Skin color changes are much harder to detect in darker skin. I am pretty sure that this would barely work on pale white people, and pretty much no one else. The people who had this idea can't change the reality of who it would work for, and it seems kinda silly to pretend.

"Note that people of all skin colors undergo the same spectral skin modulations, and thus the techniques below are applicable on any patient population"
-- top of page 4.

Problem solved?

i agree with skeptifem... should they make black/dark brown hospital gowns just in the name of "equality", when in the end it IS harder to see and detect slight color changes on dark skin tones? whose fault is it that some things are easier to see on white skin, did we just make it up cos we are racist?

i think this post was unnecessary.

For people with highly pigmented skin it is almost impossible to detect slight changes in skin colour. It is standard practice to look at the sclera (white part of the eye), this part of the body is a pinkish white in all people. It is increasingly recommended to look at the mucous membranes and sclera alone in al populations as these are much more reliable. Consequently these charts would actually work for people of most ethnicities. Something tells me that this was not what they were designed for though!

Mark Changizi here, the first author of the study. The idea works on any skin-tone at all, and although I don't mention any race, I explicitly say (on page 4), "Note that people of all skin colors undergo the same spectral skin modulations, and thus the techniques below are applicable on any patient population [1,40].)" The entire paper is couched as something applicable to all humans. So, to suggest that there is some ambiguity about whether the authors have even wondered whether it applies beyond white people is disingenuous on this blog writer's part.

Sclera work very well for detecting early jaundice. Lips and palmar surface of hand and fingers work for the evaluation of global color change related to oxygenation, no matter what skin color the patient has. For localized changes, compare the possibly affected part (eg, distal extremities in septic shock) with unaffected parts (trunk).

I might add, type and intensity of lighting has a huge impact on ease of detecting very subtle color changes. Think about color-matching clothes under incandescent bulbs versus institutional fluorescent bulbs versus daylight. Most of us have color-matched clothing indoors only to find that the colors aren't so similar in daylight.

Along a different line, more daily-life exposure to people of different skin colors should increase ability to detect color change. A physician who grew up in Southern Nigeria should be more proficient at detecting color change in extremely melanized people (jet black to color of strong coffee without cream) than a physician who grew up in a 99% white rural county in Southern Illinois - more PRACTICE, in other words.

If you want precise 02 saturation, use a pulse-ox device.

Ooopsie! SCLERAE, plural

Just perform the right blood test and it wont matter if you are white, black, green, or indigo. This is the dumbest thing I have seen in a long time.

I think this post is a terrific example of the need to read through things and think about them thoroughly, on two counts. First, I think Lisa was hugely mistaken in her post; you could call out the authors for only using one color in their illustrations, but, well, illustrations are supposed to be illustrative, and I don't think they should be faulted for picking one color and using it throughout. But not noticing the fact that the article does indeed say that this works for all skin colors is a notable failure.

Second, I think skeptifem (and those who agreed with her) definitely have a lesson to learn here: skeptifem asserted, without any particular evidence, that this technique wouldn't work on darker-skinned people. Insofar as that fact is out-and-out contradicted in the article, based on the authors' research, her comment is a prime illustration of the difference between guessing and science.

Criticizing articles published in Medical Hypotheses is like shooting fish in a barrel. It's a non-peer-reviewed 'journal' that chooses articles on their novelty value.

How is this supposed to work at all? They would need hundreds of different colored gowns to get a close enough match to the patient for the comparison to mean much.

And I would end up with every nurse thinking I had jaundice, simply because my skin is more yellow-toned than everyone expects pale skin to be (judging by makeup shades) and would undoubtedly be yellower than the gown.

Cultural skin tone misunderstandings in the hospital go both ways: I once woke up from general anesthesia with an attendant violently shaking my shoulders, rapidly slapping my cheeks, and urgently shouting "Wake up!! Wake up!!"

Another attendant told her not freak out so much. "Relax...she's Norwegian or something." I was so pale, the first attendant thought I might be dead.

Here's what my skin looks like on a normal day (no foundation, powder or photoshop whatsoever), so you can imagine how I must have looked after losing blood and waking up from an operation!

http://www.flickr.com/photos/hobannyc/4333346973/sizes/m/

Here is the perspective of an artist.

The amount of variety in skin tone would make admitting people into the hospital a monumental task, not to mention ordering enough gowns to carry the right color for everybody. Also do you match the arms or the neck or the face. I just looked in the mirror and the difference between the neck and the face is fairly obvious.

Perhaps a dot or band would be more realistic, but who would be the judge of any changes? You'd also want to be careful of beginning to place everybody getting their's from boxes X to Y being placed in a particular part of a hospital, separate but equal and all that.

Not everyone sees all colors either. When I look at a sunset I can usually see all the colors in the rainbow, my husband is not sure he believes there's any green there at all. Nevermind that he thinks there aren't any colors at all in the sky minutes before I do. OK, let's go show's over. Can't you see those purples and blues?