Research shows that biased language during clinical handoffs can negatively impact patient care

When doctors and nurses pass patient information from one shift to another — an exchange known as a “handoff” — the specific words they use behind closed doors are more important than they may realize.

A study published in JAMA network opened shows that when doctors hear a patient described in negatively biased language, they develop less empathy for the patient and, in some cases, become less accurate in recalling the patient’s critical health data. The article is titled “Biased Language in Simulated Handoffs and Physician Recollection and Attitudes.”

Such shifts in perception may be subtle and unintentional in many cases, but as these hidden biases accumulate, they can impact the care patients ultimately receive.

“There’s a lot going on here cognitively: how we process information as physicians, and how editorializing or talking negatively about the patient can really cloud the listener’s mind and impact the care they ultimately provide to the patient,” says lead author Austin. Wesevich, MD, MPH, MS, a hematologist and healthcare researcher at the University of Chicago Medicine.

This new study builds on this previous research published in JAMA Pediatrics in which Wesevich and colleagues at Duke University recorded and analyzed real transmissions at a large medical center.

In that previous work, they found that these behind-the-scenes briefings contained negative or biased language 23% of the time, especially when discussing certain groups, such as black or obese patients.

To see how these biases affect listeners, the researchers designed a follow-up survey-based experiment in which each participating doctor heard three short, recorded handoffs that closely matched the actual handoffs.

For each transference scenario, the researchers created two versions: a neutral version that simply reflected the patient’s situation and needs, and a biased version that expressed a negative stereotype, guilt, or doubt about the patient’s credibility.

After listening to each transmission, participants answered a single multiple-choice question testing their recall of important medical details, completed a survey measuring their attitude toward the patient, and wrote down three short “key takeaways” from what they heard.

“Unsurprisingly, our results confirmed that when you hear biased language about someone, you think less positively about that person,” Wesevich said. “But it was striking to find that when participants heard some level of blame being directed at the patient for their condition, they were less likely to correctly answer the multiple-choice question about the patient’s care.”

Hearing a patient described with disdain, skepticism, or stereotype-based assumptions appears to impair the listener’s ability to recall essential clinical details such as laboratory results, overnight symptoms, or recommended treatments .

In the article, the researchers note that racially minoritized patients experience a disproportionate number of medical errors in their care. Avoiding bias in handoffs could increase empathy and reduce error rates – factors directly linked to health outcomes.

“If we see in these transfers that certain types of patients are experiencing the brunt of the problem, we need to do something to help alleviate that situation,” Wesevich said. “I think standardizing transfers is the way to protect vulnerable patients by leveling the playing field of privilege.”

By pushing for standardized handoffs — sharing only neutral, medically relevant facts and omitting unnecessary commentary or personal frustrations — the researchers argue that healthcare organizations can help prevent bias from creeping into these crucial communications. Some medical organizations have begun issuing guidelines to streamline transfers, and this study adds evidence that such efforts can help protect patients’ well-being.

Even as hospital leaders, educators and policymakers work to design standardized guidelines, oversight and training aimed at neutralizing bias, Wesevich emphasizes that patients and families can make a difference, too. Speaking up when something doesn’t feel right, making sure questions are answered properly, and making sure the next shift knows important details can all counteract the effects of stereotyping, guilt, and doubt.

“Those who work in healthcare often have very good intentions, but they are human beings, they get frustrated with things and express various biases – both implicit and explicit,” Wesevich said. “So it’s important to advocate for yourself or your loved ones because you don’t know if a doctor has heard or internalized everything you would want him or her to know when caring for you after a transfer.”