The Exchange

Commentary and Observations from
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Documenting Skin Color in Medicine: Are We Unconsciously Racially Profiling?

Documenting Skin Color in Medicine: Are We Unconsciously Racially Profiling?

Practicing medicine in 2020 has certainly been challenging, especially given recent worldwide discussion on race relations. In a recent Dermatology Grand Rounds lecture, a medical student presented a fascinating review of the terminology that is commonly used in medical documentation to describe our patients: 36 y/o white male, 24 y/o Hispanic female, etc. We often describe skin color as white, black, or brown, or even use vague terms such as "skin of color" which implies all races other than white or Caucasian individuals.

This seemed like a perfectly acceptable description pre-2020. Now, however, we have a greater understanding of the disparities in healthcare based on vulnerable populations. Evidence shows that certain populations may have delays in healthcare and resulting poorer health outcomes as a result of conscious or unconscious racial bias. Think about the documentation we use when we send consults to other providers: Are certain individuals given preferential treatment based on the descriptions that are consciously or unconsciously used to describe the race of the patient?

Fitzpatrick skin type (FST) is a methodology developed by Dr Fitzpatrick in 1975 to assess a patient's propensity to burn during phototherapy. It was never intended to be used to depict race or ethnicity; however, a recent survey of dermatology practitioners and trainees found that 31% used the scale to do just that. Even more (47%) used it to describe the patient’s constitutive skin color, and 22% used it for both scenarios.

The fact of the matter is that there is no universally accepted scale for describing a patient's skin color. Perhaps the question to ask ourselves, then, is whether we, as healthcare practitioners, actually need to do so? Or can we provide exceptional healthcare to all individuals without mention of skin color in any of our medical documentation?

References
  • Adelekun A, Onyekaba G, Lipoff J. Skin color in dermatology textbooks: An updated evaluation and analysis. JAAD. 2020; [Article in press].
  • Ware OR, Dawson BS, Shinohara MM, Taylor SC. Racial limitations of Fitzpatrick skin type. Cutis. 2020;105:77-80.

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Filed under: Dermatology, Public Health

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