Administrative nurse working at a computer

Patients who are Black are more likely to have stigmatizing language in their electronic health records (EHR) than white patients, according to a new study. Researchers found this also was true for the unmarried and publicly insured.

Image of Elizabeth Tung, M.D.; Image credit: University of Chicago
Elizabeth Tung, M.D.; Image credit: University of Chicago

Investigators from the University of Chicago analyzed multiple EHR notes for approximately 18,500 patients in an urban academic medical center from January 2019 to October 2020. They looked for sentences that contained negative descriptors, such as “resistant” or “noncompliant” when referring to patient behaviors or the patients themselves.

Even after controlling for sociodemographic and health characteristics, Black patients had 2.54 times greater likelihood of having at least one negative descriptor in their history and physical notes. 

In addition, patients who had government insurance or were unmarried had higher odds of being described using negative terms when compared with patients who had private or employer-based insurance and with patients who were married, the researchers added.

“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 Elizabeth L. Tung, M.D., and colleagues.

Descriptors such as “difficult,” “challenging” and “resistant” are commonly used to describe patients in medical records, according to the authors. And although not necessarily explicitly stigmatizing terms, they “may impart a negative connotation in the context of describing a patient,” they wrote.

This is alarming in the light of earlier research, which found that only 18% of text in inpatient progress notes are manually input, the researchers said. The majority of text is imported from prior documentation, they reported.

“​​Subsequent providers may read, be affected by, and perpetuate the negative descriptors, reinforcing stigma to other health care teams,” the authors concluded.

The study was published in the journal Health Affairs.