From [HERE] Medical records contain a plethora of information, from a patient’s diagnoses and treatments to marital status to drinking and exercise habits.

They also note whether a patient has followed medical advice. A health provider may add a line stating that the patient is “noncompliant” or “non-adherent,” signaling that the patient has been uncooperative and may exhibit problematic behaviors.

Two large new studies found that such terms, while not commonly used, are much more likely to appear in the medical records of Black patients than in those of other races.

“In medicine, we tend to label people in derogatory ways when we don’t truly ‘see’ them — when we don’t know them or understand them,” said Dr. Dean Schillinger, who directs the Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center, and was not involved in the studies. “The process of labeling provides a convenient shortcut that leads some physicians to blame the patient for their illnesses.”

The first study, published in Health Affairs, found that Black patients were two and a half times as likely as white patients to have at least one negative descriptive term used in their electronic health record. The study was based on an analysis of more than 40,000 notes taken for 18,459 adult patients at a large urban medical center in Chicago between January 2019 and October 2020.

About 8 percent of all patients had one or more derogatory terms in their charts, the study found. The most common negative descriptive terms used in the records were “refused,” “not adherent,” “not compliant” and “agitated.”

“It’s not so much whether you should never use these words, but why are we applying these words with so much more frequency to Black patients?” said Michael Sun, the lead author of the study and a third-year medical school student at the University of Chicago’s Pritzker School of Medicine. “Do we really believe Black patients are truly not compliant, so many more times than white patients?”

Rather than assume the patient is lacking in motivation or disengaged, he said, the medical team should inquire whether the patient is facing financial barriers, transportation difficulties or other obstacles to adhering to treatment, such as illiteracy or trouble with English.

The researchers found that outpatient clinic records were far less likely to contain the negative comments, compared with records from hospitals and emergency rooms, perhaps because outpatient providers have ongoing relationships with their patients and are more familiar with their circumstances. [MORE]