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Why Words During Sign-Out or Handoffs Matter

February 1, 2022

Often as I am going into a room to see a patient, the nurse will give me a quick summary about the patient. Occasionally, there will be a description of the patient or the parent, usually said at the end of the summary. “Just to let you know, this parent is unhappy.”

This statement is meant to be helpful – so that I can prepare myself before going into the room. And often, it is helpful. If I know that the parent is unhappy because this is the third visit for the same complaint, I can address that by acknowledging their frustrations early and often diffuse the situation so that we can better work together to figure out what the issue is and how we will approach it.

But what if this statement is creating an implicit bias in me? What if it negatively colors my view of the patient, and makes me discount their symptoms or situation? If I am told that an adolescent female is being “dramatic” or that the parent is “difficult,” will these descriptors frame the context through which I view this patient’s symptoms, and will this alter my capacity to think broadly about all of the diagnostic possibilities?

This week, Pediatrics is early releasing a Pediatrics Perspectives article by Dr. Sonia Teneja, Dr. Thomas Kuriakose, and Dr. Robert Vinci, from Boston Medical Center and Boston Children’s Hospital, entitled “The Weight of Our Words: How Medical Communication Perpetuates Bias” (10.1542/peds.2021-054296).

The authors offer several examples that illustrate how the descriptors that we use for patients – ones that we often think will be helpful for the receiving team – can create bias, make us pass judgment on the patient or family, impact on our differential diagnosis, or result in treatment that is less effective.

The authors also make the point that, particularly when these descriptors are included in the medical record, these judgments will impact that patient’s care indefinitely. This contributes to institutional bias, health inequities, and patient distrust in the medical system.

When you read this Pediatrics Perspectives, you will likely remember instances when one or two words might have framed an entire patient encounter differently than had the words not been said. We have to remember that the words that we use – even those words in professional sign-outs and handoffs – matter.

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