Testimonial Injustice: Linguistic Bias in the Medical Records of Black Patients and Women
Testimonial Injustice: Linguistic Bias in the Medical Records of Black Patients and Women
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DOI：
10.1007/s11606-021-06682-z
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发表时间：
2021-03-22
影响因子：
5.7
通讯作者：
Chee, Brant
中科院分区：
文献类型：
--
作者：
Beach, Mary Catherine;Saha, Somnath;Chee, Brant
背景：美国黑人和女性报告感到受到卫生专业人员的怀疑或不屑一顾。目的：确定医生在医疗记录中传达对患者的不信任的语言机制，然后探索此类语言的种族和性别差异。设计：横断面。设置/参与者：2017年学术门诊内科实践中看到的所有患者笔记。主要措施：对600份临床笔记的内容分析显示，三种语言特征表明不信任：(1)引语(例如，对主题化有“反应”)；(2)暗示怀疑的特定“判断词”(例如，“声称”或“坚持”)；以及(3)证据，一种句子结构，其中病人的症状或经历被报告为传闻。我们使用自然语言处理来评估这些特征在其余笔记中的普及率，并测试种族和性别的差异，使用混合影响回归来解释患者和提供者笔记的聚集性。KEY结果：我们的样本包括165名医生撰写的9251条笔记，约3374名独特的患者。大多数患者被确认为黑人(74%)和女性(58%)。与白人患者的笔记相比，关于黑人患者的笔记包含至少一个引语(OR 1.48，95%CI 1.201.83)和至少一个判断词(OR 1.25，95%CI 1.02-1.53)的几率更高，并且使用更多的证据(Beta 0.32，95%CI 0.17-0.47)。关于女性和男性患者的注释在判断词语或证据方面没有差异，但包含至少一个引用的几率更高(OR 1.22，95%CI 1.051.44)。结论：黑人患者可能受到医生对其可信度的系统性偏见的影响，这是一种证词不公正的形式。这是造成医疗质量种族差异的另一个潜在机制，应该进一步调查和解决。
BACKGROUND: Black Americans and women report feeling doubted or dismissed by health professionals.OBJECTIVE: To identify linguistic mechanisms by which physicians communicate disbelief of patients in medical records and then to explore racial and gender differences in the use of such language.DESIGN: Cross-sectional.SETTING/PARTICIPANTS: All notes for patients seen in an academic ambulatory internal medicine practice in 2017.MAIN MEASURES: A content analysis of 600 clinic notes revealed three linguistic features suggesting disbelief: (1) quotes (e.g., had a "reaction" to themedication); (2) specific "judgment words" that suggest doubt (e.g., "claims" or "insists"); and (3) evidentials, a sentence construction in which patients' symptoms or experience is reported as hearsay. We used natural language processing to evaluate the prevalence of these features in the remaining notes and tested differences by race and gender, using mixedeffects regression to account for clustering of notes within patients and providers.KEY RESULTS: Our sample included 9251 notes written by 165 physicians about 3374 unique patients. Most patients were identified as Black (74%) and female (58%). Notes written about Black patients had higher odds of containing at least one quote (OR 1.48, 95% CI 1.201.83) and at least one judgment word (OR 1.25, 95% CI 1.02-1.53), and used more evidentials (beta 0.32, 95% CI 0.17-0.47), compared to notes of White patients. Notes about female vs. male patients did not differ in terms of judgment words or evidentials but had a higher odds of containing at least one quote (OR 1.22, 95% CI 1.051.44).CONCLUSIONS: Black patientsmay be subject to systematic bias in physicians' perceptions of their credibility, a form of testimonial injustice. This is another potential mechanismfor racial disparities in healthcare quality that should be further investigated and addressed.