In the past, doctors wrote whatever they wanted in their notes, including sarcastic and derogatory comments about the patient, assuming that the comments were no big deal. And largely, they were right, as in prior times, few patients would have asked for those records.
Today, however, such records are becoming increasingly public, particularly through the efforts of the Open Notes project. Not only that, when an EMR connects the health system, such notes may be viewed by many types of professionals, ranging from hospital-based doctors to outpatient physicians, residents to outpatient specialists and more.
But how important is this? Doctors need to reduce tension with a bit of gallows humor, don’t they? Is it worth making the effort to discourage such comments and criticism in the notes? A recent study of physicians in training suggests that it is.
The study, which appears in the Journal of General Internal Medicine, was designed to measure whether patient records serve as a means of transmitting bias from one clinician to another. Specifically, the study was intended to assess whether stigmatizing language written in a patient medical record had an effect on students’ clinical decision-making and attitudes toward the patient.
To tease out this information, the researchers created chart notes, one of which used stigmatizing language in the other neutral language to describe hypothetical patient, a 28-year-old man with sickle-cell disease.
Researchers then surveyed medical students and residents in internal and emergency medicine programs at an urban academic medical center to see how their subjects related to the vignette.
The conclusions drawn by this study should concern everyone in the healthcare business. Researchers found that when the medical students and residents were exposed to stigmatizing language in the notes, the exposure was associated with more negative attitudes toward the patient. Even more concerning, the note using stigmatizing language was associated with less aggressive management of the patient’s pain level.
Addressing this problem is not just an ethical issue, as important as that is on its own. If stigma and bias affect how medical students and residents care for patients, it undermines larger goals of the health system, particularly the need to manage populations effectively, promote patient-centered care and reduce healthcare disparities, it’s a clinical and operational issue as well.
No one is suggesting that it’s possible to squeeze all bias out of the healthcare process. However, it seems reasonable to limit how much of this bias makes it into the chart and influences other providers.