Reappraising Medical Syntax—Does Race Belong in the First Line of the Patient History?

Abstract

In the midst of the resurgent movement for racial justice, physicians and health care institutions should carefully look within for potential sources of racial and ethnic health disparities. In this issue of JAMA Internal Medicine, Balderston et al¹ report on differential documentation of race in the first line of the history of present illness (HPI). In 1200 admissions to an academic medical center in Richmond, Virginia, 33% of Black patients had their race documented in the first line of their admission note compared with 17% of White patients (adjusted odds ratio, 1.57; 95% CI, 1.11-2.25). Black clinicians had 58% lower odds of documenting race than White clinicians (adjusted odds ratio, 0.42; 95% CI, 0.20-0.80), and attending physicians had 2.37 times greater odds of documenting race than resident physicians (95% CI, 1.73-3.27) in adjusted analyses. Identify all potential conflicts of interest that might be relevant to your comment. Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. Err on the side of full disclosure. If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details.