Stigmatizing Language in Medical Records: Would a Rose by Any Other Name Receive Less Effective Care?

​The use of stigmatizing language in the medical record is "an important and overlooked pathway" by which implicit bias can be passed from one clinician to another, according to a study in the May 2018 issue of the Journal of General Internal Medicine. Bias toward certain patient groups is well documented within the American healthcare system, the authors said, noting that clinicians may have views that negatively affect care if the patient is older and has lower health literacy, is obese, has substance use disorder, or is of a certain racial or ethnic identity. For instance, the authors said, a study showed that physicians were more likely to view a patient as personally culpable for his or her condition if the person was described as a "substance abuser" as opposed to "having a substance use disorder." To see whether stigmatizing language in a patient's medical record was associated with the attitudes of physicians in training (413 medical students and residents), the authors conducted a randomized vignette study that described the same patient using two charts: one that employed stigmatizing language and another that used neutral language. The chart using stigmatizing language described the patient as "narcotic dependent," noted that his girlfriend was sitting on his bed with her shoes on, and quoted the patient as saying he had "pain up in my arms and legs." The neutral chart described his pain medication regimen in clinical terms, noted only that his girlfriend was present, and paraphrased the description of his pain.