Biased language in clinical handoffs may 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 matter more than they might realize. A new study published in JAMA Network Open shows that when clinicians hear a patient described with negatively biased language, they develop less empathy towards the patient and, in some cases, become less accurate in recalling the patient’s critical health details. Such shifts in perception may be subtle and unintentional in many cases, but as these hidden biases stack up, they can influence the care patients ultimately receive.

“A lot is going on here cognitively — how we’re processing information as clinicians, and how editorializing or talking about the patient negatively can really cloud the mind of the listener and impact the care they ultimately give that patient,” said lead author Austin Wesevich, MD, MPH, MS, a hematologist and health services researcher at the University of Chicago Medicine.

This new study builds on previous research published in JAMA Pediatrics in which Wesevich and colleagues at Duke University recorded and analyzed real-life handoffs at a major medical center. In that earlier work, they found that these behind-the-scenes briefings included negative or biased language 23% of the time, especially when discussing certain groups such as Black patients or patients with obesity.

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

For each handoff scenario, the researchers created two versions: a neutral one that simply stated the patient’s situation and needs, and a biased one that expressed either a negative stereotype, blame, or doubt about the patient’s credibility. After listening to each handoff, participants answered a single multiple-choice question testing their recall of key medical details, completed a survey that measured their attitude towards 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 feel less positively about that person,” Wesevich said. “But it was striking to find that when participants heard some level of blame being directed towards the patient for their condition, they were then less likely to correctly answer the multiple-choice question about the patient’s care.”

Hearing a patient described with scorn, skepticism, or stereotype-based assumptions appears to reduce the listener’s ability to recall essential clinical details like lab results, symptoms to watch for overnight, or recommended treatments.

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

“When we notice in these handoffs that certain types of patients are experiencing the brunt of the problem, then we need to do something to try to help alleviate that situation,” Wesevich said. “I think standardization of handoffs is the way to protect vulnerable patients by making the playing field of privilege more level.”

By pushing for standardized handoffs — where only neutral, medically relevant facts are shared, and unnecessary commentary or personal frustrations are left out — the researchers argue that healthcare institutions can help prevent bias from creeping into these crucial communications. Some medical organizations have begun issuing guidelines to streamline handoffs, and this study adds evidence that such efforts could help safeguard patient well-being.

Even while hospital leaders, educators and policymakers are working to design standardized guidelines, oversight and training aimed at neutralizing bias, Wesevich emphasizes that patients and families can also make a difference. Speaking up when something feels “off,” making sure questions are answered well, and ensuring that the next shift knows important details could all help counter the effects of stereotyping, blame and doubt.

“Those who work in healthcare are often very well-intentioned, but they’re human beings, and they get frustrated by things, and they express different biases — both implicit and explicit,” Wesevich said. “So trying to advocate for yourself or your loved ones is important because you don’t know if a clinician heard or internalized everything you’d want them to know when caring for you after a handoff.”

“Biased Language in Simulated Handoffs and Clinician Recall and Attitudes” was published in JAMA Network Open in December 2024. Additional authors include Erica Langan, Ilona Fridman, Sonya Patel-Nguyen, Monica Peek and Victoria Parente.