Racism and bias may be communicated in the medical record. One study that analyzed over 18,000 patients with 40,000 history and physical notes to assess for negative patient descriptors found that 8.2% of patients had a negative descriptor in their chart note. Although a small number, in comparison with White patients, Black patients had over twice the odds of having at least one negative descriptor in their history or physical notes. Examples of negative descriptors, or stigmatizing language, included:

  • aggressive
  • (non-)adherent
  • agitated
  • sickler
  • angry
  • challenging
  • frequent flyer
  • combative
  • defensive
  • (non-)compliant
  • confront
  • hysterical
  • (non-)cooperative
  • exaggerate
  • (un-)pleasant
  • refuse
  • resist

It is not just these types of words but how and when they are more often used that may reveal bias.

Another study found that only 18% of the text for inpatient progress notes was manually inputted and the rest copied from prior documentation, frequently from other healthcare providers. If negative descriptors are present in the notes, this practice can perpetuate and increase bias amongst future healthcare providers. Outpatient settings which tend to be less rushed and less stressful for clinicians may showcase less frequency of negative descriptors.

Evidence of implicit bias has been documented in several instances. Physicians who measurably showed bias tended towards being more verbally dominant and did not incorporate as much patient-centered language when speaking with Black patients. Bias can negatively impact the relationship between patients and providers. Patients’ lack of trust in health care providers and less adherence to treatment plans has been associated with experiencing healthcare bias.

Clinical vignettes have been used to determine how stigmatizing language affected the providers’ perceptions of patients and provider treatment plans.  It was found that the language changed providers’ perception of patient pain levels and the providers would suggest a less aggressive plan to manage their pain.

I encourage you to annually ask for a copy of your physicians’ reports and read them to see if you notice any stigmatizing language.  The clinic will ask you how far back you want these reports to go.  Three months is enough to get a gist of what has been going on lately and not too long that you would avoid reading it.

Reading the reports is also a great way to view diagnoses attached to your name and the medications the report is stating that you still take.  If you see something in any of these areas that is incorrect, that you do not agree with, or that you were never made aware of but think should have been discussed with you, you can present this to the doctor or clinic staff.  Sometimes doctors are part of a larger clinic or hospital where there is a designated person that you can express complaints to, so that may be another option for you to express your concerns.

 

Reference:

Sun M, Oliwa T, Peek M, et al. Negative Patient Descriptors: Documenting Racial Bias In The Electronic Health Record. Health Aff (Millwood). 2022;41(2):203-211. doi: 10.1377/hlthaff.2021.01423.