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

A brief 1/x https://twitter.com/MedEdPORTAL/status/1366811842882854912

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 
3/x

The use of biased clinical language was associated with less aggressive treatment of pain associated with a hypothetical patient's sickle cell vaso-occlusive crisis

https://bit.ly/2Ps4dQy 

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 

6/x

We suggest these reflective questions to guide clinical documentation that is free of bias and stigma

7/x

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

8/x

Some special considerations for clinical language as they apply to:

substance use disorder
other neuropsychiatric conditions
disabilities
social history
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