Compared with white patients, Black patients were more likely to have terms like “not compliant,” “unwilling” and “refused” in their medical charts.
study’s team designed a computer program to look for phrases with negative connotations, including “not compliant,” “not adherent” and “refused,” in medical notes written from January 2019 to October 2020 for close to 18,500 patients. Overall, 8 percent of the patients had one or more negative terms in their electronic health records.
Black patients were 2.5 times more likely to have such words in their medical notes than white patients, the researchers found. This language “has a potential for targeted harm,” says coauthor Michael Sun, a medical student at the University of Chicago’s Pritzker School of Medicine. Himmelstein and colleagues scrutinized the electronic health record for negative language like “nonadherent” and “unwilling” along with stigmatizing words — including the verb “abuse” — that label or place blame on the patient. The team studied medical notes that were written from January to December in 2018.
Overall, around 1,200, or 2.5 percent, of the admission notes contained unfavorable language. Notes about substance use disorder and diabetes had more of that language woven in, at 3.4 percent and 7 percent, respectively. In the full sample, Black patients were nearly 1.3 times more likely to have stigmatizing terms in their notes than white patients.
The new studies didn’t assess what impact the biased notes had on patients’ medical care. But other research has found that when short descriptions of a patient include stigmatizing language, the negative terms influenced physicians’ treatment decisions, making doctorsAlong with potentially leading to worse care, bias in medical notes may sour patients’ perception of their providers. Patients now have the right to read their electronic health records, as mandated in the 21st Century Cures Act.
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