{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:35:00Z","timestamp":1791444900433,"version":"4.3.3"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Stigmatizing language in electronic health records (EHRs) can generate or reinforce negative stereotypes about patients from minoritized groups and erode their trust and experience. However, less is known about the use of such language to cast doubt on patient clinical history in hospital settings.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the prevalence of language expressing doubt about patient clinical history (eg, experiences and symptoms) in hospital admission notes by patient race and ethnicity.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>In this cohort study, natural language processing tools were applied to analyze 54\u202f936 admission notes from 1249 clinicians about patients aged 18 years or older at admission and hospitalized at an academic health system in the Northeast US between January 1, 2018, and February 28, 2023. Data were analyzed from September 1, 2022, to July 31, 2023.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Patient race and ethnicity (non-Hispanic Black, non-Hispanic White, and racial and ethnic minoritized groups excluding non-Hispanic Black [includes multiple racial and ethnic groups, such as Hispanic and Asian]) as recorded in the EHR based on self-report or registrar determination.<\/jats:p><\/jats:sec>Main Outcome and Measure<\/jats:title>Binary indicator for at least 1 term casting doubt on patient clinical history was defined using epistemic stance, a linguistic construct expressing a writer\u2019s degree of certainty in information. Terms were manually validated via iterative review of notes by the study team.<\/jats:p><\/jats:sec>Results<\/jats:title>Among 56\u202f325 admission notes (mean [SD] age of patients, 55.9 [19.0] years; 30\u202f913 notes among female patients [54.9%]; 25\u202f649 notes among non-Hispanic Black patients [45.5%], 26\u202f442 notes among non-Hispanic White patients [46.9%], and 2985 notes among members of racial and ethnic minoritized groups excluding non-Hispanic Black patients [5.3%]), we analyzed 54\u202f936 admission notes that had no missing data. Among all analyzed admission notes, 39\u202f023 notes (71.0%) contained doubt language. Notes written about non-Hispanic Black patients had increased odds of containing at least 1 word or phrase of doubt (adjusted odds ratio, 1.21; 95% CI, 1.14-1.28; P<\/jats:italic>\u2009&amp;lt;\u2009.001) compared with notes among non-Hispanic White patients. Compared with notes among non-Hispanic White patients, notes written about members of racial and ethnic minoritized groups excluding non-Hispanic Black patients had similar odds of containing at least 1 term of doubt.<\/jats:p><\/jats:sec>Conclusion and Relevance<\/jats:title>In this study, language casting doubt on patient clinical history was more likely to be found in notes of non-Hispanic Black patients. These results suggest that with the implementation of policies allowing patients full access to their health records, examining clinical documentation standards may be associated with improved patient experience.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.38550","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T15:01:10Z","timestamp":1728918070000},"page":"e2438550","source":"Crossref","is-referenced-by-count":22,"title":["Race and Ethnicity and Clinician Linguistic Expressions of Doubt in Hospital Admission Notes"],"prefix":"10.1001","volume":"7","author":[{"given":"Courtney R.","family":"Lee","sequence":"first","affiliation":[{"name":"Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia"},{"name":"Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, 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