"I have a few race and ethnicity questions to ask you, you may refuse if you wish not to answer."
"Okay," she says.
I begin. "What race are you?"
She looks at me and answers, "Hispanic."
I inform her that the options are Asian, Black, Native American/Eskimo, Pacific Islander/Hawaiian, White, or Other.
She hesitates and states, "Other".
I move on to the next question, "Are you of any Hispanic/Latino/Spanish descent?"
She responds, "Yes."
"What is your ethnicity?"
"I'm from Honduras."
"What is your primary language?"
Last but not least, I ask the woman, "What is your place of birth?"
"Honduras" she reiterates. The woman looks at me and asks, "Why are you asking me these questions?"
I explain to her that the hospital collects this information from all patients to help treat patients from different races and ethnic backgrounds more efficiently. I also hand her the flyer with detailed information on all the questions, saying, "Ok, thank you, have a seat in the waiting room and they will call you when they are ready."
I work at a hospital in Worcester, MA and one of my requirements, while registering a patient, is to ask them a series of questions regarding race and ethnicity. The reason I am required to ask these questions is to provide the hospital with further information regarding their patients' culture and languages. This information helps the doctors to get acquainted with the patients, thus improving the care that is given to the patients. In addition, by asking these questions, the hospital more efficiently meets the needs and individual concerns of all the patients they serve.
A major concern in the medical field is that of differences in health-concerns among racial and ethnic groups. Medical research still has many unanswered questions about what causes these disparities, and the aforementioned questionnaire that I administered to "Patient X" above helps in learning more about racial health differences.
Ultimately, hospitals can better meet the needs of the communities they serve if they know more about their patient's race, ethnicity, culture and language.
The main reason hospitals are encouraged to ask racial and ethnic questions is to eliminate racial and ethnic disparities in healthcare. However, because race and ethnicity vary, "a critical barrier to eliminating disparities and improving the quality of patient care is the frequent lack of even the most basic data on race, ethnicity, and primary language of patients within health care organizations," according to Debra Pierce and Mary Pittnan, authors of Who, When and How: The Current State of Race, Ethnicity and Primary Language Data Collection in Hospitals. They also write, "The data-collecting methods are disparate and, for the most part, incompatible across organizations and institutions in the health care sector."
I never really put much thought into such racial and ethnical questions until I was required to ask the questions at my place of employment. These questions are very controversial because oftentimes the answers to the questions change depending on who is asking them. As a result, I started to ask myself, 'Do race and ethnicity really make a difference in how a patient is treated? If so, why is race and ethnicity relevant when the most important thing is the treatment of the patient?'
At my job, in asking these questions to the patients that enter the hospital, I have received a multitude of different answers. Some patients have refused to answer any questions pertaining to their race and ethnicity, while other patients have just expressed that they are American and nothing else should matter. Several patients have also gotten very frustrated, and are confused as to why these questions are getting asked before they receive treatment. As a matter of fact, quite a few think that these questions are a form of racial profiling.
My interest in this topic prompted me to seek more information. I also wondered if all hospitals were mandated to ask their patients these questions. My research unearthed the fact that hospitals are not mandated to ask these questions, but are highly encouraged to do so. I now understand that the purpose of these "personal interviews" is merely based on facilitating the doctors in their practices. Still, though, like many others, I feel as if these questions are not adequately or comfortably administered, as racial discrepancies oftentimes cloud one's emotional responses.
According to Pierce and Pitman, "Among hospitals that collect data on race and ethnicity, 70 percent did not see any drawbacks to collecting the data. Drawbacks reported by the remaining 30 percent included: discomfort on the part of the registrar or admitting clerk asking the patient for the information; problems associated with the accuracy of the data collected; a sense that patients might be insulted or offended, or resist answering questions about their race and ethnicity; patients often did not "fit" the categories that were given; a fear that data may not be kept confidential; and the possibility that collecting data on race and ethnicity might be used to profile patients and discriminate in the provision of care." Here, one can see where both ends of the argument meet in a sort of tension. While questions regarding race and ethnicity seem useful to the doctors in my hospital, I can see where patients begin to feel uncomfortable regarding identity.
After my research and some personal reflection on the matter I can now understand both sides of the story, and I recognize why race and ethnicity questions are asked. However, I think that if people are going to be classified based on their race and/or ethnicity they should have the same questions and answers to the questions. I think a huge part of the disparity in the information collected comes from the fact that different hospitals have different definitions for different races. One hospital might consider Hispanic a race while another might not. I think there is still much improvement needed with the questions, and when asking the questions. Racial lines are rarely drawn so neatly, and it is certainly an ambitious undertaking when hospitals attempt to draw these rigid lines. This is why a protocol needs to be established and used by the hospitals that already have these questions to eliminate all confusion by the patients and to help everyone better appreciate the goals of these questions.
Noelia Chafoya '09
Treasurer, ALANA Network