RACIAL PROFILING, CLINICAL EPIDEMIOLOGY, AND CULTURAL COMPETENCE: WHEN IS RISK STRATIFICATION BY RACE OR ETHNICITY JUSTIFIED? M.H. Chin 1 , C.A. Humikowski 1 ; 1 University of Chicago, Chicago, IL PURPOSE: Population-based, probabilistic approaches to medicine have become more prominent with the rise of the evidence-based medicine movement. Simultaneously, diverse patient populations have spurred development of curricula in cultural competence. Building upon lessons from the racial profiling debate in the legal and political realms, we aimed to develop a conceptual framework for exploring whether race and ethnicity should be used as clinical tools or if dangers of stereotyping are too great. METHODS: We reviewed key literature pertinent to racial profiling, race and medicine, and curricula in cultural competence. We explored issues of race and medicine through a regular seminar series with medical housestaff, and extensive feedback from colleagues. We developed a conceptual framework that balances clinical epidemiological principles with lessons learned from social and political racial profiling. RESULTS: We propose that viewing the patient within a wider population-based cultural setting can help guide the initial clinical approach, but individualized care is mandatory. The use of race and ethnicity as clinical tools is on a slippery slope Ð they may be useful or dangerous. Biological examples are rare in which race or ethnicity are relevant (e.g. Ð Tay ± Sachs, sickle cell). However, ethnicity may have a statistical association with a variety of factors. The potential benefit of using ethnicity as a tool is to aid an individual patient by making medical care better tailored to him or her. The potential detriments are reinforcement and perpetuation of partial myths, encouragement of undesirable behavior by creating negative expectations, and avoidance of addressing the underlying individual factors. Racial profiling has taught us that the costs of using ethnicity as a proxy for behavior are too high. But, ethnicity may appropriately be used as an initial proxy for history, language, culture, and health beliefs, as long as individualization of care is rapid. The predominant approach to cultural competence in medical education today teaches a consideration of individual patients as opposed to a rigid checklist of ethnic traits. For example, providers are advised to inquire about the meaning of illness to the patients, and the social context such as family, literacy, and finances. However, given that physicians have limited time and energy, context including race and ethnicity can be helpful in guiding initial inquiry and raising awareness that an issue (e.g. Ð strong distrust of the health care system) may be important.