Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record
Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record
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DOI：
10.1007/s11606-017-4289-2
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发表时间：
2018-05-01
影响因子：
5.7
通讯作者：
Beach, Mary Catherine
中科院分区：
文献类型：
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作者：
Goddu, Anna P.;O'Conor, Katie J.;Beach, Mary Catherine
临床医生的偏见导致了医疗保健的差异，而用来描述病人的语言可能反映了这种偏见。虽然医疗记录是沟通患者的一种不可或缺的方法，但没有研究将患者记录作为一种将偏见从一个临床医生传递给另一个临床医生的手段进行评估。评估患者病历中写的污名化语言是否与随后的实习医生对患者的态度和临床决策有关。随机研究两种图表说明采用污名化与中性语言来描述同一假设患者，一名28岁的镰状细胞病男性。共有413名实习医师：城市学术医疗中心内科和急诊医学项目的医学生和住院医师（54%的回复率）。对假设患者的态度使用先前验证的镰状细胞患者积极态度量表（范围7-35）和疼痛管理决策（仅限住院医师）使用两个选择题（复合范围2-7代表疼痛治疗强度）。接触污名化语言注释与对患者的消极态度有关（污名化20.6比中性25.6,p < 0.001）。此外，阅读侮辱性语言笔记与患者疼痛管理的不积极程度相关（5.56对6.22中性，p = 0.003）。医疗记录中用于描述患者的污名化语言可能会影响随后的培训医生对患者的态度和他们的药物处方行为。这是一个重要而被忽视的途径，通过它，偏见可以从一个临床医生传播到另一个。注意医疗记录中使用的语言可能有助于促进以患者为中心的护理，并减少受歧视人群的医疗保健差距。
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.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.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.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).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).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).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.