Doctors use more negative words in black patient records.Here’s why it’s harmful

key takeaways

  • A University of Chicago Health System study of patient records found that negative descriptions were more likely to be found in black patient records than in white patient records.
  • Health policy experts worry that negative characterizations could bias other doctors who see patient records.
  • Other providers often duplicate records about patients to save paperwork time, so negative stereotypes can persist in patients’ files.

A new study reveals when and how often healthcare providers use negative words in their notes about patients. Biggest finding: Negative descriptions were more prevalent in the health records of black patients.

The study was published in the February 2022 issue health affairs, Black patients receiving care at an urban academic medical center in Chicago, Illinois were found to be more than 2.5 times more likely to have negative descriptions listed in their electronic health records (EHR) than white patients.

According to the study, patients enrolled in Medicare and Medicaid were also more likely to have negative descriptions on file than those with private insurance.

The University of Chicago researchers behind the study said the findings are concerning because negative descriptions inserted by healthcare professionals could affect patient care.

Negative descriptions in health records

The study used a computer-based system to look at more than 40,000 patient records from 18,459 adult patients between January 2019 and October 2020. The most commonly used negative words were “rejection,” “noncompliance,” and “agitation.”

“This is my third year in medical school,” said Malika Fair, MD, MPH, MD, MPH, Senior Director of Equity and Social Responsibility at the Association of American Medical Colleges (AAMC). Something I witnessed when I first started caring for a patient. Tells very well. “You can introduce bias even before you sit down and write a chart. ”

For example, Fair said, during her medical training, doctors used the term “Hispanic panic” to refer to many Latino parents’ concerns about fevers in their children.

Monica Peek, MD, MPH, professor of medicine at the University of Chicago School of Medicine, told VigorTip that none of the terms identified in medical records were derogatory terms for the purposes of the Chicago study.

“I don’t think it’s something our doctors did on purpose out of malice, but I think because they’re commonly used words… [they were] Maybe not the best words because they lead to negative connotations,” she said.

Patient access to medical records will become mandatory

why this is a problem

Negative descriptions can persist in patients’ charts and influence how healthcare providers perceive these patients.

Jose F. Figueroa, MD, MPH, a physician and assistant professor of health policy and management at the Harvard TH Chan School of Public Health, told VigorTip that physicians often look at notes that other providers put in charts.

“If you see words like ‘challenging’, ‘aggressive’, ‘defensive’ or ‘exaggerated’ in your medical records, you probably know very little about the patient, but you may need to decide whether to treat with pain medication” Feige Roja, who was guest editor of the special health affairs question, say. “Words in electronic medical records may influence people’s decisions about whether to provide certain services.”

Additionally, physicians often copy and paste patient information for efficiency, and continue to use negative descriptions even when unnecessary.

“Other health care providers may use the same exact words and copy them and put them in their own notes without confirming whether a person is angry,” Figueroa said. “Negative descriptions are increasing in medical records, which can affect how a person is treated.”

The study did find that notes written in the EHR were less likely to have negative descriptions once the COVID-19 pandemic began. The researchers say the change may have occurred months after the start of the pandemic, after a white police officer murdered black George Floyd on May 25, 2020, against minorities more sensitive. Alternatively, doctors may be less likely to use negative terms in the charts of people being treated for COVID-19.

Patients prefer doctors of same race and ethnicity, study finds

Where are we going from here?

Changing the language found in medical records requires a broader discussion of systemic racism because providers may not even be aware that it is happening, the study’s authors said.

“Better education on race and racism may help providers understand how to identify, prevent the introduction and stop the use of negative [descriptions] in electronic medical records,” the study authors wrote.

To aid education, the AAMC Center for Health Justice and the American Medical Association Center for Health Equity recently released “Advancing Health Equity: A Guide to Language, Narratives, and Concepts.” The groups said they hope the guidance will challenge health care providers — “and all of us” — to change the way we talk to and talk about patients and communities. For example, the guide notes that the term “minority” is widely used but may also carry a derogatory connotation.

However, without training in self-awareness and potential biases, providers may not be able to change their language, the study authors said.

The researchers found that visits to a doctor’s office were described less negatively than hospitalizations. This suggests that the stress of the hospital environment may affect patient notes.

Providers may use “stereotypes as cognitive shortcuts in stressful clinical settings characterized by time pressure, increased cognitive load, and reduced resources,” the study said.

Addressing physician burnout may be an important factor in helping address racism in healthcare, the authors say.

4 ways doctors can heal from a year of burnout

what does this mean to you

U.S. law gives you the right to view all electronic health records. Asking to see your records can correct any erroneous information about you. It may also lead doctors to be more sensitive about how they describe all patients.