Beyond the Surface: How Dermatologists Navigate Race in Clinical Practice

• In Event: 20820 - Section on Medical Sociology Roundtables
  In Refereed Roundtable (90 minute): Table 19. Healthcare Providers & Practice II

Abstract

How do dermatologists construct and negotiate race in their clinical practice? In this article, I focus on how race is recorded in medical notes and examine the racial construction of atopic dermatitis. While dermatologists are aware of the social construction of race, I argue that they rely on race as a biological given to maintain their cultural authority. My analysis draws on interviews with medical students, dermatology residents, dermatologists, along with observations of medical conferences and content analysis of dermatological textbooks.

The Fitzpatrick scale is a tool that rates skin colors on a scale from I-VI. I find that the Fitzpatrick scale is used to replace racial language in medical notes. Doctors see the Fitzpatrick scale as a means to decenter the assumed whiteness of patients’ skin and account for racial diversity. In this way, it is emblematic of many of the dilemmas facing doctors about how to account for diverse patients, without reifying race as a biological category. I also examine the racial construction of atopic dermatitis (AD), one the most common forms of eczema. Research associates the development of AD with mutation in the Filaggrin gene (Smieszek 2020). However, the Filaggrin mutation is neither a necessary nor sufficient condition for developing AD. Despite research demonstrating the relationship between environmental pollutants and AD, dermatologists continue to attribute the racial disparity to the Filaggrin mutation, rather than housing, neighborhood, or environment.

While structural competency, an understanding of race as socially constructed, and an awareness of racial inequality have been emphasized in medical education, I argue that dermatologists continue to fall back on biological essentialism because structural explanations of racial disparities decenter medical authority. Taken together, these cases demonstrate that the construction of race as a biological given is tied to dermatologists’ attempts to protect their cultural authority.

Author

• Durgesh Solanki, Johns Hopkins University