Destigmatizing Chart Notes and Preventing “Infectious Negativity”

Abstract: The use of stigmatizing and biased language in medical chart notes is widespread across medical specialties, and in inpatient and outpatient settings. Medical professionals rarely receive formal training in writing chart notes, and even well-intentioned clinicians and trainees can perpetuate damaging language and narratives. Stigmatizing language includes common word choices found in patient records (“refuses,” “noncompliant,” “denies”). Chart notes can also express implicit biases against marginalized and racialized populations, as well as specific patient populations, including those with chronic pain, substance use disorders, diabetes, psychiatric illness, Sickle Cell Anemia, and disabled persons. Studies show that patients of color, those with low socioeconomic status, and those with public medical insurance are several times more likely to have negative descriptors in their chart. Importantly, the use of stigmatizing and negative language to describe patients and their families can transmit bias and negative perceptions and attitudes, or “infectious negativity” -- from one healthcare provider to another through the electronic health record. Additionally, given the mandate for open notes, patients (and proxies/parents of minors) can access chart notes and find language they find offensive or judgmental, affecting their trust in providers and potentially in healthcare more broadly.

This workshop session will discuss the effects of stigmatizing and biased language on patients and healthcare providers through select case studies. Participants will be invited to workshop alternative language that is neutral and unbiased. The workshop leaders are from different backgrounds and include clinical ethics consultants for hospital systems serving diverse patient populations, medical educators, and philosopher/bioethicists.

Keywords: Stigma, Medical jargon, Chart notes