Clinician documentation undermining patient credibility may disproportionately undermine Black individuals
FRIDAY, Aug. 15, 2025 (HealthDay News) — An analysis of more than 13 million electronic health record (EHR) notes shows potential racial bias in how doctors document patient trustworthiness, according to a study published online Aug. 13 in PLOS ONE.
Mary Catherine Beach, M.D., M.P.H., from Johns Hopkins University in Baltimore, and colleagues assessed racial differences in use of language either undermining or supporting patient credibility within the EHR. The analysis included 13,065,081 notes written between 2016 and 2023 about 1,537,587 patients by 12,027 clinicians across a large health network.
The researchers found that terms specifically related to patient credibility were relatively uncommon, with 106,523 notes (0.82 percent) containing terms undermining patient credibility and 33,706 notes (0.26 percent) supporting credibility. Notes written about non-Hispanic Black patients had higher odds of containing terms undermining credibility (adjusted odds ratio [aOR], 1.29; 95 percent confidence interval [CI], 1.27 to 1.32) and lower odds of supporting credibility (aOR, 0.82; 95 percent CI, 0.79 to 0.85) compared with notes written about White patients. Similar odds of language undermining (aOR, 0.99; 95 percent CI, 0.95 to 1.03) and supporting credibility (aOR, 0.95; 95 percent CI, 0.89 to 1.02) were seen for notes written about Hispanic/Latino versus White patients. Compared with White patients, notes written about Asian patients had lower odds of language undermining credibility (aOR, 0.85; 95 percent CI, 0.81 to 0.89) and higher odds of supporting credibility (aOR, 1.30; 95 percent CI, 1.23 to 1.38).
“For years, many patients — particularly Black patients — have felt their concerns were dismissed by health professionals,” the authors said in a statement. “By isolating words and phrases suggesting that a patient may not be believed or taken seriously, we hope to raise awareness of this type of credibility bias with the ultimate goal of eliminating it.”
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