Mary Catherine Beach1,2,3,4, Somnath Saha5,6,7, Jenny Park2,8, Janiece Taylor9, Paul Drew10, Eve Plank11, Lisa A Cooper2,3,4, Brant Chee12. 1. Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA. 2. Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. 3. Department of Health, Behavior & Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA. 4. Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA. 5. Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. sahas@ohsu.edu. 6. Center to Improve Veteran Involvement in Care, VA Portland Health Care System, 3710 SW U.S. Veterans Hospital Rd. (P3HSRD), Portland, OR, 97239, USA. sahas@ohsu.edu. 7. Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, USA. sahas@ohsu.edu. 8. School of Medicine, Oregon Health & Science University, Portland, OR, USA. 9. School of Nursing, Johns Hopkins University, Baltimore, MD, USA. 10. Department of Language and Linguistic Science, University of York, York, UK. 11. Smith College, Northampton, MA, USA. 12. Applied Physics Laboratory, Johns Hopkins University, Baltimore, MD, USA.
Abstract
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 the medication); (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 mixed-effects 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 1.20-1.83) and at least one judgment word (OR 1.25, 95% CI 1.02-1.53), and used more evidentials (β 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 1.05-1.44). CONCLUSIONS: Black patients may be subject to systematic bias in physicians' perceptions of their credibility, a form of testimonial injustice. This is another potential mechanism for racial disparities in healthcare quality that should be further investigated and addressed.
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 the medication); (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 mixed-effects 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 1.20-1.83) and at least one judgment word (OR 1.25, 95% CI 1.02-1.53), and used more evidentials (β 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 1.05-1.44). CONCLUSIONS: Black patients may be subject to systematic bias in physicians' perceptions of their credibility, a form of testimonial injustice. This is another potential mechanism for racial disparities in healthcare quality that should be further investigated and addressed.
Authors: Carlton Haywood; Mary Catherine Beach; Sophie Lanzkron; John J Strouse; Renee Wilson; Haeseong Park; Catherine Witkop; Eric B Bass; Jodi B Segal Journal: J Natl Med Assoc Date: 2009-10 Impact factor: 1.798
Authors: Anna P Goddu; Katie J O'Conor; Sophie Lanzkron; Mustapha O Saheed; Somnath Saha; Monica E Peek; Carlton Haywood; Mary Catherine Beach Journal: J Gen Intern Med Date: 2018-01-26 Impact factor: 5.128
Authors: Irene V Blair; John F Steiner; Diane L Fairclough; Rebecca Hanratty; David W Price; Holen K Hirsh; Leslie A Wright; Michael Bronsert; Elhum Karimkhani; David J Magid; Edward P Havranek Journal: Ann Fam Med Date: 2013 Jan-Feb Impact factor: 5.166
Authors: Megha Shankar; Joy Cox; Juliana Baratta; Gisselle De Leon; Jonathan G Shaw; Sonoo Thadaney Israni; Donna M Zulman; Cati G Brown-Johnson Journal: JAMA Netw Open Date: 2022-02-01
Authors: Shannon B Juengst; Marlene Vega; Alexandra B Holland; Susan Herrera; Robin T Higashi; Maria Boix Braga; Alka Khera; Chung Lin Kew; Valeria Silva Journal: J Patient Rep Outcomes Date: 2022-09-24