Study: Black patients subject to more negative descriptors in patient notes
14th March 2022 · 0 Comments
By Fritz Esker
Contributing Writer
A recent study published in Health Affairs indicated that Black patients were 2.54 times more likely to have at least one negative descriptor in their patient notes than white patients, a factor which could lead to poorer patient care.
The negative descriptors included in the analysis were “non-adherent,” “aggressive,” “agitated,” “angry,” “challenging,” “combative,” “non-compliant,” “confront,” “non-cooperative,” “defensive,” “exaggerate,” “hysterical,” “unpleasant,” “refuse,” and “resist.”
“Such a pattern of disproportionate use may indicate systemic biases in a health care delivery system against racially minoritized patients,” wrote the report.
Dr. Kevin Stephens, senior medical director at Oak Street Health and a primary care physician, said these negative descriptors can have a domino effect. Once a doctor writes down that they think the patient is exaggerating their pain, it becomes a part of their record that all future doctors will see. So, a future doctor may not be biased going into the meeting with the patient, but when they look at the patient’s record they will now have it in the back of their mind that this patient is prone to exaggerating symptoms and pain. This might cause the doctor to dismiss potentially serious problems.
“The clinical descriptors are very important and when you use an incorrect descriptor, it changes the perception of the next doctor who sees the patient,” Dr. Stephens said.
The study noted that patients who experience racial discrimination will be less likely to seek out recommended preventive screenings. Any factor that prevents Black people from seeking medical care is significant because healthcare outcomes from treatable and preventable diseases are worse among Black Americans.
According to 2018 statistics from the U.S. Department of Health and Human Services’ Office of Minority Health, Black people were 30 percent more likely to die from heart disease than non-Hispanic whites. While Black adults were 40 percent more likely to have high blood pressure, they were less likely to have their blood pressure under control. Black women were nearly 60 percent more likely to have high blood pressure compared to non-Hispanic white women.
Research from the American Cancer Society (“Cancer Facts And Figures for African Americans 2019-2021”) indicated Black Americans suffer disproportionately negative outcomes from cancer. The report (available to view on cancer.org) stated, “Collectively, blacks have the highest death rate and the shortest survival of any racial/ethnic group in the U.S. for most cancers. Black men also have the highest cancer incidence rate.”
If patients feel their doctors do not listen to them or treat them poorly, they may be less likely to seek out doctors for checkups and preventive care. Dr. Stephens said it can also lead to a distrust of doctors and the medical profession in general, which makes it harder for people to follow medical guidance on all sorts of issues, including COVID-19 vaccines.
“If you feel you’ve been treated disrespectfully or unfairly (by doctors), you’ll be less likely to follow doctors’ advice,” Dr. Stephens said.
Dr. Stephens said biased judgments can happen even if the doctor means well. He said avoiding implicit biases is not easy, but the goal for doctors should be to empathize with and form relationships with their patients.
One solution Dr. Stephens said is helpful for building doctor-patient relationships at Oak Street Health is having a scribe accompany a doctor into the room for a visit with the patient. The scribe takes notes on what the patient is saying while the doctor listens. This way, the doctor is able to look the patient in the eyes and fully engage with what they’re saying instead of trying to simultaneously listen while typing notes into a computer. Dr. Stephens added this also helps the patient feel like they are not being rushed.
The Health Affairs study’s conclusion noted the difference in negative descriptors for Black patients compared to white patients “…may indicate implicit racial bias not only among individual providers but also among the broader beliefs and attitudes maintained by the health care system.”
When asked for signs of bias in health care other than negative language in a patient’s record, Dr. Stephens pointed to the way doctors have historically used race-based calculations when testing for kidney disease. He said doctors falsely assumed Black patients had more muscle mass, and this affected their interpretations of testing data, which in turn caused kidney disease to be missed in many Black patients. Dr. Stephens added this was particularly harmful because kidney disease is much more treatable when it is caught in the very early stages.
Local governments are starting to devote more attention to health care inequity.
Sarah Babcock, chief administrative assistant to Jefferson Parish President Cynthia Lee Sheng, said she is working on a community health assessment for Jefferson Parish to determine the public health gaps and strengths within the community. The project is in its early stages as leaders and experts discuss community health care issues and work on an action plan.
“Health equity was a topic that came up regularly,” Babcock said. “In relation to access to healthcare services, the biggest problems were location of healthcare providers, lack of transportation, affordability, underrepresentation of employees of color within the health care settings, and a general fear or sense that people of color don’t belong in some of our local health care settings.”
This article originally published in the March 14, 2022 print edition of The Louisiana Weekly newspaper.
