![]() Yet despite greater recognition of the potential for clinician bias in health care delivery, 11 few studies have quantified clinician bias or examined how racism and bias are communicated among health care providers in clinical settings. Racial disparities in health and health care during the COVID-19 pandemic have brought additional attention to how structural racism (differential access to goods, services, or opportunities based on race) can affect patient care. Hence, it is not surprising that Black adults are more likely to report medical distrust 9 and that medical distrust has been found to partially mediate associations between Black race and COVID-19 vaccine declination. 8 Implicit bias has clear negative effects on provider communication, trust in medical care, and the delivery of health care to racially marginalized populations. ![]() 6, 7 In a study by Janice Blanchard and Nicole Lurie, patients who perceived racial discrimination in health care were more likely to delay care, less likely to receive recommended chronic disease screening, and less likely to follow their physician’s recommendations. ![]() 4, 5 Studies using the Implicit Association Test, a tool used to measure unconscious bias, found that health care bias was associated with lower levels of patient adherence to treatment plans and lower trust in health care providers. Studies have also identified ways in which implicit bias can negatively affect the patient-provider relationship. For example, Lisa Cooper and colleagues used audio recordings of health care encounters and found that physicians who tested higher on implicit bias measures were more verbally dominant and used less patient-centered language with Black patients. 2 Although no nationally representative studies have quantified the prevalence of implicit bias (the unconscious attitudes and stereotypes that individuals may hold), multiple studies have nevertheless documented evidence of its impacts in health care. ![]() 1 In 2020, four national surveys found that 11–20 percent of Black adults reported experiencing discrimination in health care during the preceding year. During 2005–13, 12.3 percent of Black respondents reported discrimination in health care compared with 2.3 percent of White respondents in a nationally representative study of the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System. There is robust evidence of unequal treatment by race in the US health care system and of its negative impact on patients. Our findings raise concerns about stigmatizing language in the EHR and its potential to exacerbate racial and ethnic health care disparities. Compared with White patients, Black patients had 2.54 times the odds of having at least one negative descriptor in the history and physical notes. We used mixed effects logistic regression to determine the odds of finding at least one negative descriptor as a function of the patient’s race or ethnicity, controlling for sociodemographic and health characteristics. We analyzed a sample of 40,113 history and physical notes (January 2019–October 2020) from 18,459 patients for sentences containing a negative descriptor (for example, resistant or noncompliant) of the patient or the patient’s behavior. This study used machine learning to analyze electronic health records (EHRs) from an urban academic medical center and to investigate whether providers’ use of negative patient descriptors varied by patient race or ethnicity. Little is known about how racism and bias may be communicated in the medical record.
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