Racism is embedded in many aspects of society, including medical health records.A sort of new research An article published in January 2022 quantifies negative patient descriptions that disproportionately impact the health records of people of color compared to whites. In fact, black patients had a staggering 2.54 more negative descriptions in the medical history and body record sections than white patients, the report said.
The report used machine learning to comb through the electronic health records (EHRs) of 18,459 patients, controlling for health and sociodemographic characteristics. The records may mark the patient as “non-compliant” or “non-compliant.” If a patient has diabetes and cannot control the number of people she eats after a meal because the patient is not on medication, she will be flagged as non-compliant. The study specifically searched for the following terms: (non) insistent, aggressive, agitated, angry, challenging, aggressive, (non) submissive, confrontational, (non) cooperative, defensive, exaggerated, hysterical, (un)pleasant, rejected, resist. Overall, black patient records contained more of these negative descriptions than white patient records.
What’s more, different Report Black patients were found to be aware of these biases, which negatively impacted their care and health outcomes.
A physician at Oak Street Health aims to treat people over the age of 65 with a new model of primary care, and he believes there are other words that could be misused and biased.
They include “medication for pain,” “anger” or “agitation” and “rejection,” said Dr. Kevin Stephens, Senior Medical Director Oak Street Health in an email.
“As a care provider, our medical curriculum has taught us to always use a patient’s race as a descriptor. Often, a patient’s race is irrelevant to the problem at hand and can lead providers to inaccurate stereotypes or biases about their patients and affect The way they treat patients,” Stephens said.
The wording in the medical files of black patients was markedly different from that of their white contemporaries, even though they were battling the same conditions. For example, consider a patient with sickle cell disease. Stephens explained that pain in a small number of patients is often not adequately treated. Understandably, that black patient would have a painful tendency to seek medical treatment due to sickle cell. However, it will be listed in the patient file as “examination inconsistent with patient-reported pain.” However, according to Stephens, for a white patient who did the same, the document often showed “the patient struggled with chronic pain” or “the patient reported that pain medication was not controlling the current condition.” The report supports the finding numerically: Racism affects medical health records.
Racial bias is pervasive throughout — in other words, it’s not that unfair terms are used more often by primary care providers than specialists. The best way to reduce this bias in medical records is to build and maintain relationships.
“Continuity of care and building relationships with patients allows providers to eliminate bias in their care and help patients, regardless of their race or location. It’s not about PCPs and specialists, it’s more about maintaining an ongoing relationship with patients , to understand their struggles and care needs on an individual level,” Stephens said.
Correcting racial bias in medical records is proving complex and requires action at the individual, institutional and societal levels. First, providers might consider why they use race to treat patients, Stephens suggested.
“Why do we ask questions about race when we learn about patients, and how does this information affect the way we think and see patients?” Stephens challenged. “It starts with our education, and healthcare professionals at all levels have to think about how we teach the concept of race in medical education.”
Take kidney disease, for example. Physicians across the United States use race-based calculations to determine the glomerular filtration rate (GFR), which is how doctors measure kidney function. However, Stephens said physicians are now noting that this metric does not provide the most accurate way to identify patients with chronic kidney disease (CKD) and may lead to underdiagnosed kidney disease in African Americans.The National Kidney Foundation addressed the issue in September 2021, and Outlines a new race-free approach Diagnose patients with CKD.
“Kidney disease and GFR issues were originally highlighted by medical students and are a great example of how healthcare professionals can address issues that create bias in patient care,” Stephens said.
Photo: Heidi de Marco/Kaiser Health News; Graphics: health affairs report
