'Stigmatizing' language in EHRs may negatively affect patient care for years

Including nonessential, "stigmatizing" notes in a patient's health record may lead them to receive inadequate care in the future, according to a study out of Baltimore-based Johns Hopkins University School of Medicine and published in the Journal of General Internal Medicine.

For the study, the researchers developed a series of chart notes, half of which employed "neutral language," and half of which employed "stigmatizing" language. The researchers enrolled 413 medical students and internal and emergency medicine residents to review these notes and suggest next steps, in an effort to assess whether stigmatizing language affected providers' attitudes toward patients.

All of the notes contained identical medical information about the same hypothetical patient — a 28-year-old African American man with sickle cell disease. In the "neutral" and "stigmatizing" vignettes, the patient visits a hospital's emergency department with a vaso-occlusive crisis, a painful condition common among patients with sickle cell disease.

In one example, the researchers provided select study participants with the observation, "He has about 8-10 pain crises a year, for which he typically requires opioid pain medication in the ED." Other participants received a note with "nonessential" language that implied various value judgments, according to the researchers, such as, "He is narcotic dependent and in our ED frequently."

The researchers found notes with stigmatizing language not only led participants to have a more negative attitude toward the hypothetical patient, but also affected their treatment plans. Physicians-in-training who read the stigmatizing chart notes were more likely to treat the patient's pain less aggressively, even if they recognized the language as stigmatizing.

"This record may be the only source of information a new clinician has about some patients," Mary Catherine Beach, MD, senior author and a professor in the department of medicine at the Johns Hopkins University School of Medicine, said in a May 9 statement. "We have to question the assumption that the medical record always represents an objective space."

The researchers argued clinician bias that seeps into a patient's chart notes may affect subsequent medical care for years, contributing to long-term healthcare disparities.

"This is an important and overlooked pathway by which bias can be propagated from one clinician to another," the study authors concluded. "Attention to the language used in medical records may help to promote patient-centered care and to reduce healthcare disparities for stigmatized populations."

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