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

Objective To determine how the perception of families elicited after reading progress note social commentary differs by patient race. Study design We 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. In total, 225 (49%) contained social commentary beyond parents’ names. Twelve 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.