Characterizing Stigmatizing and Biased Language in Clinical Pharmacist Documentation

Introduction

Biased language in documentation can perpetuate stigma, influence treatment decisions, and impact provider–patient relationships. As any person seeking care at acute care hospitals may face stigma, particularly those with substance use or mental health disorders, unbiased documentation is crucial. We sought to determine the prevalence of stigmatizing and biased language in electronic health records written by clinical pharmacists.

Methods

This study was conducted at two acute care teaching hospitals, St. Paul's and Mount Saint Joseph Hospitals in Vancouver, British Columbia, Canada. A list of stigmatizing and biased terms was compiled through literature review and expert consensus. A retrospective, observational, cross-sectional study of clinical pharmacist notes was performed using a data-mining algorithm to identify these terms. A content analysis was conducted to explore the ways this terminology was used and to uncover new themes not previously documented in the literature.

Results

Between November 16, 2019, and September 30, 2023, of 135 671 clinical pharmacist notes reviewed, 42 192 (31.1%) contained at least one stigmatizing or biased term. Commonly identified terms included: compliance, noncompliance, refuses, denies, and smoker. All themes previously documented in the literature (e.g., leading with race/socioeconomic status, incorrect pronouns, employing quotations to suggest lack of credibility) were observed. Additionally, new themes emerged, including the use of punctuation or formatting to amplify the stigmatizing tone and the role of electronic health records in perpetuating stigma.

Discussion

Stigmatizing language was found in 31.1% of clinical pharmacist notes. Findings from this study are assisting in the development of a multimodal educational intervention aimed at reducing the prevalence of stigmatizing language in clinical pharmacist documentation.