Clinicians more likely to use stigmatizing language against Black patients, study finds

Clinicians more often use stigmatizing language in medical records when patients are Black, researchers from Princeton University, the University of California, Los Angeles, and Harvard University report in a new study.

The paper, published in JAMA Network Open on Thursday, analyzes 49,000 medical records of patients with diabetes, chronic pain or substance use disorder at a single, unnamed medical center and found 2.5% included stigmatizing language. Negative descriptors were more common in records for Black patients, the researchers discovered. Less-experienced physicians were more likely to use such language, the study shows.

The findings underscore the need for cultural competency training and a commitment to detail when describing patients' barriers to care, the authors wrote.

A growing body of research is documenting the biases clinicians perpetuate in EHRs and analyzing how they may affect health outcomes. Using language that negatively labels patients, assigns them blame or categorizes them as potentially dangerous could stigmatize them and jeopardize the quality of their care, the report says.Electronic health records play an increasingly significant role in how clinical teams communicate internally and with their patients. Since the 21st Century Cures Act began guaranteeing patients access to their medical records last year, providers have had to reconsider how they describe patients in EHRs.

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"[Physicians] are trained on the language to use and the specific writing style, but I think historically that has been geared toward communicating with other providers," said Gracie Himmelstein of Princeton University, a co-author of the study. "We are at this weird point where doctors have been trained to write toward other doctors, and that is now opening up to patients."

University of Chicago researchers published a study in Health Affairs this month that illustrates how the language norms healthcare professionals use tend to oversimplify patients' medical needs and introduce stigmas that can follow patients to other providers. Patients who are Black, on Medicaid or unmarried were more likely to have negative descriptions such as "non-compliant" or "combative" in their medical records, the study found.

Clinicians need to be more intentional about assessing the obstacles patients face to getting care and finding more detailed ways to write them down in medical records, Himmelstein said. "Stigmatizing language itself is just part of the problem and reflects this bigger picture of underlying racial biases in healthcare."