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Talking about racial bias in health records


A recent study found evidence of bias in electronic health records. Michael Sun, the study’s lead author, talks about the implications and steps healthcare leaders should be taking.

After the publication of a study showing racial bias in health records, Michael Sun, the lead author, said he typically has received two types of reactions.

Sun, a medical student at the University of Chicago, said he heard from some who said they were glad to finally see such a study, which first appeared on the Health Affairs website last month.

Michael Sun

Michael Sun

The other type of response? Sun said people told him they see that kind of bias everyday.

“In a lot of ways, it’s discouraging to hear how pervasive it is,” Sun said in a phone interview with Chief Healthcare Executive.

Black patients had more than 2.5 times the odds of having a negative descriptor in the history and physical notes, the study found. Sun and his fellow researchers examined ​​40,113 records from 18,459 patients between January 2019 and October 2020.

The prevalence of negative descriptors associated with Black patients raises concerns about further inequities in treatment. Healthcare leaders and President Biden’s administration have been focused on reducing gaps in equity, an issue that has gained more attention due to the COVID-19 pandemic.

The study also found patients with Medicaid and Medicare were more likely to have negative descriptors in their records compared to those with private insurance. Patients who weren’t married also had greater odds of negative descriptors compared to patients who had a spouse.

Sun said he wasn’t surprised at the findings, but they are discouraging. For those who have seen bias at healthcare providers, Sun said the study at least confirms, “It was real.”

Kim Drumgo, the Geisinger health system’s chief diversity officer, recently talked about the importance of being careful with the descriptions of patients in an interview with Chief Healthcare Executive. She noted records of patients from minority groups are more likely to include terms such as “resistant” or “agitated,” which could simply reflect patients are afraid or simply asking questions.

“We need to think about our language,” Drumgo said.

In the study, researchers looked at the history and physical notes of patients’ electronic health records. Sun said the bias seen is disturbing because those notes provide an important foundation for treatment.

“That’s the note many providers, even if they don’t copy it, they refer to it. It’s read by nurses, other specialists, therapists,” Sun said.

Patient records were less likely to contain negative descriptors of Black patients after the emergence of the COVID-19 pandemic, the study found. Soon after the coronavirus upended American life, the murder of George Floyd spurred protests around the country, along with renewed conversations about racial equity in healthcare.

With the pandemic and greater focus on social justice, Sun said, “It was near impossible for most healthcare providers to not grapple with racism."

“I certainly hope healthcare providers are being sensitized and making intentional choices to be more empathetic,” Sun said.

The study sheds more light on the larger problem of systemic racism in society, Sun said. Still, healthcare providers can be taking more steps to address bias that could affect treatment.

“Some healthcare institutions implemented more bias training and paid more attention to inequities in health,” Sun said. “It’s possible for us to change language and habits we’ve been doing for a very long time.”

Healthcare providers should look at the language used by physicians and ensure patients are being discussed “in an empathetic and kind way.”

Sun said he hopes the findings will help healthcare providers understand “the people who need us most are the people we must try to extend the most compassion.”

In the future, Sun said he’d like to do more research to see if there is any difference in healthcare outcomes among patients who have negative descriptors in their health records.

Getting more diversity in the physician workforce will likely make a difference in the treatment of patients, Sun said. Roughly 5% of America’s doctors are Black, and 5% of the nation’s physicians are Latino, according to data from the Association of American Medical Colleges.

“I would love to see more diversity, different voices entering our space,” Sun said. “It’ll only lead to better care.”

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