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Regardless of race, unmarried patients and those on government health plans like Medicare and Medicaid were more likely to have negative descriptors applied to them than married or privately insured patients. Patients in poor overall health, with several chronic underlying health problems, were also twice as likely to have negative adjectives in their medical records, the study found.
The second study, published in JAMA Network Open, analyzed the electronic health records of nearly 30,000 patients at a large urban academic medical center between January and December 2018. The study looked for what researchers called “stigmatizing language,” comparing the negative terms used to describe patients of different racial and ethnic backgrounds as well as those with three chronic diseases: diabetes, substance use disorders and chronic pain.
Overall, 2.5 percent of the notes contained terms like “nonadherence,” “noncompliance,” “failed” or “failure,” “refuses” or “refused,” and, on occasion, “combative” or “argumentative.” But while 2.6 percent of medical notes on white patients contained such terms, they were present in 3.15 percent of notes about Black patients.
Looking at some 8,700 notes about patients with diabetes, 6,100 notes about patients with substance use disorder and 5,100 notes about those with chronic pain, the researchers found that patients with diabetes — most of whom had type 2 diabetes, which is often associated with excess weight and called a “lifestyle” disease — were the most likely to be described in negative ways. Nearly 7 percent of patients with diabetes were said to be noncompliant with a treatment regimen, or to have “uncontrolled” disease, or to have “failed.”
A note might say that a patient “refused diabetic diet,” for example, or was “noncompliant with insulin regimen.” The more severe the disease, the more likely the patient was to have notes with negative descriptors.
In contrast, only 3.4 percent of patients with substance use disorders were described in negative terms, and fewer than 1 percent of patients with chronic pain had notes with negative descriptions.
The medical record is the first thing a hospital-based health provider sees, even before meeting the patient, said Dr. Gracie Himmelstein, the paper’s first author, and it creates a strong first impression.