The medical advisory team of Beer advocaten regularly provides the firm's lawyers with domestic or foreign publications in the medical field that may be significant to our work. Such information can sometimes be decisive in the conduct of medico-legal discussions, for example, about medical errors. I make grateful use of it.
Very recently, a recent American publication from the Yale School of Medicine that discussed a possible link between doctors' biases and medical errors. This issue has been published in the United States for some time. This publication reported on a study of more than 2,300 patient records.
The occurrence of errors in examination and treatment had been examined. Records had also been examined for stigmatizing remarks written down by the doctor about the patients involved.
The investigators found that in about a quarter of the files there was an error in the form of missing a finding on physical examination, failure to ask an important question, inadequate examination and so on.
In the medical records in which there was such an error, stigmatizing comments were found to be twice as frequent as in other records. Moreover, the researchers indicated that there was a significant association with skin color and social status of the patients involved. Stigmatizing comments included, for example, patient credibility and stereotypical designations.
Of course, making stigmatizing remarks about patients is not limited to the United States. Also in the Netherlands you sometimes encounter abbreviations such as POP (= Pijn Over overal Pijn) and PHPD (= Pijntje Hier Pijntje Daar). Doctors recognize these comments from their colleagues. Patients usually have no idea.
There is also a cultural aspect of significance. People from different cultures often express their complaints in different ways. The expression of complaints by patients from cultures other than the Dutch here may be misunderstood by doctors or even felt as unreal, and therefore irritating. It is obvious to think that the less annoyed the doctor is with his or her patient, the better the quality of medical treatment.
The effect of stigmatizing remarks in the (electronic) medical record is magnified because they are visible to all practitioners involved and affect the perception of succeeding doctors looking at the findings of their predecessors. Thus, a highly subjective designation may actually be assumed to be true and correct by anyone involved in the care of the patient in question.
Several American publications obviously consider it important not to write stigmatizing remarks in the patient record. Of course, it is not difficult to subscribe to that conclusion. Such comments show disrespect and thus also threaten the good quality of care.
If you have questions about this blog, please contact the author, John Beer.