Judgmental language in medical charts reflects poor patient care and outcomes: researcher

“Non-compliant” isn’t a word most of us use in common speech, but it shows up a lot in medical charts. It’s jargon, a kind of shorthand that doctors, counsellors and other medical professionals use to describe their patients. It can mean anything from “the patient isn’t taking their medication properly” to “they don’t show up for appointments.”

It may also be a sign of a communication breakdown between clinician and patient that could lead to poor care and serious mental health outcomes, according to Mallory Minerson. 

Minerson is a PhD candidate in psychiatry at U of A who works as the regional clinical supervisor for mental health and addictions for the Beaufort Delta region of the Northwest Territories, which includes the northern coastal area of NWT and the territory’s High Arctic islands. 

Minerson will carry out a retrospective chart review, data mining electronic chart notes back to 2015, the year the Truth and Reconciliation Commission of Canada made its final report. She will explore how the language used when interacting with mental health professionals impacts patients’ experience and outcomes.

“My research seeks to unpack the way that we document and speak to our clients so that people feel more engaged and respected in their care,” Minerson explains. “That involves decolonizing the language we use and getting to the heart of the encounter.” 

“We hope that her work helps contribute to a learning health system for the Northwest Territories,” says John B. Zoe, governing council chair of Hotıì ts’eeda, a research support unit of Tłı̨chǫ, a self-governed region of NWT.

Hotıì ts’eeda and Mental Health Research Canada awarded Minerson a new Įnı̀ Gomǫò Whehdıı̀ Studentship to support her work. Įnı̀ Gomǫǫ̀ Whehdı̀ı means “embracing spirit” in the Tłı̨chǫ language. 

“It’s actually preventative care”

Born in Calgary, Minerson started her working life as a musical theatre performer, then discovered that she could use the arts to help people with mental health challenges. Trained as both a drama therapist and a licensed practical nurse, Minerson has experience in forensic psychiatry and addictions treatment. She’s worked in Canada’s North since 2018 and now supervises 12 therapists who care for the 6,000 people who live in eight High Arctic communities in NWT. 

“I really believe that as non-Indigenous practitioners in Canada, we have a responsibility to do reconciliation work through the care we provide,” she says.

As she sifts through the charts, Minerson will be on the lookout for shorthand phrases that can be judgmental or even racist.

“I am interested in the journey that people have taken, so I will often pull the chart and read a lot of the history when I’m taking care of folks and it’s surprising — and also not — how language influences the care that people receive. The language often discounts Indigenous knowledge and also just the patient knowing themselves.”

For example, a patient who “no-shows” for an appointment may have been up all night with a crying baby. The clinician could investigate ways to support them, perhaps connecting them with respite care or a postnatal clinic, Minerson suggests. 

“Is there something we can do to help them achieve the health outcome they are working towards, instead of just labelling it as a no-show and judging that they don’t care and are disrespecting the clinician’s time?” Minerson wonders.

Minerson will work with a community advisory committee made up of patient representatives, youth and members of the Inuvialuit Regional Corporation and the Gwich’in Tribal Council, the two main Indigenous governments in Inuvik, where she is based.

Her goal is to develop a medical language guide and toolkit that specifically references the needs of the Beaufort Delta region. “The reason I’m doing this is to provide better care and better health outcomes and better health equity for the communities I serve.“

She points out that failing to change could have serious consequences for people and communities. The NWT and Nunavut have the highest rates of suicide in Canada compared with other provinces and territories, and Minerson sees language as pivotal in primary mental health care.

“It’s preventative care to do this work,” she says. “It can be the difference between somebody saying, ‘Screw it,’ when they leave the emergency department and going out to do more harm to themselves versus somebody walking out and saying, ‘I have hope, I have support.’”

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