Analysis shows African American patients face more credibility-doubting language in medical records.
A recent study has found that Black patients are more likely than white patients to have medical notes written in ways that question their credibility. The findings come from an analysis of more than 13 million electronic health records gathered over several years at five hospitals in the Mid-Atlantic region. The research team, led by Dr. Mary Catherine Beach of Johns Hopkins University, looked at the words clinicians used when describing patients. While only a small fraction of the notes contained language that cast doubt on patients’ honesty or competence, the pattern showed that Black patient records included this treatment more often. The study suggested that even subtle choices in wording could reflect racial bias in health care settings.
Out of more than 13 million notes, just under one percent contained credibility-undermining language. Terms such as “claims,” “insists,” “noncompliant,” or “poor historian” fell into this category. These words suggest either doubt about symptoms, concerns about whether patients would follow medical advice, or suspicion of drug-seeking behavior. Though the percentage may appear small, the researchers cautioned that the use of such language may represent only a fraction of a wider issue. In many cases, subtle bias may not be as easily detected but can still influence how patients are perceived.
Examples of this subtlety include using quotation marks around a patient’s reported symptoms or pairing a patient complaint with a dismissive statement. An example given was a note that read, “Patient reports severe pain but is talking on the phone.” The phrasing implies the pain is not real, even though the patient’s own report should be taken seriously.
The consequences of such bias in Black patient records go beyond words on a page. Negative or dismissive documentation can erode trust between patients and clinicians. If a patient feels disbelieved or judged, that person may be less likely to seek care in the future or may hesitate to share important information. This can lead to poorer health outcomes, mistakes in treatment, and in some cases, life-threatening situations. Another concern is that once such language is entered into a record, it can shape how other clinicians view the patient later on, reinforcing stereotypes and unfair treatment.
The study also explored how credibility was supported or questioned across different racial groups. Black patients were more likely to face undermining terms and less likely to have notes with credibility-supporting language. For Asian patients, the trend was reversed: their records were less likely to contain undermining language and more likely to include supportive descriptions. The researchers suggested this could be linked to stereotypes about Asian people being reliable or sincere, though they noted the finding was unexpected. For Hispanic or Latino patients, there was no significant difference compared with white patients.
The study relied on natural language processing, a type of computer modeling that allows researchers to scan and analyze large amounts of text. In total, 12,027 clinicians contributed to the notes studied, covering more than 1.5 million patients between 2016 and 2023. The average patient age was 43, with just over half being women. Among the patients, 57% were white, 28% were Black, 8% were Hispanic or Latino, and 6% were Asian.
Limitations were noted. The data in Black patient records came from a single hospital system, which had a higher proportion of African American patients than the national average. The study also did not include detailed information about the backgrounds of the clinicians who wrote the notes. Still, the findings were considered significant enough to raise concerns about the role of bias in everyday medical documentation.
Experts outside the study said the results point to larger problems that should be addressed. Some called for more training in medical schools about how unconscious bias can appear in records and affect care. Others said increasing diversity among physicians could help. Research has shown that Black patients often report greater trust in Black doctors, and shared experiences between patient and physician may play a role in building stronger relationships.
While the use of credibility-undermining terms was rare overall, the fact that it happened more often with Black patients than white patients points to disparities in care. Addressing these disparities may require not only training and awareness but also changes in how health systems monitor and evaluate documentation practices. The words written into a patient’s record are not just notes for the moment; they can influence treatment decisions for years to come.
Sources:
Bias in the Chart? Black Patients More Likely to Be Doubted by Doctors
Racial bias in clinician assessment of patient credibility: Evidence from electronic health records
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