Whenever I see an article on implicit bias, I must read and write about it. This time, the article is entitled, “Embedded bias: How medical records sow discrimination” by Darius Tahir of Kaiser Health News.
The theme of the article is that doctors unconsciously (or perhaps even consciously) write notes about their patients in medical records and the “objective descriptions” they use, stick with the patient for years to come.
As one example, the author cites David Confer who explained that prior to his brain fog, he “used to be Ph.D. level”. While he was speaking figuratively, the doctor- it turns out did not take him seriously. Confer who was black and diagnosed with non-Hodgkin lymphoma was later diagnosed with cirrhosis of the liver and died in 2020. During the time that Confer was treating with the doctor, his partner Cate Cohen had a sense that the doctor was not taking Confer seriously.
A review of his medical records after Confer died confirmed her belief. The language used in the doctor’s notes was dismissive and reflected a belief that Confer would not be compliant with his care and thus a bad candidate for a liver transplant. (Id. at 1-2.) As a result, he did not get the transplant and died.
The author continues:
Doctors often send signals of their appraisals of patients’ personas. Researchers are increasingly finding that doctors can transmit prejudice under the guise of objective descriptions. Clinicians who later read those purportedly objective descriptions can be misled and deliver substandard care.
Discrimination in health care is the “secret, or silent, poison that taints interactions between providers and patients before, during, after the medical encounter” said Dayna Bowen Matthew, dean of George Washington University’s law school and an expert in civil rights law and disparities in health care.”
Bias can be seen in the way doctors speak during rounds. Some patients are described simply by their conditions. Others are characterized by terms that communicate more about their social status or character than their health and what’s needed to address their symptoms. For example, a patient could be described as an “80-year-old nice black gentleman.” Doctors mention that patients look well-dressed or that someone is a laborer or homeless. (Id. at 2.)
As a result of such biased descriptions, patients may not receive the level of care needed. In this day and age of electronic records with the ability to cut and paste, a notation by one doctor as “difficult” or “disruptive” is easily repeated from one visit to the next, from one doctor to the next, and thus almost impossible to escape. As a result of such “downstream effects”, one expert in misdiagnosis, estimates that this bias causes a misdiagnosis in about 12 million patients a year. (Id.)
And while such electronic records have been available to patients since the 1990’s, many patients who have requested their records and seen these biased or inaccurate statements hesitate to confront their doctor about such comments. They are afraid that if they do so, the doctor may refuse further treatment, or the comments may be even more biased in the future. (Id at 5.)
Many of us have grown up with the notion that we should trust and respect doctors and should be open, honest and candid with them so that they can help us get well. Indeed, that is what the doctor patient privilege is all about- allowing a patient to be candid with her doctor knowing it will remain confidential. But this article highlights that doctors are people just like you and me and have biases just like the rest of us. And those biases will creep into what is otherwise confidential records and haunt us in future treatments with other doctors.
So, the morale here is the next time you visit a doctor, be careful of your interaction because (despite the doctor-patient privilege) the doctor may unconsciously (or even consciously) write a very biased description of your visit that will stay with you for years to come.
… Just something to think about.
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