Race, ethnicity and medicine

If you were to peek inside your medical chart, you might notice that one of the things that’s recorded is your race or ethnicity. In fact, when doctors communicate with one another, the opening sentence will read something like this: “Mrs. X. is a 42-year-old Chamorro woman,” or “Mr. Y. is a 76-year-old Filipino man.” If you were the suspicious type, you might say, “Hey, what’s up with this?! Are the doctors discriminating against me?”

The truth is, race and ethnicity are important pieces of information for medical reasons. Diseases occur differently in different age groups, in different sexes and in different races and ethnicities. By mentioning your sex, age and race in the opening sentence, entire groups of diseases can be excluded and others come to mind.

For example, I received a letter last week that said, “Mrs. S. is a 52-year-old Carolinian woman who has double vision.” A study we did several years ago here in the CNMI showed that if you are a Carolinian woman in your 50s, you have a 50 percent chance of having diabetes. So, the immediate thought that comes to my mind is to test Mrs. S. for diabetes. (Diabetes can cause small strokes to the nerves that control eye movements and this causes double vision.)

Likewise, some diseases such as Multiple Sclerosis (MS) are found mostly in Caucasians, specifically those of Scandinavian descent. It doesn’t mean that you can’t get MS if you’re of another race. It just means that the chances are lower. Tumors of the eye and skin called “melanomas” almost never happen in those of us that are darkly pigmented. Melanoma is a disease found almost exclusively in light-skinned people. So, if I see a dark spot on someone’s arm, the diagnostic considerations are completely different depending on whether that person is Caucasian or Chamorro, because the Chamorro has genetic protection.

Sickle cell anemia occurs in people of African and Mediterranean ethnicity. So, if I read a medical chart and it says “Mr. T. is an 18-year-old Chinese man with bleeding inside the eye,” I don’t even consider testing for sickle cell anemia. But if I read that “Mr. T. is an 18-year-old African-American man with bleeding inside the eye,” testing for sickle cell anemia will be high on my list. Diseases also behave differently because of genetic differences. For example, glaucoma, which can be a blinding condition in anyone, is particularly aggressive in African-Americans. It needs to be followed more carefully and treated more aggressively in this population.

So, mentioning age, sex or race and ethnicity in a medical chart is not an indication of discrimination. These demographics help guide your healthcare professional to the appropriate diagnosis and help us understand how your disease might behave.

(David Khorram, MD is a board certified ophthalmologist, and director of Marianas Eye Institute. Questions and comments are welcome. Call 235-9090 or email eye@vzpacifica.net. Copyright © 2005 David Khorram.)