SHM Converge Scientific Abstract ePoster Gallery-Words Matter: The Prevalence of Stigmatizing Language in the Ehr

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This study examined stigmatizing language in 67 million clinical notes from Penn Medicine between 2017 and 2020 to see whether usage varied by patient demographics. Researchers searched for selected negative descriptors (such as “abuse,” “addict,” “agitated,” “compliance,” “defensive,” “manipulative,” and “refused”) and positive descriptors (such as “cooperative,” “good historian,” “lovely,” and “pleasant”), excluding terms that could be used in unrelated contexts. Notes came from inpatient, outpatient, emergency, nursing, and other clinical documentation.<br /><br />The corpus included over 21.7 billion words and 126.4 billion characters. Across years, common terms included “patient,” “complain,” “compliance,” and “cooperative,” while less frequent stigmatizing terms included “addict” and “manipulative.” <br /><br />Key findings showed that use of “compliance” and “cooperative” decreased as patient age increased, while “agitated” and “refused” increased after age 80. The words “compliance” and “cooperative” were used more often in notes about transgender patients. There was no significant difference in descriptor use by race.<br /><br />The authors conclude that stigmatizing language patterns differ by age and gender identity, which may reflect bias and could influence how patients are perceived by other clinicians and by patients themselves, especially as electronic health record access expands under the 21st Century Cures Act. The study suggests that understanding these patterns may help guide future interventions to reduce stigma in medical documentation.

Asset Subtitle

Subha L. Airan Javia

Meta Tag

Author List Courtney Lee, Jackson Steinkamp, Subha L. Airan Javia

Category Research

Concept Stigmatizing Language

Concept Clinical Note

Concept Patient Demographics

Concept Age

Concept Clinician Bias

Distinguished Non-Finalist

Presenter Organization University of Pennsylvania

Presenting Author Subha L. Airan Javia

Track Communication

Keywords

stigmatizing language

clinical notes

patient demographics

Penn Medicine

electronic health records

age bias

gender identity

compliance

cooperative

medical documentation

Stigmatizing Language

Clinical Note

Patient Demographics

Age

Clinician Bias