The April 2023 issue of SGIM Forum offers readers an e-collection of articles on biased language in our everyday work as general internal medicine physicians. The relevance and importance of using non-judgmental and unbiased language in our professional development from performance evaluations to letters of support—is paramount in career advancement, regardless of scientific or medical discipline. As physicians and medical trainees, we also influence the care of patients depending on how well we use person-first language that promotes equity and recognize bias in language that we read and use to describe patients (e.g., in the electronic health record, scholarly publications, and scientific research). As researchers, how we collect, analyze, and report data can be done with attention to how systemic biases influence our scientific findings. To introduce the various ways that biased language can influence our day-to-day work, authors of articles in this issue offer reflections and introductions to some of the key issues in practice.
In clinical care and research, person-first language can be used to communicate respectfully and appropriately about an individual, with a shift in language from “a person is” to a “a person who has.”1 For example, rather than referring to a patient as a “diabetic,” they “have diabetes.” A very thorough and complete guide to advancing health equity through language and narrative was published in 2019 by the American Medical Association (AMA) and Association of American Medical Colleges (AAMC) Center for Health Justice.2 I highly recommend a complete read of this guide to familiarize with best practices that can apply to numerous settings in our routine work and professional (and even personal) lives.
To open this issue, Sgro notes in his column in this issue, “That physicians’ words have such power is a function of our status compounded by the vulnerable position in which we encounter our patients. And our words can do more than wound, demoralize, or bias.” Our words can take on a sense of digital permanence also in the electronic health record: Solovieva and Rao discuss the concept of testimonial injustice or the use of language that can instill bias or disbelief in the reader through chart notes. Bass, SGIM CEO, and Gonzalez and Lypson discuss receiving a grant for a project on promoting diagnostic excellence from the Council of Medical Specialty Societies (CMSS) that focuses specifically on mitigating racial disparities in diagnosis. Hicks, SGIM President, offers his parting reflections in his final SGIM Forum President’s Column. The more we can educate ourselves about best practices and the invisible influencers of our daily thought, the more we can be mindful to mitigate their impacts on how we think and act.
The AMA, AAMC, and CMSS naturally are not the only professional organizations that are paying attention to these issues. The American Medical Informatics Association is also developing an Inclusive Language and Context Style Guide,3 with the aim of issuing this as a scholarly communications guide not only for their annual meeting submissions but also as a tool to potentially influence other spheres of science and publishing. Each of these types of resources offer another set of perspectives and learning points for us to potentially adopt in our practices.
Regarding career advancement, three articles in this issue focus on the issue of bias in performance evaluations and letters of support. Finta, Sheffield, and Lukela call for formal training for residents on how to give feedback in ways that avoid unintended bias. Conigliaro, et al, describe their innovative program, Promotion Support for Women in Medicine, designed to build a pool of skilled letter writers to sponsor women academic faculty in their promotions—and do so while applying best practices in avoiding gender-biased language in their support letters. Sagar, et al, summarize some of the key pitfalls of biased language in letter writing and offer specific strategies for writing letters that avoid biased language.
In the prompted words of ChatGPT: “It is essential for general internal medicine physicians to be aware of their own biases and take steps to address them, such as engaging in diversity, equity, and inclusion training, seeking feedback from colleagues and patients, and being mindful of the potential impact of their biases on their work. By doing so, physicians can improve the quality of their research, patient care, advocacy, and professional advancement, and work towards creating a more equitable healthcare system.” I have heard numerous talks that acknowledge that no person (and no physician) is exempt from implicit bias. We all have them. To mitigate those biases and change how we think and act to benefit our patients and each other, we need to start shifting how we think about using language in our routine work as physicians, medical educators, advocates, and researchers.
- CDC. Communicating with and about people with disabilities. https://www.cdc.gov/ncbddd/disabilityandhealth/materials/factsheets/fs-communicating-with-people.html. Accessed March 15, 2023.
- AMA. Advancing health equity: A guide to language, narrative and concepts. https://www.ama-assn.org/about/ama-center-health-equity/advancing-health-equity-guide-language-narrative-and-concepts-0. Accessed March 15, 2023.
- AMIA. Update on AMIA Inclusive Language and Context Style Guidelines. https://amia.org/news-publications/update-amia-inclusive-language-and-context-style-guidelines. Published March 1, 2022. Accessed March 15, 2023.
Health Equity, Health Policy & Advocacy, SGIM, Social Justice, Vulnerable Populations
WORDS MATTER: AWARENESS OF STIGMATIZING LANGUAGE IN INPATIENT DOCUMENTATION AND THE EFFECT ON ATTITUDES AND DECISION MAKING
It is a call day, and you are the medical student/resident/attending working…
UNINTENDED BIAS IN STUDENT EVALUATIONS: A KEY TOPIC FOR INCLUSION IN INTERNAL MEDICINE RESIDENCY CURRICULUM
A female medical student reviews narrative feedback from the senior resident she…