Why the medical professions should be color blind

The role of race in college and graduate school admissions remains controversial in the U.S. In fact, the Supreme Court is currently taking up a challenge to a University of Texas program that considers race in its admission decisions.  Critics of race-based admissions question whether educational institutions would serve the goals of affirmative action better by relying exclusively on non-race based criteria, such as socioeconomic status and family educational history. Indeed, during oral arguments in the Fisher v. University of Texas case, Justice Alito questioned why African-Americans or Hispanics from privileged backgrounds “deserve a leg up against, let’s say, an Asian or white applicant whose parents are absolutely average in terms of education and income.”

Most of us would love to live in a color blind world. But sometimes being a member of a historically repressed minority group brings students valuable perspectives that cannot be captured by measures of socioeconomic status. I learned this lesson the hard way, when I was the attending physician on the general medical ward at the Ann Arbor Veteran’s Affairs Hospital.

William Reed (a pseudonym) was one of the patients on my service that month. A middle-aged African American man stricken by a bout of congestive heart failure, Reed lay in bed with his petite, gray haired wife seated next to him.  I entered the room surrounded by my students.  Early in our conversation, Mr. Reed mentioned that he had grandchildren.  Feigning surprise, I looked over at his wife with an astonished expression on my face: “Impossible! How could someone as young as you be a grandmother?” She laughed and we continued talking about her husband’s health.

I had used some version of that compliment many times in my career.  An elderly man would sit in my exam room next to his equally elderly wife, and I would pretend to mistake her for his daughter, my “error” almost always eliciting a proud chuckle from both patient and spouse. But on that day, my attempt at flattery did not go over very well with one of my students. When we paused in the hallway to discuss Mr. Reed’s clinical condition, she politely asked me to clarify something about our bedside discussion: “Were you worried about insulting the patient’s wife by mentioning how young she is?,” the student asked.

“Of course not,” I said.  “I have yet to meet a woman who doesn’t like being complimented on her youthful looks.”

“Well isn’t there a chance,” the student persisted, “that as an African American, she would be insulted that you are, in effect, accusing her of having babies and grandbabies at too young of an age?”

The student asked this question very gently and non-threateningly, but her directness and the fact that she was an African American woman herself caused her question to rattle around my brain like a course of electric shock therapy.  My first instinct was to get defensive. I hadn’t meant anything racial by my comment.  I had made that kind of comment to all kinds of people over the years, white and black; middle aged and elderly. But of course, my lack of racial discrimination wasn’t a good defense.  Instead, it was the source of my offense—to not take account of someone’s race when making this kind of comment is racially insensitive.   Suppressing my desire to defend my innocent comment, I thanked the student for helping me see the world through this couple’s eyes.

Good medical care requires good communication.  And for doctors to communicate effectively with their patients, they need to appreciate what their patients are thinking and feeling.  All too often, we fail at this basic art. As I explain in my book, Critical Decisions, this failure starts with the language we physicians use when conversing with our patients.  We explain that a test result is “negative” forgetting that negative—which is a good thing in most medical contexts—won’t sound good to many patients; we slip into jargon (“your peripheral smear showed immature cells,” as one of my residents explained to a patient during another of my hospital months), unaware that these words are uninterpretable by most people who haven’t received medical training.

Failure to take the patient’s perspective goes well beyond medical language, however.  We physicians frequently don’t notice when our patients are confused or overwhelmed.  We also fail to recognize when our patients are frightened or in pain, with one study of experienced oncologists revealing that when their patients communicated that they were suffering (“I am in pain, doctor”), the oncologists failed to acknowledge this suffering in 4 out of 5 cases.

And of course, as my interaction with the Reeds demonstrated, we physicians all too easily forget that many of our patients come from different backgrounds than we do, backgrounds that shape the way they view the world and the way they interpret their medical encounters.

I learned several important lessons from the medical student that day.  Most importantly, she taught me to more carefully consider how my words sound to my patients.  She also taught me that the medical workplace is made better by having a diverse workforce.  Medical care is about more than pills and laboratory tests.  Identifying the right diagnosis and treatment often depends as much on good communication as it does on modern medical technology.  Had I, a white male, been surrounded in that hospital room only by a bunch of white male medical students—even ones “absolutely average in terms of education and income”–I would not have learned that my attempt at a harmless compliment would translate poorly across cultural contexts.

As a society, we continue to struggle to grasp the harms and benefits of affirmative action, and of policies that promote diversity in education and in the workforce.  In the medical profession, however, diversity in the workforce not only benefits patients, by improving the pool of talent we draw upon to care for them, but also benefits the medical profession, by increasing the chance that all of us physicians–regardless of our race, religion, gender or socioeconomic background–will be better attuned to the ways our words and actions appear to people whose backgrounds differ from our own.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

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  • http://twitter.com/NCBeernut Scott

    I don’t see how race played into your scenario. Why couldn’t it have been a white student who came up to you and asked you if a white female patient might have been offended by your comment? Any women of any race may be offended if she thought you were suggesting she had children at too young an age. You are right, we should be more colorblind. We sadly live in a country that puts too much emphasis on race and less on qualification and life experiences. Understanding different perspectives come through experience, not by the color of your skin.

    • Suzi Q 38

      At one of my follow-up visits after my hysterectomy, I asked my gyn/oncologist if I could go to Europe in a few months.
      He said: “Sure, but how do you get to go?”
      I thought it was an odd question, so I asked him to clarify.

      “What do you mean, how can I physically go, how can I financially go, or how do I find the time to go?”

      I decided to make a joke out of it…”Well doctor, in order to find the time and money to go to Europe, all you have to do is get cancer.”
      I went on…”When you get cancer, your family feels sorry for you and finds the time and the money.”

      Then I got personal: “I think that YOU want to go to Europe. What is keeping you from going to Europe?”

      “Time.” He said. “My wife and I don’t have the time.”
      “Well doctor, you can make the time, especially if you let your wife know how important it is to you.”

      He didn’t mean to be condescending, and imply that we didn’t have the money to go, he was thinking about how he wanted to go, but didn’t have the time and said it a little wrong to me.

      I think that with all of this “P.C.” going around, there are a lot of good conversations that people are missing out on because people are concerned about offending others.

      That is just too bad.

    • Suzi Q 38

      What if the doctor asked the husband if he was the wife’s son?

      Those would have been “fighting words,” LOL.

      I once asked a doctor of the beautiful young 20 something woman was his daughter.
      I was wrong. The young lady was the 60 something doctor’s wife…….

  • AMS

    This article and all the political correctness in it is exactly whats wrong with this country. You meant it as a complement and a kind gesture. No need to worry someone may get offended and spend hours psychoanalyzing whether you should have said it or not. The medical student that corrected you should have been sent to the couple to ask them how they felt about it, and when they tell her it really was just a joke/complement, she’ll know she shouldn’t get so worked up about something so trivial.

    There is nothing wrong with the resident saying “immature cells” as long as he/she then explains what that means. Patient like knowing the fancy medical terms. When they later read a report about it they’ll no a little bit about what it means and be able to share that with family members.

    Acceptance to medical school should reflect how hard you work in pre-med, volunteer experience, work experience, and personal skills during the interview. How much money your parents make or the color of your skin should not play into the decision, period.

  • Suzi Q 38

    Doctors have flat out asked me: “Do you mind if I ask you what your nationality is?” Not because they needed to know in order to treat me properly for my UTI, but because they just were curious.
    I don’t see why it is so wrong to be interested in another person in a non-sexual manner.

    I am a Eurasian, and look mostly Asian but not quite, as my grandfather was from Germany. My maiden name is also very German.

    What also throws people off is my perfect English, as if I was brought up in California, which I was.

    It was far worse about 30 years ago.
    Doctors would ask me: But why is your English so good?
    I would politely explain that I was born in Hawaii, yet lived in California most of my life, since I was a small child.

    It is sad that everyone has to be so P.C., because I love talking about Hawaii, where I was born, and where many of my family members still live.
    The fact remains is that the world is full of people that are different colors.
    This is what makes mundane days interesting.

  • Anon

    ” “Well isn’t there a chance,” the student persisted, “that as an African American, she would be insulted that you are, in effect, accusing her of having babies and grandbabies at too young of an age?” ”

    Really bad example. The GRAY-HAIRED patient laughed and enjoyed the compliment, but the student went Black Panther on the doctor and pulled nothing out of something.

    The student might as well have said, “Isn’t there a chance that as a black woman, she might’ve been offended at your white coat? Couldn’t she see it as a robe of authority, power, and maintenance of status quo, much like the KKK’s white robe?”

    Speaking of which, Affirmative Action is a status quo. Most med school seats will go to elite whites, while a few token seats will be reserved for the couple of “correct” minorities worthy of elite white sympathy. All the better to shut out all the others who aren’t elite or deemed worthy of sympathy.

  • Docbart

    Don’t all patients deserve the most accomplished physicians we can turn out? What good is communication if the physician is mediocre? Why do we get meritocracy in professional sports, which have limited impact on our lives, but we expect patients to trust their lives to a physician who may have been chosen to fulfill a quota? Why don’t we have racial quotas in sports? I would love to see Inuit pro basketball players, and black and latino hockey players?

  • Guest

    Wow–I think the woman who would think someone would find offence was being much more racist and stereotyping than you. She seems to be commenting on what she sees as “typical” in the black community.

  • http://twitter.com/dixiesez Dixie Sez

    Wow, I think that the woman who found offense in this is being much more stereotyping–she must view this as the true reflection of reality in the black community–a sad commentary.

  • http://www.facebook.com/drlingal Linda Burke-Galloway

    As you can see from my picture, I’m an AA physician. The med student’s question was naive and reflects a lack of wisdom that comes with age and experience. I can tell you that most AA women would be flattered immensely to receive that type of compliment. Yes, at times, race does matter but the example you gave was certainly not one of those times. “Don’t sweat the small stuff.”

  • katerinahurd

    In order to establish good communication with a patient, the medical professional should be aware that language is culture just like the medical language is in the culture of medical professionals. Medical professionals should also be aware that race is not a biological concept. Race is a falsely imposed concept upon variant human phenotypes. I am surprised that Dr.Ubel doesn’t understand how the language he used to make a joke when visiting white patients was not perceived in the same fashion as when he repeated the same joke to his black patients. Do you think that black Americans are unforgiving because of how they were used in the Tuskeegee study on syphilis? Lack of trust can not build a healthy communication relationship.

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