Our medical records contain a lot of information. Much of it objective – lab results, vital signs, living situation, or observations of symptoms, for example. Our providers also record our complaints, and their thoughts regarding the causes for these symptoms, part of their differential diagnosis. There is often brief commentary, too, on our presentation: something like “well developed” and “pleasant” or, “difficult.” What our providers say in our medical chart gets identified by subsequent providers but also defense attorneys and experts hired by defendants. So, what kind of a patient are you?

Defendants commonly blame patients in medical negligence claims along the theory that the plaintiff contributed to their injury or did not make reasonable efforts to get better. And, where there is a question of patient follow through, defendants will often try to point to commentary in the medical record that the patient was “noncompliant,” “non-adherent,” “combative,” “refusing” care, or “argumentative,” to name a few examples.

The thing is, these types of labels tend to be assigned more frequently to certain categories of patients: they appear in medical records of African American patients two and a half times more than those of white patients. Similar stigmatizing descriptors appear more frequently in charts of unmarried patients and those on public insurance plans, as well as patients with “lifestyle” diseases like obesity and diabetes. In addition to the troubling racial component, this sort of behavior smacks of a lack of empathy, as providers entering these notes know full well that every subsequent provider has access to this patient’s chart, and it may negatively inform their approach to the patient. Less present in providers minds though, is the reality that this language might become an exhibit for why a patient is less worthy of a substantial verdict than a patient who was not given any of those negative descriptors.