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Somnath Saha: Examining Clinician Bias and Underrepresentation in Medicine


“Sticks and stones may break my bones, but words can never hurt me,” so goes the old childhood saying. Somnath Saha, MD, MPH, a faculty member at the Johns Hopkins Center for Health Equity, says research shows this is far from the truth when it comes to the quality of healthcare.  

“Clinician bias is commonly considered a cause of health care disparities, but since most biases are unconscious, and therefore invisible, it is difficult to determine their impact on patient care,” Saha says. Through their research, Saha and his colleagues, including CHE faculty member Mary Catherine Beach, are exploring how issues such as stigmatizing language and underrepresentation of people from Black, Indigenous, and Latino communities in health professions impact health outcomes for historically disadvantaged populations. 

Stigmatizing language in medical records is a common pathway for bias and refers to the use of words or phrases that reinforce negative stereotypes, prejudices, or discriminatory attitudes toward certain groups of people. Such language may include phrases that suggest that the patient is responsible for their illness and/or that the patient is untruthful, for example, stating that “the patient claims…” or referring to a patient as “a drug addict.” 

“Clinician bias is commonly considered a cause of health care disparities, but since most biases are unconscious, and therefore invisible, it is difficult to determine their impact on patient care.” 
                                                                                                                       -Somnath Saha, MD, MPH

“Clinicians write notes about patients that are then read by other clinicians,” Saha explains. “Our work has shown that clinicians use more stigmatizing language when writing about Black versus White patients. We have also demonstrated that clinicians reading notes with stigmatizing language develop negative attitudes toward the patient that can adversely impact the quality of care that patient receives.” 

Saha's work highlights the role of stigmatizing language in medical records as a conduit for transmitting bias, particularly concerning Black versus White patients stating, “stigmatizing language represents a pathway by which clinician bias may contribute to racial disparities in the quality of care patients receive.” 

Saha’s research includes collaborations “with a multidisciplinary team including linguists, computer scientists, and experts in communication and health equity, to develop methods to detect and quantify stigmatizing language in medical records, and strategies to reduce the use of such language, with the hope of eliminating this potential source of inequitable care,” he says. 

Additionally, Saha is investigating how the underrepresentation of Black, Indigenous, and Latino communities in healthcare professions impacts the quality of care. There are disparities between the demographic composition of the US population and that of physicians, he says, and physicians from underrepresented backgrounds disproportionately serve disadvantaged communities, leading to higher-quality care for patients of color. 

“These groups comprise approximately 35% of the US population but only about 12% of US physicians,” he says, and these statistics are concerning  because, “Physicians who are underrepresented in medicine (URM) disproportionately provide care for disadvantaged communities, including communities of color, and that patients from these communities tend to receive higher-quality care when cared for by URM physicians.”  

According to Saha’s findings, increasing the number of URM physicians could improve health equity. But, he says, “efforts to remedy the underrepresentation of physicians of URM physicians have been hampered by a variety of obstacles, including the recent ban on affirmative action.” 

Despite these challenges, Saha remains committed to using his research to help inform policy. 

“Along with others, I am committed to contributing evidence and informing policy to work towards a more racially and ethnically diverse workforce to most effectively provide health care for an increasingly diverse population, with the ultimate goal of reducing inequities in health and health care,” he says. 

Learn more about Saha’s recent research.  

Development of a Tool to Measure Student Perceptions of Equity and Inclusion in Medical Schools

Validating Computer-Generated Measures of Linguistic Style Matching and Accommodation in Patient-Clinician Communication

Ambulatory Intensive Care for Medically Complex Patients at a Health Care Clinic for Individuals Experiencing Homelessness: The SUMMIT Randomized Clinical Trial

After Affirmative Action - Working Toward Equitable Representation in Medicine

Trajectories of care and outcomes of Veterans receiving home-based primary care

The RWJF Health Policy Research Scholars: Interdisciplinary Leaders Advancing Health Equity

Patient-Provider Shared Decision-Making, Trust, and Opioid Misuse Among US Veterans Prescribed Long-Term Opioid Therapy for Chronic Pain

Assessment and Prevention of Hypoglycemia in Primary Care Among U.S. Veterans: A Mixed Methods Study