The Point of View of a Sentiment: Towards Clinician Bias Detection in Psychiatric Notes

Abstract

Negative patient descriptions and stigmatizing language can contribute to generating healthcare disparities in two ways: (1) read by patients, they can harm their trust and engagement with the medical center; (2) read by physicians, they may negatively influence their perspective of a future patient. In psychiatry, the patient-clinician therapeutic alliance is a major determinant of clinical outcomes. Therefore, language usage in psychiatric clinical notes may not only create healthcare disparities, but also perpetuate them. Recent advances in NLP systems have facilitated the efforts to detect discriminatory language in healthcare. However, such attempts have only focused on the perspectives of the medical center and its physicians. Considering both physicians and non-physicians' point of view is a more translatable approach to identifying potentially harmful language in clinical notes. By leveraging pre-trained and large language models (PLMs and LLMs), this work aims to characterize potentially harmful language usage in psychiatric notes by identifying the sentiment expressed in sentences describing patients based on the reader's point of view. Extracting 39 sentences from the Mount Sinai Health System containing psychiatric lexicon, we fine-tuned three PLMs (RoBERTa, GatorTron, and GatorTron + Task Adaptation) and implemented zero-shot and few-shot ICL approaches for three LLMs (GPT-3.5, Llama-3.1, and Mistral) to classify the sentiment of the sentences according to the physician or non-physician point of view. Results showed that GPT-3.5 aligned best to physician point of view and Mistral aligned best to non-physician point of view. These results underline the importance of recognizing the reader's point of view, not only for improving the note writing process, but also for the quantification, identification, and reduction of bias in computational systems for downstream analyses.