Physicians Use More Negative Words in Black Patient Records. Here's Why That's Harmful

A new study is revealing when and how often healthcare providers use negative words in notes about patients. The biggest finding: negative descriptions are much more prevalent in the health records of Black patients.

The study, published in the February 2022 issue of the journal Health Affairs, found that Black patients who received care at an urban academic medical center in Chicago, Illinois, were more than 2.5 times as likely as White patients to have negative descriptions listed in their electronic health record (EHRs).

Patients on Medicare and Medicaid also had a higher likelihood of having negative descriptions in their files compared to people who had private insurance, according to the study.  

The University of Chicago researchers behind the study say the findings are concerning because negative descriptions inserted by healthcare professionals could potentially impact patient care.

"This is something I witnessed as early as my third year of medical school when I first started taking care of patients," Malika Fair, MD, MPH, Senior Director of Equity and Social Accountability at the Association of American Medical Colleges (AAMC), told Verywell. "Bias can be introduced even before you sit down to write in the chart."

For example, Fair said that during her medical training, doctors used the term “Hispanic panic" to refer to concern among many Latinx parents when a child has a fever. 

In the case of the Chicago study, none of the terms identified in medical records were derogatory, study author Monica Peek, MD, MPH, a professor of medicine at the University of Chicago School of Medicine, told Verywell.

"I don't think it was something that our physicians were purposely doing with malicious intent, but I think because they were words that are used commonly… [they were] maybe not the best words because they can lead to a negative connotation," she said.

Why It's a Problem

Negative descriptions can persist in a patient’s chart and influence how healthcare providers perceive those patients.

Jose F. Figueroa, MD, MPH, a physician and Assistant Professor of Health Policy and Management at the Harvard T.H. Chan School of Public Health, told Verywell that physicians frequently look at notes other providers put in charts.

“If you see words such as 'challenging,' 'combative,' 'defensive,' or 'exaggerates,' in the medical record, you may know little else about the patient, but you may have to decide whether to treat with pain medicines," Figueroa, who served as a guest editor of the special Health Affairs issue, said. "The words in the EHRs may be influencing people’s decisions about whether to offer certain services.” 

Additionally, physicians often copy and paste patient information to be more efficient, perpetuating the use of negative descriptions, even when unnecessary.

“Other healthcare providers may take the same exact word and copy it and put it in their own note without confirming whether a person was, say, angry," Figueroa said. "The negative description keeps growing in the medical record and that could impact how a person is treated.”

The study did find that notes written in EHRs once the COVID-19 pandemic began were less likely to have negative descriptions. Reasons for the change, according to the researchers, could have included more sensitivity to minorities after the murder of George Floyd, a Black man, by a White police officer on May 25, 2020, a few months after the pandemic began. Alternatively, doctors may have been less likely to put negative terms in the chart of a person being treated for COVID-19.

Where Do We Go From Here?

The study authors say changing the language found in medical records requires a much wider discussion about systemic racism, since providers may not even realize it's happening.

“Better education on race and racism may help equip providers with the understanding needed to identify, prevent introduction of, and discontinue use of negative [descriptions] in the EHR," the study authors wrote.

To help educate, the AAMC Center for Health Justice and the American Medical Association Center for Health Equity recently released "Advancing Health Equity: A Guide to Language, Narrative and Concepts." The organizations say they hope the guide will challenge healthcare providers—“and all of us”—to change how we speak with and about patients and communities. The guide points out, for example, that the word “minority” is widely used, but can be pejorative. 

However, providers may be unable to change their language without self-awareness and training on potential biases, according to the study authors. 

Researchers found that visits to a doctor’s office, compared to inpatient care, accounted for fewer negative descriptions. This suggests the stressful environment of a hospital setting could be influencing patient notes.

Providers may use “stereotypes as a cognitive shortcut in stressful clinical environments characterized by time pressure, increased cognitive burden, and decreased resources,” the study says.

The authors say addressing physician burnout may be an important factor in helping to address racism in health care.