Black patients less credible to their physicians than white patients, clinician EHR notes suggest

Black patients are more likely than white patients to find language in their clinician notes that indicates they are not believed by their physicians, according to a recent Johns Hopkins University study published in the Journal of General Internal Medicine

Seven study insights: 

1. For the study, researchers at the Baltimore-based health system analyzed 600 clinic notes for patients in an academic ambulatory internal medicine practice in 2017. 

2. The group focused on determining whether it "could identify linguistic mechanisms through which physicians communicate disbelief of patients in medical records, and if so, to explore racial and gender differences in the use of such language," said Mary Catherine Beach, MD, a member of the Johns Hopkins Berman Institute of Bioethics, according to an April 7 news release

3. Dr. Beach and her team worked with a linguist and computer scientist to identity three aspects of language in clinic notes by which physicians communicate disbelief of patients: quotation marks around patients' words; specific judgment words such as "claims" or "insists" that suggest doubt; and evidentials, which is a sentence instruction in which patients' symptoms or experience is reported as hearsay. 

4. The researchers evaluated the prevalence of the three language aspects in more than 9,000 notes and tested the differences by race and gender. Results showed that all three forms of language were more often in the records of Black patients than white patients. 

5. Women's records were also somewhat more likely than men's to have quotes, but not judgment words or evidentials, the researchers said. 

"Some of this language reflects how clinicians are taught to document things, and there are reasons to use quotes and evidentials that don't necessarily cast doubt on what patients are saying," said Somnath Saha, MD, internal medicine physician at Johns Hopkins. "But if it's just benign word use, why would we see a difference in their application by patients' race and gender? That's what makes such language so insidious."

6. The researchers concluded that because of the prevalence of EHRs, clinicians' notes follow a patient wherever they go in the healthcare system and could adversely affect their care in the future. 

7. Dr. Beach said Johns Hopkins has been "extremely receptive" to addresses the effects of biased language on patient care and has asked her to speak to residents and all current medical students about the team's research. 


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