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Snarky Sign-outs – How to Avoid Bias During Handoff

November 9, 2023

Written by Clay Smith

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Our words during handoff can bias our colleagues against our patients. Here’s how it happens and what we can do to improve.

Dude was so drunk he…oh wait…sorry
This was a cross-sectional audio analysis of 302 internal medicine and pediatric resident inpatient handoffs coded for issues that might introduce bias: 1) stereotypes – perpetuating negative stereotypes, 2) blame – blaming the patients for their symptoms, and 3) doubt – casting doubt on patient reports and experiences. In total, 23% of handoffs had some type of biased language. Black race was associated with any bias: OR 1.7 (95%CI 1.0-3.0, p=.049). Stereotyping was present in 11%; blaming in 13%; doubt in 5%.

I thought some of the concrete examples were helpful. For stereotyping, an immigrant patient was called a “mail-order bride.” For blame, a motor vehicle crash with spine fracture was attributed to the patient being “drunk,” and a leaky ostomy was blamed on a patient’s obesity. For doubt, a patient’s 10 out of 10 pain attributed to bunions was questioned, and another patient was said to have “malingering-type behavior.”

How will this change my practice?
We don’t want to bias our colleagues during handoff. On the other hand, we want to avoid credulity and don’t want our colleagues to be unaware of real issues, such as malingering or intoxication. That said, our words matter and can cause serious hurt. I have said so many stupid things. So, as an expert in putting my foot in my mouth, I try hard to only say things about people that I would say in front of them.

Patient Factors Associated With Biased Language in Nightly Resident Verbal Handoff. JAMA Pediatr. 2023 Oct 1;177(10):1098-1100. doi: 10.1001/jamapediatrics.2023.2581.

What are your thoughts?