Transmission of negative biases through social commentary included in neonatal intensive care unit progress notes

Abstract

Abstract Objective: To determine how the perception of families elicited after reading progress note social commentary differs by patient race. Study Design: Retrospectively performed content analysis of social commentary in physician progress notes for Neonatal Intensive Care Unit patients hospitalized from 2018-2019. Neonatologists blinded to patient race rated how commentary impacted their perception of the patient’s family on a 5-point Likert scale. Frequency of negative ratings was compared across reported race using chi-squared tests. Results: We reviewed charts of 460 neonates. 225 (49%) contained social commentary beyond parents’ names. 12 neonatologists rated how commentaries impacted their perception of the patient’s family; 79%, 18%, and 3% were rated neutrally, negatively, and positively, respectively. Frequency of negative ratings was significantly greater among American Indian/Alaska Native than other patients (35% vs. 22%, p<0.001). Conclusions: Physician documentation of social commentary in patient notes may reflect and perpetuate implicit biases that contribute to race-based healthcare disparities.