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Embedded bias: How medical records can sow discrimination anf and substandard healthcare treatment

cesces profile image
9 Replies

I was surprised by this article. And the nuanced effect of what your doc writes up in your medical records.

I've actually seen seen positive signalling in mine. But I can have smart mouth on me. I could easily see in insecure doc give some negative signalling.

If you are a minority or a member of any marginalized or discriminated against group, I think maybe it is important to keep your antenna alert to this problem.

Embedded bias: How medical records sow discrimination | News-Medical

As long term Prostate Cancer patients, our medical records become important and follow us around for the rest of our lives.

This can be troubling if you are a minority, or a member of any other discriminated against group.

And a bad relationship with a prejudiced or judgmental doc can cause you hidden problems later.

I have some thoughts on how to counteract or neutralize this problem, but I would like to hear your thoughts first.

(Warning - this article doesn't refer specifically to prostate cancer)

The stereotypes that can find their way into patients' records sometimes help determine the level of care patients receive. Are they spoken to as equals? Will they get the best, or merely the cheapest, treatment? Bias is "pervasive" and "causally related to inferior health outcomes, period," Matthew said.

Narrow or prejudiced thinking is simple to write down and easy to copy and paste over and over. Descriptions such as "difficult" and "disruptive" can become hard to escape. Once so labeled, patients can experience "downstream effects," said Dr. Hardeep Singh, an expert in misdiagnosis who works at the Michael E. DeBakey Veterans Affairs Medical Center in Houston. He estimates misdiagnosis affects 12 million patients a year.

Conveying bias can be as simple as a pair of quotation marks. One team of researchers found that Black patients, in particular, were quoted in their records more frequently than other patients when physicians were characterizing their symptoms or health issues. The quotation mark patterns detected by researchers could be a sign of disrespect, used to communicate irony or sarcasm to future clinical readers. Among the types of phrases the researchers spotlighted were colloquial language or statements made in Black or ethnic slang.

"Black patients may be subject to systematic bias in physicians' perceptions of their credibility," the authors of the paper wrote.

That's just one study in an incoming tide focused on the variations in the language that clinicians use to describe patients of different races and genders. In many ways, the research is just catching up to what patients and doctors knew already, that discrimination can be conveyed and furthered by partial accounts.

Confer's MedStar records, Cohen thought, were pockmarked with partial accounts — notes that included only a fraction of the full picture of his life and circumstances.

Cohen pointed to a write-up of a psychosocial evaluation, used to assess a patient's readiness for a transplant. The evaluation stated that Confer drank a 12-pack of beer and perhaps as much as a pint of whiskey daily. But Confer had quit drinking after starting chemotherapy and had been only a social drinker before, Cohen said. It was "wildly inaccurate," Cohen said

Embedded bias: How medical records sow discrimination | News-Medical

Https://news-medical.net/news/20220...

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cesces
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Seasid profile image
Seasid

It is happening more often than we would like to admit.

I don't drink alcohol nor I smoke, but I have an addictive personality type as I love to drink hot chocolate.

I know the best would be to stop that "addiction".

Then I would be accused that I eat high carbohydrate and fatty food. Then that I don't eat enough fruit and veggies etc.

mrscruffy profile image
mrscruffy

I am a Hispanic Jew(non Practicing) being treated my a female, Pakistani, Muslim, I am doomed. Hahaha. My MO knows about my many vices. I have never felt that I am getting sub standard care nor being discriminated against. I absolutely love my MO and treatment center

cesces profile image
cesces in reply tomrscruffy

Lol

I'm certain it varies by Doc.

I did notice my radiation oncologist in his notes went out of the way to present my personality in a positive agreeable manner.

I'm certain there are ways to hint hint do just the opposite.

mistersafety profile image
mistersafety

I've taken advantage of on-line electronic records to read my docs' notes and sometimes add my own! When I make my own notes about the visit, especially when the facts or tone are different from the specialist doc's, I make sure to share them with my PCP.

dmt1121 profile image
dmt1121

I definitely can see that this happens. No matter how much we want to believe that doctor's are above this, it is part of an individual's personality and experience. Being a doctor or a judge does not make people less themselves. It only gives more guidelines for behavior and conduct.

While I am not by any means wealthy, I am also not in a commonly thought of disadvantaged or discriminated group. Regardless, I have experienced this type of dismissive response from doctors when raising certain questions. It is both a question of protocols to do with insurance and resources, as well as following the status quo which creates less problems for the doctors within their organizations....as well as personal ingrained prejudice.

It is wrong for people facing life-threatening illnesses to not have the compassion and attention of their doctor as an individual, a person who is afraid, uncertain and seeking not just scientific data but caring and detailed responses to serious concerns.

Shorter profile image
Shorter

Not only medical records, but refusal to treat. I have experienced this in my state and it is legal per law passed last year.

cesces profile image
cesces in reply toShorter

Can you explain this with more words.

What is this and what does it look like.

How does it get communicated?

groundhogy profile image
groundhogy

I had a general practicioner some years ago accidentally bumble and stumble upon that i had a heart calcium score of like 300. He accidentally saw it on an mri.

He had been checking my colesterol for years. I was angry. My last scan was a zero. Where was he when my scan was 10? 50? 100? 200? 250?

I had words with him..

The next several visits there was this stenographer in the corner typing every word. He told me it was just a new policy and that it saved him from taking notes. Right...

Fast forward.

I had many difficulties getting a doc to treat me. Its taken me 2 years to get treatment.

I often wonder what is in those secret notes.

Seasid profile image
Seasid in reply togroundhogy

Wow

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