Bias in clinical notes impacts treatment of patient pain

Stigmatizing language in patient medical records impacts physicians’ attitudes toward clinical decision making, according to a study published in the May 2018 issue of the Journal of General Internal Medicine.

  Clinician bias and stigmatized language could lead to healthcare disparities. In this study, researchers from Johns Hopkins University School of Medicine in Baltimore examined whether stigmatizing language in patient medical records affected physician attitudes toward clinical decision making.

“Implicit bias is the automatic activation of stereotypes derived from common cultural experiences, which may override deliberate thought and influence one’s judgment in unintentional and unrecognized ways, and may affect communication behaviors and treatment decisions,” wrote first author Anna Goddu, a medical student at Johns Hopkins University School of Medicine, and colleagues. “Clinicians may acquire implicit bias towards patients from one another when communicating verbally or when writing or reading medical records; physicians-in-training may absorb these attitudes as part of the 'hidden curriculum' of medical training.”

In the study, 413 medical students and residents were given a chart with either stigmatizing or neutral language to describe a hypothetical patient with pain and sickle cell anemia. Following a survey of physicians’ attitudes, researchers noted the exposure to stigmatizing language correlated to an increase in negative attitudes toward the patient. Additionally, the stigmatizing language group of physicians treated the patients’ pain less aggressively than those with patients in the neutral language group.

“Stigmatizing language used in medical records to describe patients can influence subsequent physicians-in-training in terms of their attitudes towards the patient and their medication prescribing behavior,” concluded Goddu and colleagues. “This is an important and overlooked pathway by which bias can be propagated from one clinician to another. Attention to the language used in medical records may help to promote patient-centered care and to reduce healthcare disparities for stigmatized populations.”