Stigmatizing Language In Patient Records Can Do Lasting Harm

Published: Thursday, July 15, 2021 - 4:18pm
Updated: Friday, July 16, 2021 - 7:20am
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In the era of electronic health records, a physician's notes can follow a patient from doctor to doctor.

When the chosen words convey bias or stigmatize the patient, they can perpetuate bad treatment, poor health outcomes and self-fulfilling prophecies.

A content analysis of 600 notes by 138 physicians working in a high-pressure urban medical setting divided remarks into positive and negative types.

Practicing physicians led the JAMA Network Open study and consulted other doctors to assess the results.

Content analysts study reams of text to identify recurring themes. In this case, researchers combed through records of 507 patients, 69% of whom were female and 80% of whom identified as Black/African American.

Negative comments voiced disapproval of patients' reasoning or self-care, or discredited patients by using words like "supposedly," "claims" or "insists." Sometimes they painted patients as difficult. Occasionally they stereotyped them by race or class, in some cases quoting their poor grammar or use of African American Vernacular English.

Positive notes expressed compliments, approval and respect for patient decisions. Some used words like "charming," "inspiring," "pleasant" or "kind." Some minimized blame by taking into account extenuating circumstances or patient challenges such as memory issues. Some humanized their comments by presenting the situation from the patient's perspective.

Previous studies link worse health care to race, ethnicity, class, age, obesity and substance use disorders.

But they also suggest the way doctors describe these conditions in their notes can affect how future doctors perceive patients who have them. For example, doctors in a 2018 study were more likely to blame a patient for being a "substance abuser" than for "having a substance use disorder."

Such judgements can affect a doctor's notions on how — or if — to treat a patient.

The authors say attending physicians and residents in outpatient internal medicine clinics like the one studied face stressors that can bring out the need to vent frustrations.

But they added such pressures can also allow implicit biases to inject themselves, however unconsciously, into physician attitudes and notes.

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