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Cited by 437Obesity and Health PracticesEmpathy and Medical EducationPatient-Provider Communication in Healthcare

Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record

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P. Goddu, Anna, O’Conor, Katie J., Lanzkron, Sophie, Saheed, Mustapha O., Saha, Somnath, Peek, Monica E., Haywood, Carlton, Beach, Mary Catherine·2018·Journal of General Internal Medicine
DOI 10.1007/s11606-017-4289-2PMC PMC5910343
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Abstract

Background Clinician bias contributes to healthcare disparities, and the language used to describe a patient may reflect that bias. Although medical records are an integral method of communicating about patients, no studies have evaluated patient records as a means of transmitting bias from one clinician to another. Objective To assess whether stigmatizing language written in a patient medical record is associated with a subsequent physician-in-training's attitudes towards the patient and clinical decision-making. Design Randomized vignette study of two chart notes employing stigmatizing versus neutral language to describe the same hypothetical patient, a 28-year-old man with sickle cell disease. Participants A total of 413 physicians-in-training: medical students and residents in internal and emergency medicine programs at an urban academic medical center (54% response rate). Main measures Attitudes towards the hypothetical patient using the previously validated Positive Attitudes towards Sickle Cell Patients Scale (range 7-35) and pain management decisions (residents only) using two multiple-choice questions (composite range 2-7 representing intensity of pain treatment). Key results Exposure to the stigmatizing language note was associated with more negative attitudes towards the patient (20.6 stigmatizing vs. 25.6 neutral, p < 0.001). Furthermore, reading the stigmatizing language note was associated with less aggressive management of the patient's pain (5.56 stigmatizing vs. 6.22 neutral, p = 0.003). Conclusions Stigmatizing language used in medical records to describe patients can influence subsequent physicians-in-training in terms of their attitudes towards the patient and their medication prescribing behavior. This is an important and overlooked pathway by which bias can be propagated from one clinician to another. Attention to the language used in medical records may help to promote patient-centered care and to reduce healthcare disparities for stigmatized populations.

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  • Goddu et al's study highlights that perceptions and stereotyping among HPs can be triggered prior to in-person meetings with patients through language and words used in medical records or referral letters.

    “Goddu et al’s86 study highlights that perceptions and stereotyping among HPs can be triggered prior to in-person meetings with patients through language and words used in medical records or referral letters.”

    From Health professionals implicit bias of patients with low socioeconomic status (SES) and its effects on clinical decision-making: a scoping review (2024) · cites this paper as [86]

    The Abstract and Discussion report that stigmatizing language in medical-record notes influenced physicians-in-training’s attitudes toward a hypothetical patient, consistent with impressions forming before an in-person meeting. The study used chart notes, however, and does not establish the same effect for referral letters. (LLM, conf=0.86)

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Authors
P. Goddu, A., O’Conor, K. J., Lanzkron, S., Saheed, M. O., Saha, S., Peek, M. E., Haywood, C., & Beach, M. C.
Affiliations
  • Johns Hopkins University (US)
  • Oregon Health & Science University (US)
  • University of Chicago (US)
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2018-01-26
Volume
33
Issue
5
Pages
685-691
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-017-4289-2
PMC
PMC5910343
OpenAlex
W2792485237
Cited by
437
References
2
Citations by year
2026: 72 · 2025: 79 · 2024: 65 · 2023: 75 · 2022: 57 · 2021: 52 · 2020: 14 · 2019: 14 · 2018: 8 · 2013: 1
FWCI
41.34
Type
journal article
Language
en
Update notices
correction (2018-10-18)
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Johns Hopkins University
  • National Heart, Lung, and Blood Institute (R01HL088511)
  • National Institute on Drug Abuse (K24DA037804)
Topics
  • Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
  • Health Sciences › Medicine › Psychiatry and Mental health › Empathy and Medical Education
  • Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
Keywords
stigmatizing language, medical records, clinician bias, sickle cell disease, physician attitudes, pain management, health care disparities, medical students, residents (medical training), patient-centered care
MeSH terms
Attitude of Health Personnel, Female, Humans, Internship and Residency, Language, Male, Medical Records, Stereotyping, Students, Medical

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