Abstract 1 - Language And The Transmission Of Bias In The Medical Record

Do Words Matter? Stigmatizing Language And The Transmission Of Bias In The Medical Record Goddu, A.P., et al, J Gen Intern Med 33(5):685, May 2018

SUMMARY:

• It is well documented that not all patients are treated equally in the healthcare system. It is possible, that we are contributing to the problem of bias by what we write in the medical record.
• In this clever study the authors examine whether or not stigmatizing language written in the chart impacted the attitudes and treatment plan of the next physician seeing the patient.
• The authors used a simple vignette study design (not real patients in a clinical setting).
• They created two charts with the same medical information about the same hypothetical patient with sickle cell disease – the first with stigmatizing language and the second with neutral language.
• The stigmatizing note was full of unnecessary and negative statements (e.g. his complaints about the housing authority, words that cast doubt on the story, and inappropriate quotes).
• They then had medical students, EM and IM residents read the notes and compete a survey assessing their attitudes of the patient and treatment decisions.
• They surveyed 413 participants with a response rate of only 54%. Ideally, we would have liked to see this closer to 80%.
• The authors found that exposure to the stigmatizing language note was associated with more negative attitudes towards the patient and less aggressive management.
• Interestingly, the attitude to both patients based on the charts was lower among residents compared with medical students.

FULL ARTICLE: https://link.springer.com/article/10.1007%2Fs11606-017-4289-2

PMID: 29374357

EDITOR’S COMMENTARY: This was a randomized vignette study of two chart notes employing stigmatizing versus neutral language to describe the same hypothetical patient with sickle cell disease. The study looked at whether language in the chart biased residents and med students. They found that attitudes towards the patient in the stigmatizing note was more negative and subsequently this patient received less pain medicine. In sum, the authors make the argument that what we write is an important and overlooked pathway by which bias can be propagated from one clinician to another. This bias furthers healthcare inequality for the individual patient and entrenches healthcare disparities overall for those who are stigmatized.

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