Research from University of Oregon finds bias in the language of doctors

Adapted from a story written by Jim Murez, University of Oregon

(MARCH 11, 2022) According to Macmillan Dictionary, bias is "an attitude that you have that makes you treat someone in a way that is unfair or different from the way you treat other people." Biases based on gender and ethnicity have been found throughout society, including medical care. Now a researcher from the University of Oregon has learned how those biases also show up in the language that doctors use in their reports.

The research shows that physicians were more likely to refer to female patients impersonally compared with male patients. Also, physicians were more likely to use negative emotion words in their reports on Black patients compared with white patients. Those were some of things that David Markowitz learned from his research. He is an assistant professor who studies the psychology of language at the University of Oregon. He analyzed 1.8 million medical records for the language doctors used. He discovered clear differences in the way they communicated with different patients.

“What was most surprising is how clear the signals were in the data,” Markowitz said. “It really paints a picture that bias is not just a one-off phenomenon among certain physicians or individuals. Bias is systemic, subtle, and consequential in medicine." In other words, it's not just the problem of an individual with prejudice. Rather, it involves many people in many places. It can be part of the health care culture. And a person's language can lead to other problems. "The evidence suggests bias manifests in how physicians talk about their patients,” said Markowitz. “And it's probably not too far of a leap to also suggest it might affect their care as well.”

Markowitz used a database of medical records for nearly 46,000 critical care patients. The database included over 58,000 hospital admissions to Beth Israel Deaconess Medical Center in Boston. The records excluded patient names. However, the records included demographic data and notes from doctors and nurses. Markowitz measured impersonal pronouns (such as it, someone and who), positive emotion terms (brave, safe and gentle), negative emotion terms (bad, weak and panic), body terms (nerve, spine, stomach), analytic thinking, and cognitive processing terms (solve, determine and perhaps).

“I looked at language patterns reflecting bias across groups,” Markowitz said. “So, for example, there are patients who are identified as white or Black or male, female, etc. Using computational methods to analyze language, I identified patterns of bias through the descriptions of a patient’s condition and progress.”

The study provides evidence for how language plays a central role in the patient-physician relationship. It demonstrates systematic gender and ethnicity biases in medicine through language. The evidence establishes a link between communication patterns and bias that is often not seen in medicine, Markowitz noted. The analysis suggested that physicians talk about female patients in impersonal and emotional terms compared with male patients. Physicians pay less attention to the negative experiences of Black patients than white patients. Physicians also require more effort organizing their thoughts around problems/solutions for Black females compared to other groups of people. Additionally, physicians writing about male patients focused more on their body than those writing about female patients.

Markowitz says the data has some problems. It came from one hospital. It did not include physician demographics. Still, he believes the data could be a "red flag" to direct attention to the problem and study it more.

“How can we take this information and then either provide trainings or provide ways of understanding the systems that are perpetuating bias?” Markowitz said. “Because medicine as an institution has a significant negative history of undermining people of color and undermining women. So how can we use this evidence to motivate change? We need ways to improve the system because making it more inclusive not only provides better care, it's also just the right thing to do.”