Executive Summary
Stigmatizing language in patient records is more common in some demographic groups. The language is connected to diagnostic errors and poor outcomes.
- Black people and homeless people were more likely to be stigmatized.
- The language can affect how clinicians see their patients.
- Newly trained clinicians may have a better approach
Stigmatizing language is inappropriate in healthcare and can easily seep into documentation and verbal communication. One of the worst effects of such comments is that it can lead to diagnostic errors and other threats to patient safety, according to recent research.
Stigmatizing language is widespread throughout medical documentation and more likely to be found in the records of some patients, says Katherine Brooks, MD, clinical lead for information guidance with the San Francisco Department of Public Health and clinical mentor with the University of California-Berkeley UCSF Joint Medical Program. The problematic language is more likely to be found in the records of Black patients, those with public insurance, and patients with certain comorbidities, she says.
Brooks and her colleagues recently investigated associations between stigmatizing language and errors in the diagnostic process. Their research is available online at https://bit.ly/3Uu464W.
Their analysis drew on the data of a larger study of patients who were hospitalized on internal medicine services and who had either died or required intensive care early in the course of their hospitalization — within the first 48 hours. About a quarter of those patients had a diagnostic error.
Reviewers identified any stigmatizing language in the patient’s chart and found that there was more stigmatizing language found in the charts of Black and homeless patients. The bias toward stigmatizing language in those groups had been documented earlier.
“We went on to try to correlate this with the clinical outcome, which has really not been done in the literature so far. This association intuitively makes a lot of sense, but we don’t really know the exact mechanism,” Brooks says. “We know that provider biases have a huge influence on patient care, particularly the diagnostic process, which is quite cognitive. And there is the opposite effect in which providers are seeing stigmatizing language documented in the chart and that’s leading them to have a different level of investment or level of care for that patient.”
There is not a lot of work being done in this space, and any real progress will require culture change, Brooks says. The current generation of trainees coming out of medical school has a much greater awareness and knowledge of inequities in medicine and, particularly, how identity affects a lot of clinical processing, Brooks says.
“This is, thankfully, improving. I think a lot of it also has to do with providers being better trained in understanding how the cognitive process and understanding that we are prone to errors,” he says. “I think what’s a little bit newer is a move towards training clinicians to understand how their own social biases also impact their clinical reasoning and at times their care.”
Source
- Katherine Brooks, MD, Clinical Lead for Information Guidance with the San Francisco Department of Public Health and Clinical Mentor with the University of California-Berkeley UCSF Joint Medical Program, San Francisco, CA. Email: [email protected].
Stigmatizing language is inappropriate in healthcare and can easily seep into documentation and verbal communication. One of the worst effects of such comments is that it can lead to diagnostic errors and other threats to patient safety, according to recent research.
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