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Title: Is Medical Profiling Racist?: Another Point of View
Mary A. Nelson
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Editor’s note: The enclosed letter is another response to a September editorial by syndicated columnist and economics Professor Walter E. Williams. The editorial, “If Medical Profiling Saves a Life, is it Racist?” raised the issue of using physical attributes or other estimators based on culture, race or ethnicity to treat patients more effectively, part of “mankind’s attempt to cope with information cost.” Professor Williams also used the same rational to address racial profiling, posing the question if the practice is a “sign of racism or economizing on information costs?”
A previous retort was posted by Lawrence W. James, President & CEO of The Center for Multicultural Competence in Healthcare Organizations (CMCHO), a group that teaches the practice of using cultural, racial and ethnic data to improve patient care, better known as culturally competent care.
Professor Williams’ article is reminiscent of many of the futile, quasi-philosophical debates I was forced to sit through as a criminal justice student during undergrad. While healthy debate is valuable in stimulating and supporting evaluative thought, the inherent problem with Mr. Williams’ argument is the blatant oversimplification of the intent behind racial profiling.
Sure, racial profiling can be a method of information gathering, but it is the cost and/or result of such “information gathering” that is the problem (or difference when correlating it to the practice of medicine). This is where intent plays a significant role.
As argued (by Larry James), there is an inherent difference between a physician’s intent and, for example, a police officer’s intent when utilizing ethnicity in their decision making. Racial profiling (in the sense that it is most commonly referenced) has intent to harm, hinder, or restrict. That same vocabulary does not at all reflect the intentions behind physicians and the services they provide. Physicians help, advise, and heal - altruism is inherent in medicine. More specifically, a physician’s intent in “racial profiling” under a medical context is to help develop differential diagnoses, reveal lifestyle habits that may put patients at risk for disease, and to understand cultural practices/beliefs that may shape how a patient wishes to ultimately be treated. Recognizing racial differences and using that information to curtail medical treatment is founded in concrete, measurable factors like genetics and their role in biological systems.
I challenge Professor Williams to find a comparably concrete measure when an individual is assumed to have criminal tendencies based on the color of their skin. Quoted in the article was the statement “crime rates for blacks are at least 10 times as high as they are for whites”. If one wants to claim that as concrete, then they have to think about how those crime rates become so exaggerated because of practices like racial profiling by law enforcement.
That leads to the idea of cost. Professor Williams refers to “information costs” and I think (Larry James) raised an interesting question about the cost of being wrong. When a physician examines an African-American patient presenting with anemia, he may consider sickle cell anemia is his differential because of the high prevalence of the disease in this population. Is that physician profiling by race? Yes. What if the physician is wrong? Most likely, the patient is relieved, reassured, and has avoided unnecessary/inappropriate treatment. No harm.
In another light, when a physician takes the time to ask the patient about their culture and incorporate certain aspects of their race/ethnicity into their care, both the patient and the physician benefit. Patients are usually appreciative of a physician’s attention to these kinds of factors and generally are not offended when a physician tailors their care to their culture because it is done with respect, dignity, and with the patient’s well-being in mind. Not to do so is very “costly”.
Alternatively, what happens when a police officer acts on a prejudice assumption and is wrong? Bidirectional distrust and anger is further perpetuated, thereby hindering the stability of mutually respectful relationships and representing even greater societal costs.
I can certainly appreciate Professor Williams’ idea of information cost and the proposition that racial profiling is a method by which certain individuals acquire information about the world around them. However, racial profiling is too multi-factorial and cannot be distilled down to such a simplistic argumentation as presented.
Furthermore, as a future physician, I find it a great disrespect to be lumped into the category of racial profiling. It’s a complete misrepresentation of our profession, one that is embodied in the Hippocratic Oath, as we pledge to compassionately and ethically care for all.
Mary A. Nelson
Medical College of Virginia
Virginia Commonwealth University
Class of 2012
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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
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