Case Scenario

A patient files a complaint with hospital administration after reviewing his electronic health record through the patient portal. His new primary care physician began his documentation by describing the patient as a “55-year-old African-American male with uncontrolled blood pressure due to noncompliance with medical care.” The patient had recently started a new job and could not pay for his prescriptions because his health insurance coverage had not taken effect yet. The patient did not attend follow-up visits and a recommended cardiology consultation because he could not afford the copayments for the visits. The patient identifies as Dominican Hispanic, not African American, and feels he was being stigmatized for his race and socioeconomic status and was a victim of stereotyping and racial bias.

Clinical Commentary

Medical education teaches that documenting the history of the present illness begins with age, race, and sex.¹ However, this documentation approach has been associated with negative effects on patient care, leading to stereotyping and bias in medical encounters.^1–3 Clinicians receive inconsistent education on how documentation of race affects clinical decision-making.^1,3 Historically, the use of racial categories was based on the mistaken belief that there are inherent biologic differences among races. It is now understood that these differences are predominantly the result of structural racism instead of biology.^4–6