Physician Attitudes Embedded Within Electronic Medical Records of Persons With and Without Serious Mental Illness

Negative descriptors and stigmatizing language of patients have been found in electronic medical records. Using electronic health records, this study sought to describe language patterns that reflected positive or negative attitudes for patients with and without a serious mental illness.

Content analysis was performed on ambulatory internal medicine progress notes from patients with serious mental illness (schizophrenia, bipolar disorder, major depression with psychosis; n = 511) and a control population (n = 511), matched on age, sex, and race. Fisher's exact test was used to compare frequencies of identified themes across groups.

Language reflecting negative attitudes appeared at greater frequency in notes of patients with serious mental illness than without (18.0% vs 11.7%, P = .006). Language expressing physicians' frustration (5.7% vs. 2.2%, P = .005) and questioning patient's credibility (5.1% vs. 1.8%, P = .0005) also appeared more frequently in notes for patients with serious mental illness (vs. without). Language reflecting positive attitudes appeared at similar rates (37.0% vs. 34.4%, P = .4). Compliments or approval of patients (16.8% vs. 8.0%, P < .001) or shared decision-making statements (8.2% vs. 4.7%; P = .03) were more frequent among patients with mental illness than without.

Physicians may have differential emotional engagement-positive and negative-during visits with patients with serious mental illness. While not common, negative language and questioning patient credibility occurred more frequently in notes for patients with SMI than without. Given the stigma surrounding mental illness, work is needed to understand whether negative attitudes conveyed in notes are associated with poorer quality of care.