The institutions of American healthcare have begun to reckon with the potential for unintentional bias in the ways doctors are trained and how they communicate—with each other and with patients—about race and ethnicity. 

Here in optometry, we’ve seen the creation of advocacy groups such as Black Eyecare Perspective and numerous task forces on diversity, equity and inclusion. Addressing the issue more broadly, the American Medical Association recently published guidance in JAMA on how authors of scientific articles could use terms with greater care to be more accurate about the populations studied while avoiding old habits that might come off as dismissive to underrepresented populations.

Some of the standard demographic categories used in medical research encompass literally billions of people with vastly heterogenous physical as well as cultural characteristics. With that in mind, just how useful is, for instance, “Asian” as a descriptor? There are obvious benefits to clinical care from recognizing racial and ethnic components of disease processes, and the AMA effort seeks to enhance the precision of that analysis.

The recommendations also try to walk the line between encouraging doctors to bring more nuance to their understanding of how race and ethnicity imbue a person with identity while taking care not to define individuals solely by those associations. 

 We have a lengthy news story about the AMA guidelines on our website and will cover the topic more fully in an upcoming print issue, but here are some key recommendations specific to the use of wording in publications:

  • Using specific racial and ethnic categories is preferred over collective terms when possible. Categories included in groups labeled as “other” should be defined.
  • When collective terms are used, merging of race and ethnicity as “race/ethnicity” is no longer recommended. Instead, “race and ethnicity” is preferred, with the understanding that there are numerous subcategories within these two areas.
  • The general term “minorities” should not be used when describing groups or populations because it is overly vague and implies a hierarchy among groups. Instead, writers should include a modifier when using the word “minority” and should not use the term as a standalone noun for racial and ethnic minority groups and individuals. 
  • The nonspecific group label “other” for categorizing race and ethnicity is uninformative and may be considered pejorative.
  • Authors are encouraged to provide greater detail about the distribution of multiple racial and ethnic categories.
  • Racial and ethnic terms should not be used in noun form. Instead, the adjectival form is preferred.

We at Review will also look for ways to be more descriptive in the language used to discuss race and ethnicity as predisposing factors for potential health risks. Disparities in access to medical care among different populations should also be recognized and addressed by authors. These efforts would give us all a fuller picture of the state of healthcare today, and what to do about it.