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Prejudices in Medical Records are All too Common

— October 17, 2022

Healthcare providers are using biased language in record-keeping.

Not everyone receives the same health care. Some get treated differently, solely based on their race, religion, economic status, age, and education level –even if on paper it’s unethical or even illegal. Patient interactions with healthcare providers can quickly take a detour if prejudices get intermingled with healthcare information outlined in their medical records.

How doctors describe patients in their records can have lasting effects on their quality of care. Having a bigoted disposition can overshadow logic, leaving room for mistreatment and unethical healthcare practices. Doctors often record personal biases in descriptions of patients. Patients can be labeled as “difficult,” “disruptive,” “non-compliant,” “defensive,” “aggressive” or “resistant”. Labels like these are hard to escape from and often affect how other health care professionals will approach future appointments and care.

Several studies are raising concerns after discovering clinicians’ usage of discriminatory language in their visit summaries. The University of Chicago conducted a study on negative patient descriptions. The team sought to understand how biased language will affect a patient’s care. In their study, they reviewed over 40,000 patient files searching for such language. Results showed that Black patients were 2.54 times more likely to have negative descriptions listed in their files. Additionally, other groups discriminated against were patients using government insurance and those unmarried.

Prejudices in Medical Records are All too Common
Photo by Gustavo Fring from Pexels

Micheal Sun, a third-year student at the University of Chicago Pritzker School of Medicine stated, “Patients can see these notes and if they see that they’ve been identified as defensive or angry, they might not come back to see that provider again. Or they might not feel empowered to speak up regarding their health care needs out of fear of being viewed negatively by their providers.” Additionally, this can influence those discriminated against not to seek out health care at all.

“Social psychology finds that attitudes can be reflected through people’s language.” If the use of biased language in a medical record can affect how other clinicians feel and or treat that patient in future interactions then the patient’s credibility might also be dismissed. Future clinicians might not take their concerns for their health seriously and write them off entirely. This can result in misdiagnosis, or no treatment being given at all.

A study of 138 clinicians and 600 of their notes for 507 patients showed that 69% were female, 80% were Black, and 15% were white. Soon a pattern developed, showing language associated with insinuations of patient incompetency. Some physicians expressed doubt in their records using quotations. For example, “‘apparently he was at home on the floor feeling fine when suddenly he felt fatigued all over his body.’” Another physician noted that the patient, “‘Insists she gets sick from vaccines.’” The study showed that sometimes physicians would quote part of the patient’s history or belief system, leading researchers to conclude they questioned the legitimacy of what the patient said. “One physician wrote, “He claimed it was from ‘fluid in my knee,’” and another physician wrote, “She takes albuterol for chronic bronchitis.” The quotation marks recorded by the doctors insinuate doubt the patient understands their medical condition.

Patients being labeled as difficult also suffer directly from bias, as it results in mistreatment to misdiagnosis. Patients that show “disruptive behaviors” are often elderly, have cognitive disabilities, or have psychiatric disorders. Physicians tend to treat those that are “difficult” as if it’s a burden to the healthcare provider. Frustration, lack of patience, and lack of compassion often interfere with diagnostic reasoning leading to a false diagnosis, or none at all. They unfairly blame the patient as if their condition or behavior is their fault, thus being the patient’s problem. When other healthcare providers see these notes, the patient is less likely to receive kindness or genuine care.

It is important to raise awareness of the major effects these biases have on patients’ health. Physicians and other clinicians need to remain vigilant in their encounters with patients to remain free of prejudices. Micheal Sun encouraged, “As physicians, we come from a position of privilege and power. It’s our responsibility to advocate for our patients and enact change within our own organizations.”


Black patients are more than twice as likely to be described negatively in medical records

Physician use of stigmatizing language in patient medical records

Medical Care and demographic Characteristics of “difficult” patients

Study finds racial bias in how clinicians describe patients in medical records

Why patients’ disruptive behaviors impair diagnostic reasoning: a randomized experiment

Embedded Bias: How Medical Records Sow Discrimination

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