Negative descriptors in clinician notes for sickle cell patients are closely associated with stigma surrounding opioid use.
RT’s Three Key Takeaways:
- Opioid Stigma Connection: Researchers found that patients with sickle cell disease are more likely to have negative descriptors in their clinical notes due to clinician bias surrounding opioid use rather than race or chronic pain alone.
- Clinical Consequences: Negative biased language in patient records is associated with decreased clinician empathy and less accurate recall of critical patient health details.
- Educational Solutions: An anti-bias curriculum utilizing roleplay and skills-based learning is currently being tested to mitigate these biases and improve care quality for patients with sickle cell disease.
New research from UChicago Medicine suggests that clinician bias toward patients with sickle cell disease may be primarily driven by stigma associated with opioid use. The study, published in Journal of the American Medical Association (JAMA) Network Open, analyzed how intersectional factors like race, chronic pain, and opioid treatment influence the language clinicians use in medical records.
“Nationwide, patients with sickle cell disease are not receiving the same quality of care that other patients experience,” said Austin Wesevich, MD, a hematologist and health services researcher at the University of Chicago Medicine, in a news release.
The research team employed natural language processing (NLP) and machine learning to review the electronic health records (EHR) of more than 18,000 adult patients. The analysis included nearly 40,000 clinician notes, searching for negative descriptors such as “aggressive,” “noncooperative,” and “noncompliant.”
According to the study, patients with sickle cell disease had higher odds of having negative descriptors in their records compared to Black patients and patients with chronic pain. However, their odds were similar to those of patients diagnosed with opioid use disorder, suggesting that bias toward sickle cell patients is most strongly connected to opioid use stigma.
“Although patients with sickle cell disease routinely use opioid medications to manage their chronic pain, the vast majority do not have an opioid use disorder,” said Monica Peek, MD, the Ellen H Block professor for health justice at UChicago Medicine, in a news release. “And yet, within healthcare professions and society as a whole, there is a persistent bias that stereotypes these patients primarily as ‘drug-seekers’ rather than regular people managing a chronic disease.”
The study also highlighted the downstream effects of these biases. Previous research from 2024 indicated that when clinicians encounter negatively biased language in a patient’s record, they demonstrate less empathy and are less likely to accurately recall critical health details.
In response to these findings, Wesevich, Peek, and colleagues developed an anti-bias educational intervention. The curriculum uses adult learning theory, incorporating roleplay and skills-based learning to demonstrate how bias affects care quality.
“Clinicians cannot measure pain directly without asking the patient, so it’s a choice to believe patients when they share their pain levels,” said Wesevich, in a news release. “A patient with sickle cell disease who experiences daily pain and who happens to be Black and asking for opioid treatment deserves no less trust than any other patient.”
The curriculum has been delivered to nearly 70 UChicago Medicine residents during the 2025-2026 academic year. Early data collection suggests the intervention is effective, and several other academic institutions have expressed interest in the program.
“We need effective anti-bias interventions to improve care for patients with sickle cell disease, and this deeper understanding is a step in the right direction,” said Wesevich, in a news release.
