Previous article
Bempedoic Acid for the Prevention of Cardiovascular Disease
Jun 2024
Next article
RSVpreF (Abrysvo) and Nirsevimab-alip (Beyfortus) for the Prevention of Respiratory Syncytial Virus Infection
Lown Right Care
Reducing Overuse and Underuse

Avoiding Racist and Judgmental Clinical Documentation: Helping to Achieve Health Equity

Alan R. Roth, DO, FAAFP, FAAHPM,
Jamaica Hospital Medical Center, Jamaica, New York
Andy Lazris, MD, CMD,
Personal Physician Care, Columbia, Maryland
Patient Perspecitive by Helen Haskell
John James

American Family Physician. 2024;109(6):575-577.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Address correspondence to Alan R. Roth, DO, FAAFP, FAAHPM, at aroth@jhmc.org. Reprints are not available from the authors.

Author disclosure: No relevant financial relationships.

  1. 1.Balderston JR, Gertz ZM, Seedat R, et al. Differential documentation of race in the first line of the history of present illness. JAMA Intern Med. 2021;181(3):386-388.
  2. 2.Cooper RS, Nadkarni GN, Ogedegbe G. Race, ancestry, and reporting in medical journals. JAMA. 2018;320(15):1531-1532.
  3. 3.Nawaz H, Brett AS. Mentioning race at the beginning of clinical case presentations: a survey of US medical schools. Med Educ. 2009;43(2):146-154.
  4. 4.Ricks TN, Abbyad C, Polinard E. Undoing racism and mitigating bias among healthcare professionals: lessons learned during a systematic review. J Racial Ethn Health Disparities. 2022;9(5):1990-2000.
  5. 5.Williams JC, Andreou A, Castillo EG, et al. Antiracist documentation practices - shaping clinical encounters and decision making. N Engl J Med. 2023;389(13):1238-1244.
  6. 6.Fernández L, Fossa A, Dong Z, et al. Words matter: what do patients find judgmental or offensive in outpatient notes?. J Gen Intern Med. 2021;36(9):2571-2578.
  7. 7.Goddu AP, O'Conor KJ, Lanzkron S, et al. Do words matter? Stigmatizing language and the transmission of bias in the medical record [published correction appears in J Gen Intern Med. 2019; 34(1): 164]. J Gen Intern Med. 2018;33(5):685-691.
  8. 8.Beach MC, Saha S, Park J, et al. Testimonial injustice: linguistic bias in the medical records of Black patients and women. J Gen Intern Med. 2021;36(6):1708-1714.
  9. 9.Sun M, Oliwa T, Peek ME, et al. Negative patient descriptors: documenting racial bias in the electronic health record. Health Aff (Millwood). 2022;41(2):203-211.
  10. 10.Healy M, Richard A, Kidia K. How to reduce stigma and bias in clinical communication: a narrative review. J Gen Intern Med. 2022;37(10):2533-2540.
  11. 11.Himmelstein G, Bates D, Zhou L. Examination of stigmatizing language in the electronic health record. JAMA Netw Open. 2022;5(1):e2144967.
  12. 12.Park J, Saha S, Chee B, et al. Physician use of stigmatizing language in patient medical records. JAMA Netw Open. 2021;4(7):e2117052.
  13. 13.Yearby R, Clark B, Figueroa JF. Structural racism in historical and modern US health care policy. Health Aff (Millwood). 2022;41(2):187-194.
  14. 14.U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Access to health services. Accessed April 4, 2024. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-health-services
  15. 15.Lee DC, Liang H, Shi L. The convergence of racial and income disparities in health insurance coverage in the United States. Int J Equity Health. 2021;20(1):96.
  16. 16.Ansell DA, McDonald EK. Bias, black lives, and academic medicine. N Engl J Med. 2015;372(12):1087-1089.
  17. 17.Carter RT, Lau MY, Johnson V, et al. Racial discrimination and health outcomes among racial/ethnic minorities: a meta-analytic review. J Multicult Couns Devel. 2017;45(4):232-259.
  18. 18.Brett AS, Goodman CW. First impressions - should we include race or ethnicity at the beginning of clinical case presentations?. N Engl J Med. 2021;385(27):2497-2499.
  19. 19.Amutah C, Greenidge K, Mante A, et al. Misrepresenting race - the role of medical schools in propagating physician bias. N Engl J Med. 2021;384(9):872-878.
  20. 20.Bourgois P, Holmes SM, Sue K, et al. Structural vulnerability: operationalizing the concept to address health disparities in clinical care. Acad Med. 2017;92(3):299-307.
  21. 21.Healy M, Kidia K. The power in our words: reducing bias in clinical communication. Am Fam Physician. 2023;107(5):454-455.
  22. 22.Beach MC, Saha S. Quoting patients in clinical notes: first, do no harm. Ann Intern Med. 2021;174(10):1454-1455.
  23. 23.The Commonwealth Fund. Coleman A. Almost 3.8 million people have lost their Medicaid coverage since the end of the COVID-19 public health emergency. August 9, 2023. Accessed April 4, 2024. https://www.commonwealthfund.org/blog/2023/almost-38-million-people-have-lost-their-medicaid-coverage-end-covid-19-public-health
  24. 24.Edgoose JYC, Quiogue M, Sidhar K. How to identify, understand, and unlearn implicit bias in patient care. Fam Pract Manag. 2019;26(4):29-33.

Lown Institute Right Care Alliance is a grassroots coalition of clinicians, patients, and community members organizing to make health care institutions accountable to communities and to put patients, not profits, at the heart of health care.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

A collection of Lown Right Care published in AFP is available at https://www.aafp.org/afp/rightcare.

Previous article
Bempedoic Acid for the Prevention of Cardiovascular Disease
Jun 2024
Next article
RSVpreF (Abrysvo) and Nirsevimab-alip (Beyfortus) for the Prevention of Respiratory Syncytial Virus Infection

Current issue

May 2026

May 2026

Copyright © 2026 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. See permissions for copyright questions and/or permission requests.