We always aim to ensure that the scientific merit of the clinical guidance we publish shines through. Articles often give diagnostic or treatment advice in a way that’s so evidence-based it almost, in a way, makes the patient irrelevant. How they feel, speak or act doesn’t factor into your clinical assessment, right?
Wrong. Patients are more than just as a set of eyes to be examined, of course; they’re complex, unique people with personalities and values shaped by their lives, families and peers.
This month, we’re bringing the individual into the equation with a series of articles that explores how race, ethnicity, culture, sexual orientation and other markers of identity can manifest in the exam room. Why, you may ask? To fill in an important part of the puzzle that’s often ignored, to the detriment of the doctor-patient relationship and possibly the outcomes of the care provided.
At last fall’s Academy of Optometry annual meeting, guest speaker Beverly Daniel Tatum, PhD, a psychologist who studies cross-racial dynamics, discussed an exercise she uses to uncover deep-seated feelings of marginalization. If you ask a group of people to describe themselves as many ways as possible in 15 seconds, you’ll get a lot of results about jobs, hobbies, family responsibilities and so on—what they do. But people whose race, ethnicity, religion, gender or orientation differs from the broader society will write down those characteristics, too—what they are.
“If you are seen as outside the norm, people remind you of that and you have it as part of your social understanding of the world and so it becomes salient for you,” Dr. Tatum explained. Recognizing these experiences and the feelings of discrimination or alienation that often accompany them is the first step toward building a stronger rapport with people of different backgrounds.
However, it’s important to avoid conceiving of a person from a different walk of life as some exotic “other” to be studied like a rare plant or bird. Striking the right balance can be tricky: we should aim to recognize individual distinctions and understand their implications, but then pivot to finding common ground. Hopefully, a concerted effort might eventually reduce disparities in health care among various groups (along with lowering tensions).
In our corner of the world, a recent study in the Ophthalmology journal found that the normative databases of OCT devices are largely comprised of data from Caucasian individuals, leading to false readings of possible glaucomatous damage in some Asian patients, who can have thinner-than-average RNFLs. That’s one small way eye care is engineered for the past—when US demographics were more homogenous—instead of the present and future. Deeming one group “normal” skews the delivery of care toward their needs (and away from that of others).
Unfortunately, some of these topics have become politicized, creating friction over pronoun use, racial representation and other hot-button issues. Consider: aside from the social benefits of striving for greater inclusivity, there’s valuable data to be gleaned from seeing all facets of your patient. You wouldn’t do an eye exam and fail to look at the retina. Bring that same inquisitiveness and attention to the rest of the person to get the complete picture.