“Sticks and stones may break my bones, but words will never hurt me.”
Many of us remember this rhyme from our childhoods – shared to help us stand up to bullying and encourage us to let words roll off our backs. But words can have a destructive impact on patient care, particularly for patients of color and especially Black patients. As we observe Black History Month, with this year’s Black Health and Wellness theme, thinking about how words can cause pain and suffering in patient care is timely.
Data reveal the disparities in patient care resulting from implicit bias related to race and ethnicity. According to a 2018 American Bar Association publication, Black patients experiencing heart disease were more likely to receive less costly and more conservative treatments, and less likely to receive beneficial procedures such as bypass surgery and angiography. Another example is that Black women were less likely wto receive potentially life-saving mastectomies than white women.
Now, connect this data to how language is used to describe patients and their behaviors. For example, a doctor’s notes in health records are essential in sharing the story of a patient’s health status and care plans with other providers, helping them get to know the patient even before they meet. But the words used by the doctor can also potentially deliver negative and/or biased impressions of a patient; this is particularly true for Black patients.
In a recent study published in Health Affairs, researchers reviewed electronic health records from an academic medical center. They wanted to learn if a provider’s use of “negative patient descriptors” varied according to the patient’s race or ethnicity. Examples of these words and phrases include “non-adherent with medication,” “agitated,” and “challenging.”
The researchers discovered that Black patients were 2.54 times more likely than white patients to have at least one negative descriptor in their doctor’s notes. And because other caregivers view these notes, bias in the care these patients receive can be perpetuated, further influencing racial and ethnic healthcare disparities through stigmatization.
Putting it all together, Black patients experiencing care disparities are at additional risk of bias and discrimination because of the language used to describe their condition and care needs. And the patient may not even be aware of the words used in the health record and the stigma that potentially results. As we think about health and wellness among Black patients this month, we need to recognize and understand that words can hurt physically as well as emotionally – and so choose them carefully.
Rose M. Tedesco
(Commonwealth Medicine Cultural Diversity Committee)