Personal reflections on race-based medicine: narrative analysis of a case study using a situated lens

Background: Race-based medicine was initially established to risk-stratify patients using algorithms based on biological similarities. This generalized form of medicine resulted in harmful practices and health inequities. Although race-based medicine has received increasing attention as a harmful practice contributing to structural and systemic racism in medicine, the individual patient perspective remains relatively under-studied, particularly in obstetrics. This qualitative case study uses a situated lens to explore the individual experience and perspective of race-based medicine in perinatal care. Methods: This was an institutional review board approved qualitative study utilizing semi-structured interviews as part of a larger study investigating the birth experiences of military beneficiaries. The interview was recorded and transcribed with data inductively analyzed using narrative analysis with positioning theory to identify positions and lived experiences during the individual's care experiences. Results: Narrative analysis yielded the following themes: (1) self-identity; (2) reinforcing racial sensitivity; (3) health individualization; (4) internal conflict with external perception and honesty; (5) trust and respect; (6) resisting negative influence and press/stories; (7) intellectualization; and (8) fear vs. empowerment for personalized birth wishes. Each theme represented valid concerns patients may experience with race-based medicine in a healthcare setting. Conclusions: The application of race-based medicine during prenatal care may harm the relationship between pregnant individuals and clinicians, leading to an overall negative experience and erosion of trust in the healthcare system. Implementing personalized race-conscious healthcare rather than race-based medicine is essential to improving patient-doctor relationships by building trust and eliminating unnecessary medical practices.