Health care professionals may be more likely to use such terms as “agitated,” “aggressive,” and “not compliant” to describe Black patients in their medical notes than White patients, a report in Health Affairs suggests.
“Our findings suggest disproportionate use of negative patient descriptors for Black patients compared with their White counterparts, which raises concerns about racial bias and possible transmission of stigma in the medical record,” wrote Michael Sun and Elizabeth L. Tung, M.D., of the University of Chicago and colleagues.
Numerous studies point to evidence of unequal treatment by race in the U.S. health care system and its negative impact on patients, according to the researchers. For the current study, the researchers used machine learning techniques to analyze medical providers’ use of negative patient descriptors in the history and physical notes in the electronic health records (EHRs) of patients seen at a large urban academic medical center in Chicago. These data included health records for patients who received treatment in an emergency department, inpatient setting, or outpatient setting between January 1, 2019, and October 1, 2020.
The final sample consisted of 18,459 patients (average age 47 years; 56% women) with 40,113 history and physical notes for analysis. The majority of the patients in the sample were Black (61%), followed by White (30%), Hispanic or Latino (6%), and other (3.5%). In total, 8.2% of patients had one or more negative descriptors recorded in the electronic history and physical notes.
After controlling for sociodemographic and health characteristics, the researchers found that Black patients had 2.54 times the odds of being described with one or more negative descriptors in the EHR compared with White patients. Patients with Medicaid or Medicare insurance also had over twice the odds of a negative descriptor compared with patients with private or employer-based insurance. In contrast, notes written during outpatient encounters were less likely to include a negative descriptor compared with those written during inpatient encounters.
Sun, Tun, and colleagues noted several limitations of the study, including its focus on data drawn from a single urban academic medical center during the COVID-19 pandemic.
Nonetheless, the authors cautioned, “History and physical notes provide key information frequently drawn on by other care providers. Negative descriptors written in the admission history and physical may be likely to be copied into subsequent notes, recommunicating and amplifying potential biases. … Future research is needed to investigate the longitudinal consequences of a negative descriptor in a patient’s medical record.”
For related information, see the Psychiatric News article “Special Report: Racism and Inequities in Health Care for Black Americans.”
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