 |
|
Title: Is Medical Profiling (aka Culturally Competent Care) Racist?
By Lawrence W. James
|
|
Is Medical Profiling (aka Culturally Competent Care) Racist?
A few weeks ago, noted columnist, Walter E. Williams wrote an editorial entitled “If medical profiling saves a life, is it racist?” Today, I am responding to this recent editorial in which I believe Mr. Williams has significantly oversimplified the above issue. I have laid out below in detail my disagreement with a number of his points.
In his editorial, Mr. Williams first defined profiling in general as “a practice where people use an observable or known physical attribute as a proxy or estimator of some other unobservable or unknown attribute.” He then went on to say that profiling “represents mankind’s attempt to cope with information cost.” His editorial then cited a few examples of healthcare practices that are a result of data which indicates a probability of a person contracting a certain disease based on their race, culture or ethnicity. He called this practice, “medical profiling”.
Following this, Mr. Williams moved on to his primary premise, which was to equate what he called medical profiling with the more commonly known practice of racial profiling we know to exist in other areas of life such as law enforcement, housing, retailing, etc. Some examples of his point were driven home via these additional questions: “Should doctors and medical insurance companies be prosecuted for the discriminatory practice of routine breast cancer screening for women but not for men?” and, “Other than simply stating that it is acceptable to use race or ethnicity as information acquisition technique in the case of medicine but not in other areas of life, is there really a difference?”
Finally, Mr. Williams, closed his editorial by 1) citing several examples of groups and individuals (Capital Cabbies in DC, Papa John’s pizza delivery in St. Louis and even civil rights activist, Jesse Jackson) who seemingly support your claim of legitimacy for racial profiling by their public statements and 2) posing this final question: “Is the racial profiling done by cab drivers, pizza deliverers or Jesse Jackson a sign of racism or economizing on information costs?”
First and foremost, let me say that I do not have a problem with Mr. Williams’ definition of profiling nor his proposed rationale for its existence. The proper use of data to indicate probable causal relationships is indeed a very valuable process. The key word in that last sentence, however, is “proper.” Proper use means conducting further investigations to confirm facts, not making assumptions and taking actions without indisputable evidence. A competent medical professional would never make a clinical diagnosis or initiate a clinical procedure without further investigation or testing, which brings me to the first of my key points of contention with his editorial. Unlike the other areas of life he mentioned, in the field of medicine, none of the aforementioned additional testing or investigation would ever be done without the consent of the patient or his or her family; a big part of my answer to his primary question “what’s the difference?”
Another huge difference maker is the basic premise that “medical profiling”, as he calls it, is done to help save a life, not restrict one as in the frequent cases of discriminatory acts (i.e. unlawful searches and detentions by the justice system or denial of sales or service by businesses) against people who look or talk differently than the majority population. In fact, his “medical profiling” actually ensures every patient’s right to the highest quality of care possible by using all information, available and approved for use by the patient and his or her family, to more effectively and efficiently diagnose and treat his or her illness.
Finally, in answer to his question as to whether the racial profiling personally done by cab drivers, pizza deliverers and even someone like a Jesse Jackson is justified or not, I would say that these are personal decisions made every day by individuals assessing their unique circumstances. And every day these individuals must ask themselves if the person or group that alarms them is a legitimate threat or if they simply find them threatening because they are from a different, diverse background? Whatever their final assessment, the important thing for them to consider is this: Will their resulting actions infringe upon that other group’s rights in a way that causes them harm or puts them at a personal disadvantage? If so, as individuals (not businesses or law enforcement officers, the legal system should tell them what they can and cannot do) they will need to be sure of their justification for those actions and willing to face the consequences if they are wrong.
And, while we are on the subject of human rights, I’ll close with this question: In which scenario do you feel that your rights as a U.S. citizen would be most evident? Would it be when you are lying in a hospital bed, surrounded by people who are trying to help you get better by asking you a series of questions based on your cultural, racial or ethnic background? Or, would it be when you are stopped in a neighborhood that is not your neighborhood (or maybe it is in your neighborhood, in your own home, as it was in Mr. Gates’ case in Boston), and asked a series of questions about why you are there, apparently based on your cultural, racial or ethnic background? I contend that, regardless of anyone’s ability to build an academic argument for there being no difference in the two situations, our human element would feel the difference. You and I and even Mr. Williams would feel the difference, just as Mr. Gates apparently did on that now famous evening in Boston. Whether we would react as strongly as he did to those feelings depends on the nature of our individual personality. I pray that we will never have to discover just how close our personal reaction would actually be to his.
By the way, the practice of using cultural, racial and ethnic data to improve patient care does exist in health care and it is growing rapidly across the U.S. It is called culturally competent care.
Lawrence W. James is the President, CEO of The Center for Multicultural Competence in Healthcare Organizations (CMCHO, LLC), a healthcare assessment, training and consulting consortium in Cincinnati, Ohio and, the principal consultant of L.W. James & Associates, LLC, a healthcare strategic marketing firm also located in Cincinnati. He has nearly 30 years of progressive corporate executive experience stretching across a wide range of for profit and non-profit industries, from consumer goods to healthcare.
September 2009
|
The Center for Multicultural Competence
in Healthcare Organizations
4555 Lake Forest Drive - 650 Westlake Center
Cincinnati, OH 45242
P: 513.563.3004 - F: 513.563.3011
|
|
|
|
Article