Stigmatizing language used more often in admission notes for Black patients than whites, study finds

Stigmatizing language about patients is relatively rare in hospital admission notes, but is more frequently applied to non-Hispanic Black than to white patients, according to results of a new study.

Using natural language processing, researchers analyzed more than 48,000 EHR notes written about 29,783 patients at a large urban medical center during 2018. They found that about 1,200, or 2.5%, of the notes included stigmatizing language, which they define as either marking or labeling someone as ‘other’; blaming the patient; or invoking danger. Examples, they say, include labeling patients with substance use disorders “substance abusers,” emphasizing patient responsibility for their illness, and calling distressed patients “belligerent” or “combative.”

The findings echo those of another recent study showing that language used to describe patients in electronic health records may be perpetuating racial bias and other negative stereotypes in health care,

Among the entire sample in the latest study, the admission notes on non-Hispanic Black patients had a .67 percentage points greater probability of containing stigmatizing language compared to notes on white patients. Researchers found similar language disparities in notes on patients with diabetes, substance use disorder and chronic pain, three common reasons for admission.

The authors note that EHRs have become the primary means of communications between physicians in the same practice, hospital and hospital system. Given that reach, stigmatizing language has the potential to compromise care by communicating bias between physicians. They cite vignette studies showing, for example, that doctors are less likely to recommend treatment for patients labeled “substance abusers” than for those diagnosed as having “substance use disorder.” In addition, they say, the language doctors use is important in building healthy relationships with patients, especially in light of patients’ near-universal access to their EHR records made possible by the 21st Century Cures Act.

The codification of stigma regarding Black patients in EHR notes is especially worrisome, they write, given that the history of medical experimentation and physician mistreatment of Black patients has already undermined their trust in the medical system. With more patients gainingaccess to their medical records, the disproportionate use of stigmatizing language in notes for Black patients risks…undermining efforts to promote racial equity in care.”

The study, “Examination of Stigmatizing Language in the Electronic Health Record,” was published January 27 in JAMA Network Open