Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record

Goddu, Anna P.; O’Conor, Katie J.; Lanzkron, Sophie; Saheed, Mustapha; Saha, Somnath; Peek, Monica E.; Haywood, Carlton; Beach, Mary Catherine

doi:10.1007/s11606-017-4289-2

Cited by 237 publications

(171 citation statements)

References 30 publications

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“…Goddu et al (2018) identified stigmatising language in clinical documentation and explored its impact on physicians’ decision‐making. Their results revealed an alarming connection: notes containing stigmatising language led to the patient's pain being managed less aggressively (Goddu et al, 2018). The study demonstrates the biasing effect of documentation and, how bias and stigma can cascade from one individual to the next through notes, thereby perpetuating the stigma and with implication for patient care.…”

Section: Literature Reviewmentioning

confidence: 99%

How forensic mental health nurses’ perspectives of their patients can bias healthcare: A qualitative review of nursing documentation

Martin

Ricciardelli

Dror

2020

Journal of Clinical Nursing

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Aims and Objectives Our aim was to examine the notes produced by nurses, paying specific attention to the style in which these notes are written and observing whether there are concerns of distortions and biases. Background Clinicians are responsible to document and record accurately. However, nurses’ attitudes towards their patients can influence the quality of care they provide their patients and this inevitably impacts their perceptions and judgments, with implications to patients’ care, treatment, and recovery. Negative attitudes or bias can cascade to other care providers and professionals. Design This study used a retrospective chart review design and qualitative exploration of documentation using an emergent theme analysis. Methods We examined the notes taken by 55 mental health nurses working with inpatients in the forensic services department at a psychiatric hospital. The study complies with the SRQR Checklist (Appendix S1) published in 2014. Results The results highlight some evidence of nurses’ empathic responses to patients, but suggest that most nurses have a style of writing that much of the time includes themes that are negative in nature to discount, pathologise, or paternalise their patients. Conclusions When reviewing the documentation of nurses in this study, it is easy to see how they can influence and bias the perspective of other staff. Such bias cascade and bias snowball have been shown in many domains, and in the context of nursing it can bias the type of care provided, the assessments made and the decisions formed by other professionals. Relevance to Clinical Practice Given the critical role documentation plays in healthcare, our results indicate that efforts to improve documentation made by mental health nurses are needed and specifically, attention needs to be given to the writing styles of the notation.

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Section: Literature Reviewmentioning

confidence: 99%

How forensic mental health nurses’ perspectives of their patients can bias healthcare: A qualitative review of nursing documentation

Martin

Ricciardelli

Dror

2020

Journal of Clinical Nursing

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“…For instance, chart notes can portray patients negatively through word choice or the presentation of irrelevant details and can cast doubt on patients’ veracity or imply that they are responsible in problematic interactions; such stigmatizing notes are associated with more negative attitudes towards patients and poorer patient care. 18 Reflections and actions that help practitioners address their own implicit biases can improve care provided to patients, 19 suggesting that such interventions would also improve food insecurity interventions.…”

Section: Food Insecurity and Marginalizationmentioning

confidence: 99%

Why Marginalization, Not Vulnerability, Can Best Identify People in Need of Special Medical and Nutrition Care

Walker

Fox

2018

AMA Journal of Ethics

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In a 2015 paper published in the Journal of Bioethical Inquiry, bioethicist Henk ten Have identifies vulnerability as a “controversial topic in bioethics” and argues that bioethical attention to vulnerability comes at the expense of sufficient attention to the social structures that shape human life. In this paper, we situate ten Have’s argument within the broader bioethical literature, emphasizing how critiques of vulnerability can enrich approaches in clinical settings, including in nutrition, where the concept of vulnerability is not foreign (eg, children are often labeled members of a vulnerable group). We use an example of food (in)security to show how reframing vulnerability to capture “layers of marginalization” can help clinicians and organizations more clearly identify who is most in need, develop solutions for what should be done, and determine how and by whom those solutions should be implemented.

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“…Use of non-judgmental, respectful and uniform language to describe individuals with substance use disorders (SUDs) has been encouraged by clinical and research communities [1][2][3][4][5], federal agencies [6] and international health organizations [6,7]. The public, health professionals, treatment providers and policy stakeholders can stigmatize SUDs [6,[8][9][10][11][12], which may prevent individuals from seeking, receiving and participating in necessary treatment [9,[13][14][15].…”

Section: Introductionmentioning

confidence: 99%

In their own words: language preferences of individuals who use heroin

Pivovarova

Stein

2019

Addiction

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Background and Aims Use of non‐judgmental, respectful and uniform language to describe individuals with substance use disorders (SUD) is recommended to reduce stigma. However, existing research concerning the use of labels for substance use has largely focused on perspectives of treatment providers and the general public, and to a lesser degree of those in long‐term recovery. This study aimed to examine and compare labels that individuals who use heroin and are initiating SUD treatment (1) use to describe themselves and when speaking with others who use drugs, with family and with treatment providers, and (2) prefer to be called and never want to be called. Design and Setting This was a cross‐sectional survey study using a convenience sample of individuals initiating an in‐patient managed withdrawal program in Massachusetts, USA. Participants Between October 2017 and May 2018, 263 participants were enrolled. Measures Participants completed a survey about (1) what labels they used to refer to self and when talking with others who use drugs, with providers, families and at 12‐Step meetings and (2) to identify which label they preferred least and most for others to use when referring to them. Findings More than 70% of participants used the term ‘addict’ to describe themselves and when speaking with others. However, use of ‘addict’ varied by context, and was most common at 12‐Step programs. Fewer than 15% reported using ‘user’ or slang terms, most commonly ‘junkie’, in any communications. The most‐preferred label for others to call them was ‘person who uses drugs’, while the most common label that participants never wanted to be called was ‘heroin misuser’ or ‘heroin‐dependent’. Conclusion Label preferences by individuals who use heroin and are in early recovery are consistent with general guidelines about use of first‐person language and suggest avoidance of language indicative of drug misuse or dependence.

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Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record

Cited by 237 publications

References 30 publications

How forensic mental health nurses’ perspectives of their patients can bias healthcare: A qualitative review of nursing documentation

How forensic mental health nurses’ perspectives of their patients can bias healthcare: A qualitative review of nursing documentation

Why Marginalization, Not Vulnerability, Can Best Identify People in Need of Special Medical and Nutrition Care

In their own words: language preferences of individuals who use heroin

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