Describing patients by race/ethnicity

[Emergent]

When patients present to our ER, the admitting reps are, apparently, required to assign a race or ethnicity to patients. I'll see it at the top of the computer screen. It's so obnoxious and inaccurate.

The main categories are White, Black/African American, Hispanic, Native American/Alaskan Native, Asian, Other, Declines to state.

I doubt they are actually asking patients, just making a judgement call. Plus, some of them are probably as annoyed as me by the whole thing and assigning Black to a White person, and White to a Black person, etc.

The whole thing is, frankly, offensive. Lumping everyone with some connection to Hispanic origins together is absurd, for one thing. Many Mexicans I see probably belong to the American Native category, and some Hispanics are thoroughly European. And what about mixed race people? My granddaughter is half Asian, what is she? Well, the most adorable baby girl on the planet, that's what. And the smartest, and prettiest.

Why don't they have a category for prettiest baby?

[Sour Lemon]

Describing race or ethnicity is done for several reasons as you have heard in this thread and is I believe very valuable.

Identifying race/ethnicity can provide a clue into possible issues or help guide the nursing plan. I used to work in a hospital that was very close to a reservation. Knowing that the patient was native would help indicate what interventions might be successful and what would not.

For example, if you started them on a medication that needed a strict dosing cycle at home forget it...culturally time is not valued and little thought is given to it. Many of them do not have running water at home BUT do have access to clinics...if they can catch a ride or borrow a horse (not kidding). They also have a tendency to have certain diagnosis (lots of studies on this) that will also help clue you in.

Acknowledging race or ethnicity or culture =/= racism.

We are all different, by trying to ignore the differences we are doing the equivalent of sweeping things under the rug. Acknowledge and celebrate those differences.

We do have a question that asks about "cultural considerations". That seems more valid, to me. I have some Native American in me (among other things), but have nothing to do with the culture. And "Caucasian" describes a lot of cultures ...none of which are differentiated in the paperwork, for some reason.

I don't think any of it has to do with "racism", it's just a mildly annoying and outdated way of thinking.

[Asystole RN]

We do have a question that asks about "cultural considerations". That seems more valid, to me. I have some Native American in me (among other things), but have nothing to do with the culture. And "Caucasian" describes a lot of cultures ...none of which are differentiated in the paperwork, for some reason.

I don't think any of it has to do with "racism", it's just a mildly annoying and outdated way of thinking.

Depending on where you live, sure. Maybe your charting system is not as detailed as it needs to be but do not equivocate that as a universal experience. Throwing the baby out with the bath water.

If you did have enough Native American/Indian in you for you to declare yourself as such then it is noteworthy data. If you had enough Hmong in you to declare yourself Hmong it is noteworthy data.

Data, whether you in your microsystem deem it valuable or not, does not determine it's overall value. Keep in mind that some of us also mine data of seemingly limited immediate value later on for studies.

Mildy annoying? Sure. Outdated? No way. The only thing outdated is that we do not go into more depth asking about race, ethnicity, country of origin, cultural affiliation, sexual orientation/identity, etc, etc.

[Sour Lemon]

Depending on where you live, sure. Maybe your charting system is not as detailed as it needs to be but do not equivocate that as a universal experience. Throwing the baby out with the bath water.

If you did have enough Native American/Indian in you for you to declare yourself as such then it is noteworthy data. If you had enough Hmong in you to declare yourself Hmong it is noteworthy data.

Data, whether you in your microsystem deem it valuable or not, does not determine it's overall value. Keep in mind that some of us also mine data of seemingly limited immediate value later on for studies.

Mildy annoying? Sure. Outdated? No way. The only thing outdated is that we do not go into more depth asking about race, ethnicity, country of origin, cultural affiliation, sexual orientation/identity, etc, etc.

I don't have enough of anything in me to make it noteworthy, yet I'm still prompted to check a box or "refuse" to answer. I prefer to find out about people on an individual basis. Very few of us fit into the categories that so many are eager to assign.

[Asystole RN]

I don't have enough of anything in me to make it noteworthy, yet I'm still prompted to check a box or "refuse" to answer. I prefer to find out about people on an individual basis. Very few of us fit into the categories that so many are eager to assign.

Sounds like a local charting issue to me, a limitation of the technology you are using.

Ideally someone should not be assigning you any kind of demographic, they should be documenting what demographic you assign yourself to.

Demographics are important, don't dismiss the entire idea of gathering demographic information because your particular system is limited or that you do not have an immediate use. Demographics are very important to some of us.

It is like saying we should throw out the specialty L&D because you might work in oncology. Just because it is not important to you does not mean it is not important.

[Sour Lemon]

Sounds like a local charting issue to me, a limitation of the technology you are using.

Ideally someone should not be assigning you any kind of demographic, they should be documenting what demographic you assign yourself to.

Demographics are important, don't dismiss the entire idea of gathering demographic information because your particular system is limited or that you do not have an immediate use. Demographics are very important to some of us.

It is like saying we should throw out the specialty L&D because you might work in oncology. Just because it is not important to you does not mean it is not important.

Sigh. I give up.

[Asystole RN]

Sigh. I give up.

Why? I apologize if I am not getting it.

Is the issue that you think demographics are not clinically useful? They are absolutely useful, there really are biological differences and many times more importantly cultural differences, lots of research on the topic. The Pima Indians for example were the focus of some famous research.

Why do you think race or ethnicity are not important to document? Personally I think the more demographic information we collect the better.

[Emergent, RN]

Using race and ethnicity in careful research, with accurate information and a controlled study is one thing. Having hurried admitting clerks, or even doctors and nurses, do a quick judgement call and assign a race, or categorize people by a language group origin, is useless and counterproductive. I think it's obnoxious and it's definitely bad science.

[Anonymous865]

Using race and ethnicity in careful research, with accurate information and a controlled study is one thing. Having hurried admitting clerks, or even doctors and nurses, do a quick judgement call and assign a race, or categorize people by a language group origin, is useless and counterproductive. I think it's obnoxious and it's definitely bad science.

That reminds me of an acronym frequently used by computer scientists - GIGO which stands for Garbage In = Garbage Out. The results are only as good as the input data.

The patient should also understand that the information they are providing is for research. No one should tell the patient or even imply that the information is necessary for the patient's care and treatment.

If a patient does not want to provide this unnecessary data or does not want you to use their PRIVATE information for research, that choice should be respected.

[cleback]

Since hospitals are now required to complete community health assessments, they probably want that demographic information. Although I understand your concerns, if 60% of diabetic visits or admissions were of Hispanic ethnicity, that might be helpful information to have to former a more targeted community intervention.

[Swellz]

I was just reading a consult note on my patient that describes him as African-American. He's from Iran or Iraq. This was a freehand note, rather than one where you check a box, so I thought it was an interesting choice, especially given this man's appearance. I don't know if he's an American citizen, but this label calls him that. I have been in courses where we debated whether the Middle East should be considered Asia or Africa. Would Asian-American have described him better? No. Why not say he's a Middle Eastern man?

[Libby1987]

I guess I drank the Koolaide. I thought the race designations were to identify disparities in services provided.

[ThePrincessBride, MSN, RN, NP]

I find it funny how so many people, particularly white and black Americans, claim to be part native when a vast amount of native Americans were wiped out with European diseases before so many interracial relationships and families could be established. In reality, the majority who claim it don't have it.

That said, I think ethnicity can actually be relevant in medical history as certain ethnic backgrounds have a tendency to react differently to certain treatments from others. Problem is when HCPs get lazy and use stereotypes to create a care plan rather than individual data.