SHM Converge Scientific Abstract ePoster Gallery-Identification and Analysis of Context-Specific Stigmatizing Language in Clinical Notes

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This study examined stigmatizing language in clinical notes and focused on terms that are almost always used in a negative, stigmatizing context. Researchers analyzed 80 million notes from 1.5 million patients between 2015 and 2022, reviewing sample notes for 21 commonly cited stigmatizing terms.

The goals were to identify terms used consistently in stigmatizing ways and to see whether use of these terms varied by patient demographics or mental health comorbidity.

Five terms were found to be context-specific and almost always stigmatizing: <strong>refuse, narcotic, substance abuse, combative, and hysterical</strong>. The study found important disparities in who received these terms in their notes. Patients identifying as <strong>male or nonbinary</strong>, several <strong>racial and ethnic minority groups</strong>, and patients with <strong>at least one mental health comorbidity</strong> were more likely to have at least one context-specific stigmatizing term in their clinical record.

Notably, having a mental health comorbidity was strongly associated with stigmatizing language use. Some groups showed higher odds than White patients, including Black or African American, American Indian or Alaska Native, Asian, Latinx, and multiracial patients, while some other groups had lower odds.

The authors conclude that stigmatizing language in clinical documentation may reinforce bias, influence clinician attitudes, affect prescribing, and worsen disparities. They recommend broader analysis of additional stigmatizing terms, revision of standard note templates to remove such language, and implementation of a custom EHR dictionary to flag stigmatizing terms and suggest alternatives during note-writing.

Asset Subtitle

Anoop N. Muniyappa

Meta Tag

Author List Andrew R. Lai, Anoop N. Muniyappa, Aylin Ulku, Bassem Ghali, Raman Khanna, Zoë Kopp

Category Research

Concept Stigmatizing Language

Concept Clinical Notes

Concept Terminology

Concept Context

Distinguished Non-Finalist

Presenter Organization University of California, San Francisco

Presenting Author Anoop N. Muniyappa

Track Other

Keywords

stigmatizing language

clinical notes

health disparities

mental health comorbidity

refuse

narcotic

substance abuse

combative

hysterical

electronic health record

Stigmatizing Language

Clinical Notes

Terminology

Context