The March issue of Harper’s Magazine including a fascinating small excerpt* from a Pearson nursing textbook, an excerpt alerting nursing students to cultural differences that might affect the way patients report their pain. It gave diverse reasons various racial or ethnic groups might be more or less likely to request or consume pain medications. I thought this information would be extremely useful to nurses.

Due to a groundswell of objections citing racism, Pearson has announced it will be withdrawing the passages from future publications of the text, both online and hardcopy; recalling some of the extant textbooks; scrutinizing its textbook line for similar material; and not including similar material in the future.

Pearson apparently agrees with the objectors, so I must be a racist.

The primary objection is that the groups are too large, so a clinician might react incorrectly to an individual simply because s/he is a member of the group.

Here’s an example: “Filipinos clients may not take pain medication because they view pain as the will of God.” How would such information be used? I thought that, confronted with a Filipino patient possibly non-compliant, a nurse would be sure to make a space for that sort of objection to surface during the conversation. Spirituality is a topic often avoided outside of explicitly religious care providers.

Do the objectors think that someone who read that statement would not bother to prescribe pain meds to a Filipino, assuming the patient wouldn’t use them?

I understand that America has a long and ongoing history of undertreating people of color, but I don’t think that’s because the clinicians in question know more or less about those people’s cultures. I think it’s because the clinicians in question are actual racists, as in, they respect, believe, and value people different from them less than they do people similar to them, even if they do so subconsciously.

But I am an old person raised during a more explicitly racist time, in a state that even today produces racially-biased outcomes for its citizens, and still has some racially-explicit laws on the books. And I readily agree that completely individualized treatment is by far the best. Understanding the patient’s background, current home environment, previous treatments, and attitudes toward health care, then customizing treatment around these factors as well as his or her expressed genome, including markers, and current microbiome, would be outstanding. A clean page for each patient, no assumptions.

Until we are all in the top 1% though, most of us get the probabilistic method of treatment:

You have the symptoms of this disease, which is currently going around.

People your age with those symptoms are usually suffering from this.

We have successfully treated your disease in others using this method. 

Clinicians make assumptions all the time. They have to in order to manage their case loads. If a little background information about a patient’s culture could bring a little more individualization to treatment, I think that could be a good thing.

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* The complete item is here: https://harpers.org/archive/2018/03/regarding-the-pain-of-others/ .