How medical providers describe their patients in electronic records can have significant effects on their patients’ care. Two recent studies offer new insight and present an opportunity to improve health outcomes by eliminating negative descriptions.
Though such language is not common, studies published in January in the journals Health Affairs and JAMA Network Open found medical providers were more likely to apply stigmatizing language in electronic health record (her) notes of non-Hispanic Black patients than of White patients.
Stigmatizing language can mark someone as “other” and assign blame for a medical condition on a patient’s prior compliance with medical advice, the JAMA Network Open study’s authors said. These terms include “belligerent,” “challenging,” “unwilling,” “refuses,” and “difficult patient.”
According to the studies, doctors are more likely to use language in electronic health records signaling that their Black patients are less cooperative than White patients. This can create a false impression that these Black patients do not merit the time and attention required for quality treatment, the authors said.
“Stigmatizing language may compromise care by communicating discriminatory beliefs between clinicians,” said the authors of the JAMA Network Open study, noting, for example, that “clinicians were less likely to recommend treatment for patients labeled substance abusers than for those described as having substance use disorder.”
In addition, the authors note how negative language in health records — available for patients to read at no charge following the implementation of a federal law in April 2021 — can undermine the physician-patient relationship. This holds particular concern, the authors said, considering how the historical mistreatment of Black patients has undermined trust.
The authors of the Health Affairs study suggest enhanced training to avoid negative descriptors, particularly those reflective of implicit racial bias. In addition, the authors endorse efforts to address structural factors, such as burnout, that can exacerbate the use of stereotypes.
“Better education on race and racism may help equip providers with the understanding needed to identify, prevent introduction of, and discontinue use of negative descriptors in the EHR,” the authors said, adding that updated guidelines may be needed that both “affirm the importance of non-stigmatizing, patient-centered language” and “align professional standards with practices and prevent the transmission of bias across institutions.”
Women’s Health Research at Yale Director Carolyn M. Mazure, PhD, said, “The most important step toward any remedy is first recognizing that a problem exists. With this acknowledgement and a growing commitment from institutional leaders to end discrimination against all those seeking care, we can continue to address systemic deficiencies and improve medical practice so that everyone benefits.”