Physician Use of Stigmatizing Language in Patient Medical Records

Abstract

<div class="section"> <a class="named-anchor" id="ab-zoi210509-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d16053005e297">Question</h5> <p id="d16053005e299">What types of stigmatizing language are written by physicians about patients in their medical records? </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi210509-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d16053005e302">Findings</h5> <p id="d16053005e304">This qualitative study of 600 encounter notes from 138 physicians found 6 ways that physicians express positive feelings toward patients in medical records, including compliments, approval, and personalization. This study also found 5 ways that physicians express negative feelings toward patients, including disapproval, discrediting, and stereotyping. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi210509-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d16053005e307">Meaning</h5> <p id="d16053005e309">These findings suggest that physicians should increase their awareness of stigmatizing language in patient records to ensure that their notes are informative and respectful. </p> </div><p class="first" id="d16053005e312">This qualitative study examines both negative and positive attitudes expressed by physicians about patients in electronic medical records. </p><div class="section"> <a class="named-anchor" id="ab-zoi210509-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d16053005e316">Importance</h5> <p id="d16053005e318">Negative attitudes toward patients can adversely impact health care quality and contribute to health disparities. Stigmatizing language written in a patient’s medical record can perpetuate negative attitudes and influence decision-making of clinicians subsequently caring for that patient. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi210509-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d16053005e321">Objective</h5> <p id="d16053005e323">To identify and describe physician language in patient health records that may reflect, or engender in others, negative and positive attitudes toward the patient. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi210509-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d16053005e326">Design, Setting, and Participants</h5> <p id="d16053005e328">This qualitative study analyzed randomly selected encounter notes from electronic medical records in the ambulatory internal medicine setting at an urban academic medical center. The 600 encounter notes were written by 138 physicians in 2017. Data were analyzed in 2019. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi210509-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d16053005e331">Main Outcomes and Measures</h5> <p id="d16053005e333">Common linguistic characteristics reflecting an overall positive or negative attitude toward the patient. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi210509-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d16053005e336">Results</h5> <p id="d16053005e338">A total of 138 clinicians wrote encounter notes about 507 patients. Of these patients, 350 (69%) were identified as female, 406 (80%) were identified as Black/African American, and 76 (15%) were identified as White. Of 600 encounter notes included in this study, there were 5 major themes representing negative language and 6 themes representing positive language. The majority of negative language was not explicit and generally fell into one or more of the following categories: (1) questioning patient credibility, (2) expressing disapproval of patient reasoning or self-care, (3) stereotyping by race or social class, (4) portraying the patient as difficult, and (5) emphasizing physician authority over the patient. Positive language was more often more explicit and included (1) direct compliments, (2) expressions of approval, (3) self-disclosure of the physician’s own positive feelings toward the patient, (4) minimization of blame, (5) personalization, and (6) highlighting patient authority for their own decisions. </p> </div><div class="section"> <a class="named-anchor" id="ab-zoi210509-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d16053005e341">Conclusions and Relevance</h5> <p id="d16053005e343">This qualitative study found that physicians express negative and positive attitudes toward patients when documenting in the medical record. Although often not explicit, this language could potentially transmit bias and affect the quality of care that patients subsequently receive. These findings suggest that increased physician awareness when writing and reading medical records is needed to prevent the perpetuation of negative bias in medical care. </p> </div>