The clinical impact of biased language in handoffs

© Ranta Images - stock.adobe.com

“Those who work in health care are often very well-intentioned, but they’re human beings, and they get frustrated by things, and they express different biases – both implicit and explicit,” Austin Wesevich, MD, MPH, MS, a hematologist and health services researcher at the University of Chicago Medicine and the lead author of a new study surrounding clinician’s biases, said in a university release.

The study, published in the Journal of the American Medical Association (JAMA) Network Open, revealed that when clinicians hear a patient described with negatively biased language, they can become less empathetic towards the patient and, in some cases, become less accurate in recalling the patient’s critical health details. This issue is particularly prevalent during “handoffs,” when clinicians pass patient information from one shift to another. Although the biases may begin subtly, they have a chance to compound and ultimately impact the quality of care a patient receives.

“A lot is going on here cognitively – how we’re processing information as clinicians, and how editorializing or talking about the patient negatively can really cloud the mind of the listener and impact the care they ultimately give that patient,” Wesevich explained.

In August 2023, Wesevich and colleagues from Duke University published research in JAMA Pediatrics that recorded and analyzed real-life clinical handoffs from a major medical center. In that study, they determined that 23% of the behind-the-scenes briefings included negative or biased language, especially when discussing Black patients or patients with obesity.

Wesevich’s latest study is meant to build on his research from 2023. Researchers designed a survey-based experiment in which each of the 169 participating residents and medical students were played audio of three brief, recorded handoffs which were closely modeled after real handoffs.

For each recording, the researchers created two versions: a neutral handoff, simply stating the patient’s condition, situation and needs, and a biased one that expressed a negative stereotype, or cast blame or doubt on the patient’s credibility. After listening to each recording, study participants answered a single multiple-choice question testing their ability to recall key medical details, they completed a survey that measured their attitude towards the patient and they wrote down three “key takeaways” based on the recorded handoff.

“Unsurprisingly, our results confirmed that when you hear biased language about someone, you feel less positively about that person,” Wesevich said. “But it was striking to find that when participants heard some level of blame being directed towards the patient for their condition, they were then less likely to correctly answer the multiple-choice question about the patient’s care.”

Participants who received biased handoffs had a harder time recalling key clinical information—including lab results, symptoms to watch for and recommended treatments—than those who received neutral-language handoffs, although the difference was not statistically significant. However, participants who heard a patient described with blame-bias did have significantly lower clinical information recall accuracy than those who received neutral-language handoffs.

Wesevich’s new study maintains the indication that racial bias exhibited during verbal patient handoffs can adversely impact the quality of care that racially minoritized patients, specifically Black patients, receive. Researchers point to a disproportionate rate of medical errors in the care of racially minoritized patients and suggest that avoiding bias in handoffs could increase empathy and reduce error rates, thereby improving the overall quality of care.

“When we notice in these handoffs that certain types of patients are experiencing the brunt of the problem, then we need to do something to try to help alleviate that situation,” Wesevich said. “I think standardization of handoffs is the way to protect vulnerable patients by making the playing field of privilege more level.”

In the study, the researchers echo this sentiment and push for the standardization of handoffs, arguing that health care institutions have the power to prevent bias from entering these communications by requiring handoffs to only share neutral and medically relevant facts. Until standardized handoffs become a reality, Wesevich encourages patients and their families to speak up, ensuring that all questions are answered and that the next shift knows important clinical details.

“…trying to advocate for yourself or your loved ones is important because you don’t know if a clinician heard or internalized everything, you’d want them to know when caring for you after a handoff,” Wesevich said.