In the mid-1990s, when Somnath Saha was a medical resident at the University of California, San Francisco School of Medicine, he came across a cluster of studies showing that Black people with cardiovascular disease were treated less aggressively compared to White people. The findings were “appalling” to the young physician who describes himself as a “Brown kid from suburban St. Louis, Missouri.”

Saha had experienced racism growing up, but was surprised to see such clear signs of inequity within the field of medicine. “There was an injustice happening in my own backyard,” he said.

Indeed, bias towards Black patients can be challenging because many doctors either don’t realize their biases or won’t admit to them. Saha, now a professor of medicine at Johns Hopkins University, likens implicit bias — unconscious judgments that can affect behavior — to “an invisible force.”

While numerous studies have found evidence of racial discrimination in medicine through patient reports, less is known about how implicit bias shows up in medical records, and how stigmatizing language in patient notes can affect the care that Black patients receive.

That’s part of the reason why, about seven years ago, Saha began poring through medical records. For him, they offered a window into doctors’ feelings about their patients.

As part of his latest research, Saha’s team examined the records of nearly 19,000 patients, paying particular attention to negative descriptions that may influence a clinician’s decision-making. The data, which was recently presented at the 2023 American Association for the Advancement of Science annual meeting, isn’t yet published, but it suggests what researchers have long speculated: Doctors are more likely to use negative language when describing a Black patient than they are a White patient. The notes provide, at times, a surprisingly candid view of how patients are perceived by doctors, and how their race may affect treatment.

The study adds to a concerning body of literature that explores how racial bias manifests in health care. Researchers like Saha are interested in how such prejudice leaves a paper trail, which can then reinforce negative stereotypes. Because medical notes get passed between physicians, Saha’s research suggests they can affect the health of Black patients down the line.

“The medical record is like a rap sheet, it stays with you,” Saha said, adding that “these things that we say about patients get eternalized.”

Research has long shown that Black patients experience worse health outcomes compared to White patients, in part due to biased medical care. Black women, for example, are three times more likely to die from pregnancy-related complications compared to White women. And Black patients often report feeling like physicians don’t listen to their needs or don’t believe their concerns.

Studies appear to back that up. Last year, researchers at the University of Washington found that non-Hispanic White children who went to the emergency room for migraines were more likely to receive pain medications compared to children of color — even though the two groups reported similar pain scores. Other studies echo similar results for adults as well.