Patients and their "ethnicity": why all the questions????
Collecting demographic information from our patients is an important part of acquiring a better understanding of possible disease risk factors. Particular groups in society may be more vulnerable to certain conditions. For instance, those from an Asian background may be prone to deficiencies in various metabolic enzymes, including alcohol dehydrogenase, lactase or glucose6phosphatedehydrogenase (G6PD). Cystic fibrosis and rosacea tends to be a disease suffered by those with Northern European heritage. Thalassaemia is moreprevalent in the Mediterranean population, and sickle cell anaemia is most common in individuals of sub-SaharanAfrican descent.
This does not mean that only those groups will have these types of diseases. However, Australia is a multicultural nation, and a patient’s genetic heritage can have an influence on disease outcomes. Information about non-modifiable risk factors (such as ancestry) can behelpful in determining whether or not modifiable risk factors in that person’s life could help in mitigating disease.
The Royal Australian College of General Practitioners defines ethnicity in reference “to geographical and cultural origins, which are sometimes used when referring to specific conditions, eg. betathalassaemia is more common in Australian people of Greek ethnicity or background”. Unfortunately, there are variations in the use and understanding of terminology, which can lead to confusion and discomfort when engaging with this part of history taking. As with asking any question to a given patient, it is important to be open and honest, with the understanding that the patient can refuse to provide an answer if they wish. “Ethnicity” can be a problematic word; other words that can be used to address this question include “ancestry” or “heritage”, particularly since people are often interested in their own family roots. Some ways to address this include asking the following questions in relation to conditions that can run in families with a particular genetic heritage:
● Where do your grandparents come from?
● What part/s of the world does your family come from?
● Whereabouts in the world are your ancestors from?
Asking questions in this way, in addition to clarifying their purpose makes it more likely for you to acquire the information you need in a non-judgemental manner. It is very easy to make assumptions about a patient simply based on their name and appearance. You can
only know if you ask!