variable. Yes, medicine is complicated. But so is how our patients identify themselves. This complexity of identity is what makes “getting to know your patient” important, and allows for deeper cultural engagement, exchange, understanding, and, ultimately, helps us to create a culturally competent health plan with our patients.

The category “other” has seen a reemergence at our hospital, with epidemiology meetings highlighting that it is as high as 17% at times. “Other” isn’t an identity, and Dr. King’s words come to mind—“Justice delayed is justice denied. Similarly, “Identity delayed is identity denied.” Healthcare professionals have free rein to discriminate with the use of the category “other,” while patients may never know they are represented in a manner that doesn’t take into account who they truly are.

I ask for us all to consider the removal of the category “Other,” even if it results in complicating the electronic medical records data reviews. Doing so will require various actions. For instance, knowing how to create an environment in which the doctor-patient relationship is one where they can share their racial identity with pride. Second, discussing with administration the ability to enter data that isn’t present on the predetermined racial categories. Also, creating a selection on how race was noted (meaning, was it self-identified or selected by the staff).

Clearly, structural changes in how race is captured in medical records is warranted. These actions can serve as a corrective to the dangerous, and likely unconscious, notion of racial bias towards our patients. We all have a great opportunity to be part of (if not the leader of) this solution.  William Osler emphasized to know who the patient is with the disease; he saw no “other” option.