As providers, how we refer to patients — in written and more commonly, verbal clinical communication — is often biased or stigmatizing.

This can impact clinical care in unanticipated ways.

Some highlights from our workshop on reframing these tendencies https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏾" title="Rückhand Zeigefinger nach unten (durchschnittlich dunkler Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (durchschnittlich dunkler Hautton)">

A brief https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> 1/x https://twitter.com/MedEdPORTAL/status/1366811842882854912">https://twitter.com/MedEdPORT...

How do we define stigmatizing, biased clinical language?

- Casting undue doubt: "claims he has 10/10 pain"
- Implying undue culpability
- Perpetuating stereotypes
- Including details that are unnecessary to care and might bias future providers: e.g., criminal history

2/x

Some examples of neutral language (blue), as compared to stigmatizing or biased language (red), in describing a patient with sickle cell disease presenting to the ED with a vaso-occlusive crisis

https://bit.ly/2Ps4dQy ">https://bit.ly/2Ps4dQy&q...
3/x

The use of biased clinical language was associated with less aggressive treatment of pain associated with a hypothetical patient& #39;s sickle cell vaso-occlusive crisis https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏾" title="Rückhand Zeigefinger nach unten (durchschnittlich dunkler Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (durchschnittlich dunkler Hautton)">

https://bit.ly/2Ps4dQy ">https://bit.ly/2Ps4dQy&q...

4/x

Conditions associated with chronic pain often fall in the category of "medically inexplicable" or contested illnesses — and ones that more often affect women

Clinical language often emphasizes the absence of “objective” or “organic” causes, rather than legitimizing symptoms

5/x

Gender norms around pain perception and expression, combined with the fact that these conditions are under-researched, lead to these descriptors.

Overall, this clinical language leads to men’s pain being more readily believed and treated.

https://bit.ly/3sL3mca ">https://bit.ly/3sL3mca&q...

6/x

We suggest these reflective questions to guide clinical documentation that is free of bias and stigma https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏾" title="Rückhand Zeigefinger nach unten (durchschnittlich dunkler Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (durchschnittlich dunkler Hautton)">

7/x

Ask these questions and assess baseline assumptions as you frame clinical documentation to ensure it& #39;s free of bias and stigma

8/x

Some special considerations for clinical language as they apply to:

https://abs.twimg.com/emoji/v2/... draggable="false" alt="☑️" title="Kästchen mit Häkchen" aria-label="Emoji: Kästchen mit Häkchen">substance use disorder
https://abs.twimg.com/emoji/v2/... draggable="false" alt="☑️" title="Kästchen mit Häkchen" aria-label="Emoji: Kästchen mit Häkchen">other neuropsychiatric conditions
https://abs.twimg.com/emoji/v2/... draggable="false" alt="☑️" title="Kästchen mit Häkchen" aria-label="Emoji: Kästchen mit Häkchen">disabilities
https://abs.twimg.com/emoji/v2/... draggable="false" alt="☑️" title="Kästchen mit Häkchen" aria-label="Emoji: Kästchen mit Häkchen">social history
https://abs.twimg.com/emoji/v2/... draggable="false" alt="☑️" title="Kästchen mit Häkchen" aria-label="Emoji: Kästchen mit Häkchen">gender identity

9/9

Loved working on this with colleagues @JRaney_MD @Riagpal @KimHoangMD @MikeGisondi

Adding our non-Twitter-dwelling co-conspirators: Tiffany Lee, MD, Samuel Ricardo Saenz, MD, MPH, Peter Leahy, MD, Carrie Johnson, MBA, Cynthia Kapphahn, MD, MPH