St. Louis Children’s Hospital

By Leah Nchama, MD; edited by Katie Plax, MD, director of the SLCH Adolescent Center

The Adolescent Center is an outpatient resource developed to assist health care providers in the prompt assessment and care of patients 12 – 21 through consultations, evaluation, treatment and education. The center may be reached at 314.454.2468. Health care providers who would like to be added to the e-mail distribution list for the Adolescent Update newsletter may contact Dr. Katie Plax at plax_k@wustl.edu.

Race is a characteristic point of social contention in the United States. Now complicating interaction among and between race groups in this country is the emerging concept of biracial or multiracial rights. In 1967, the United States Supreme Court ruled to abolish laws banning interracial marriage, an action that resulted in a biracial baby boom. Indeed, the prevalence of multiracial births is now increasing at a higher rate than that of single-race births. In 2000, the National Census permitted citizens to self-identify as multiracial, and 2.4 percent of the U.S. population marked two or more racial categories on census forms that year.

Despite societal demonstrations for the necessity of multiracial awareness, the health care profession is behind in its multicultural sensitivity. In a field where often-erroneous racial identifiers are a part of traditional patient presentations (a practice that may trigger prejudice), it is not surprising multiracial patients and the issues they face remain largely neglected in medical research and practice. This neglect occurs despite the fact that multiracial youth are likely to encounter distinctly complex developmental issues, as their background further complicates identity consolidation during adolescence.

In order to promote healthy physician-patient relationships with multiracial young people, health care workers should strive to make their practices “multiracial-friendly” environments, familiarize themselves with concerns that may surface during multiracial identity development, and be aware of appropriate health care interventions.

The pediatric physician can take measures to create a more welcoming and socio-culturally sensitive office environment for both multiracial and nonmultiracial patients alike. Simply having artwork in the waiting room that portrays structurally, racially and ethnically mixed families, or providing an array of magazines and literature that covers a varied selection of subject matter and reading levels, reflects physicians’ recognition of social diversity.

Furthermore, providing literature or displaying posters from nonprofit multiracial organizations (such as the MAVIN Foundation or The Association of MultiEthnic Americans) or providing appropriately multilingual brochures about health care concerns (such as bone marrow donation or multiracial identity development) is not only indicative of socio-cultural sensitivity, but it also increases awareness of and participation in these initiatives. In addition, it has become common for medical workplaces to post nondiscrimination statements stating that equal care will be given to all patients, regardless of their age, race, ethnicity, physical ability, religion, sexual orientation or gender identity.

Administrative policies should also acknowledge social diversity. Relevant days of observance, for example Martin Luther King, Jr. Day (the third Monday of January), Juneteenth (June 19th), Cinco de Mayo (May 5th), and Chinese New Year (the first to the 15th day of the lunar month), should be considered when devising schedules for both patients and staff members. Intake forms for new patients should leave a blank space, as opposed to using check boxes, for the patient or parent to fill in their race or ethnicity (should the physician choose to request that information at all). In addition, while taking a history, the physician should inquire about patients’ race or ethnicity in so much that it is necessary to assess their health concerns. Why this information is needed (i.e., to determine patients’ health risk resulting from their genetic predisposition and/or familial history) should be explained prior to asking.

Furthermore, physicians should be aware of obstacles to patient care that stem from factors such as socioeconomic status and cultural norms, but they should not make assumptions based on their impression or stereotypes of patients’ socio-cultural background. Using nonjudgmental language, physicians should not be reluctant to tell patients they are unfamiliar with specific cultural norms. Physicians’ willingness to learn should apply not only to their medical education, but also to their humanistic edification.

When speaking with multiracial youth in particular, asking open-ended questions, using race-neutral language, and not making assumptions are important ways to avoid patient alienation. Race identity development in multiracial patients is a complex and dynamic process, and the way in which individuals identify themselves might vary from their racial, cultural, ethnic and parental identifications and might even vary on a situational basis. Thus, when essential to their care, it would be prudent for physicians to use language similar to that used by patients to describe themselves, their identity and their family, and to explore the extent of patient identity development. It must be concurrently kept in mind that patients may use words such as “mulatto,” “halfie,” and “hapa” to describe themselves and/or their family, but it would be inappropriate for physicians to use these terms themselves.

K. Prewitt declared that the recognition of multiracial individuals on the 2000 National Census was a “. . . turning point in the measurement of race . . . and that the arrival of a multiple-race option in the census classification will so blur racial distinctions in the political and legal spheres and perhaps also in the public consciousness that race classification will gradually disappear.” This task will require a massive amount of education, collective tolerance and time; thus, members of society must learn how to function under the umbrella of a flawed race-based social structure in the interim. The promotion of cultural open-mindedness, the perpetuation of racial acceptance, and the encouragement of healthy self-identity are all causes to which informed health care workers can lend their energy to benefit patients of all races.

References

• Practice guidelines were modeled on the GLMA brochure, “Guidelines for care of lesbian, gay, bisexual, and transgender patients.” (http://ce54.citysoft.com/_data/n_0001/resources/live/GLMA%20guidelines%202006%20FINAL.pdf; accessed 1/28/08)

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