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In this blog, Catia Nicodemo and Brooke Scoles explain how research from the Health Economics group of the Nuffield Department of Primary Care Health Sciences and the London School of Economics found that language from online discussions reveals doctors have more negative attitudes toward specific medical conditions. This was true even when comparing diseases with similar characteristics.

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Our study, recently published in the Journal of Economic Behavior & Organization, analysed the perspectives of doctors expressed in online medical forums. We studied stigma by utilising variations in text data from physician comments in online discussions for a range of diseases and comparing diseases with similar severity.

In this study, we try to answer the following question: do medical professionals judge chronically ill patients differently depending on their specific disease? Patients deserve equal and compassionate treatment. If healthcare providers take preconceived prejudices into practice, changes to training and recruitment may affect the quality of care. These prejudices may distort estimates of the number of people who suffer from these diseases and may distort research priorities. Diseases the medical community considers undeserving may receive disproportionately low attention compared to their severity and prevalence. Thus, a deeper understanding of this topic is important to ensure compassionate patient treatment, to shape healthcare policies, and to promote efficient functioning of healthcare markets.

First, we compared a range of diseases against three categories: myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), depression, and the autoimmune diseases multiple sclerosis and rheumatoid arthritis. Next, we used dictionary methods to compare five additional chronic diseases: Lyme disease, Ehlers-Danlos syndrome (EDS), Alzheimer’s disease, osteoporosis, and lupus.

We found that physicians discussed ME/CFS, depression, and Lyme disease with more negative language than the other diseases in the set. In discussions of ME/CFS, physicians used more than four times more stigmatising words than for depression. Compared to depression, for ME/CFS, there were more stigmatising words, the words were harsher in tone, and the words were more strongly associated with the disease.

The results also showed lower incidence of medical jargon for stigmatised diseases, suggesting that studies on stigma can use medical jargon as an implicit measure of the concept.

Our research made use of the fact that emotions can be measured in language. Using machine learning and natural language processing, we compared whether diseases with similar symptom profiles and demographic characteristics were discussed with different types of words.

We found that doctors did use more judgemental language when discussing particular diseases. Interpreting language requires analysing context, which is why studies on stigma usually are completed qualitatively. This limits the work to studying specific diseases with small sample sizes. However, using computerised methods allows researchers to compare an array of diseases across large amounts of text.

Beliefs impact behaviours. If patients with the same severity of symptoms are viewed differently based on their disease type they may receive lower quality of care and this can impact population health. Negative biases toward patients can result in delays in referrals and the delay or denial of treatment. Receiving delayed treatment or the wrong treatment can cause patients to remain sick and prevent improvements in these patients’ health.

Further, if diseases impact certain groups disproportionately, this can perpetuate existing inequalities. Thus, understanding physician perspectives is important for understanding inequalities in other markets, e.g. the labour market. It is also important for understanding determinants of productivity and ultimately GDP.

The implications of this are significant. If the views of the medical community are not objectively determined this can result in patients receiving lower quality of care than would be appropriate for the severity of the condition. Negative views among the medical community could impact research if conditions that are stigmatised or minimised are not prioritised for funding. It could also impact the level of researcher interest which is a variable used in funding decisions.

Patients deserve to be treated compassionately, and for those with severe illnesses, they deserve commensurate treatment. If healthcare providers take the preconceived prejudices expressed online into their practice, this can impact quality of care. By identifying widespread yet previously unrecognised stigma associated with ME/CFS, depression, and Lyme disease, physicians and health systems can develop methods to address these biases and improve patient care.

Read the article here: https://www.sciencedirect.com/science/article/pii/S016726812200347X

Opinions expressed are those of the author/s and not of the University of Oxford. Readers' comments will be moderated - see our guidelines for further information.

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