Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 May;33(5):685-691.
doi: 10.1007/s11606-017-4289-2. Epub 2018 Jan 26.

Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record

Anna P Goddu  1 , Katie J O'Conor  2 , Sophie Lanzkron  3 , Mustapha O Saheed  4 , Somnath Saha  5   6 , Monica E Peek  7 , Carlton Haywood Jr  3 , Mary Catherine Beach  2
Affiliations

Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record

Anna P Goddu et al. J Gen Intern Med. 2018 May.

Erratum in

Abstract

Background: Clinician bias contributes to healthcare disparities, and the language used to describe a patient may reflect that bias. Although medical records are an integral method of communicating about patients, no studies have evaluated patient records as a means of transmitting bias from one clinician to another.

Objective: To assess whether stigmatizing language written in a patient medical record is associated with a subsequent physician-in-training's attitudes towards the patient and clinical decision-making.

Design: Randomized vignette study of two chart notes employing stigmatizing versus neutral language to describe the same hypothetical patient, a 28-year-old man with sickle cell disease.

Participants: A total of 413 physicians-in-training: medical students and residents in internal and emergency medicine programs at an urban academic medical center (54% response rate).

Main measures: Attitudes towards the hypothetical patient using the previously validated Positive Attitudes towards Sickle Cell Patients Scale (range 7-35) and pain management decisions (residents only) using two multiple-choice questions (composite range 2-7 representing intensity of pain treatment).

Key results: Exposure to the stigmatizing language note was associated with more negative attitudes towards the patient (20.6 stigmatizing vs. 25.6 neutral, p < 0.001). Furthermore, reading the stigmatizing language note was associated with less aggressive management of the patient's pain (5.56 stigmatizing vs. 6.22 neutral, p = 0.003).

Conclusions: Stigmatizing language used in medical records to describe patients can influence subsequent physicians-in-training in terms of their attitudes towards the patient and their medication prescribing behavior. This is an important and overlooked pathway by which bias can be propagated from one clinician to another. Attention to the language used in medical records may help to promote patient-centered care and to reduce healthcare disparities for stigmatized populations.

Keywords: bias; clinical decision-making; communication; disparities; language; medical record; stigma.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Data Statement

The data sets analyzed in this study are available from the corresponding author on reasonable request.

Figures

Figure 1
Figure 1
Effect of stigmatizing language on attitudes (Panel A) and on pain management (Panel B)
See this image and copyright information in PMC

Comment in

References

    1. Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc. 2002;94(8):666–8. - PMC - PubMed
    1. Drwecki BB, Moore CF, Ward SE, Prkachin KM. Reducing racial disparities in pain treatment: the role of empathy and perspective-taking. Pain. 2011;152(5):1001–1006. doi: 10.1016/j.pain.2010.12.005. - DOI - PubMed
    1. Todd KH, Samaroo N, Hoffman JR. Ethnicity as a Risk Factor for Inadequate Emergency Department Analgesia. JAMA. 1993;269(12):1537–1539. doi: 10.1001/jama.1993.03500120075029. - DOI - PubMed
    1. Green CR, Anderson KO, Baker TA, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003;4(3):277–294. doi: 10.1046/j.1526-4637.2003.03034.x. - DOI - PubMed
    1. Uncapher H, Areán PA. Physicians Are Less Willing to Treat Suicidal Ideation in Older Patients. J Am Geriatr Soc. 2000;48(2):188–192. doi: 10.1111/j.1532-5415.2000.tb03910.x. - DOI - PubMed

Publication types

LinkOut - more resources