Disrespectful Language in Medical Records Isn't Rare, Survey Shows

— Majority felt it would lead to worse health outcomes

A sizeable proportion of patients reported disrespectful or judgmental language in their medical records, a nationally weighted survey showed.

More than one in six adults (17.1%) reported such language in their own medical records or in those of a loved one, Natasha Steele, MD, MPH, of Stanford University School of Medicine in California, and colleagues wrote in JAMA Network Openopens in a new tab or window.

More concerningly, nearly three-quarters (73.3%) believed that language would lead to worse health outcomes, such as a prescription for the wrong medicine or diagnostic errors, they noted.

"Our study demonstrates the need for clear standards promoting respectful communication in both medical documentation and clinical interactions," Steele and team wrote. "Clinical training programs should emphasize person-centered language, particularly since written notes are increasingly visible to patients, with special attention to populations that may be subject to bias based on social identity."

The 21st Century Cures Act contained a provision known as the information-blocking ruleopens in a new tab or window, which mandated that clinical notes must be made available immediately to patients through their electronic health record portals. Stigmatizing language is "pervasive in clinical documentation across healthcare settings," the researchers wrote, but there has been little research on the patient perspective of such language.

Given the potential for increased insights into clinical notes with the information-blocking rule, Steele and colleagues conducted a survey from Nov. 21 to Dec. 4, 2025 to assess that perspective. A total of 500 adults responded. Their mean age was 48, 51% were women, 60% were white, 11% were Black, and 18% were Hispanic.

The majority of respondents used their patient portal (71.2%) while the rest did not; their experience encountering disrespectful or judgmental language in person was assessed. A similar proportion (15.6%) reported disrespectful or judgmental language during in-person healthcare encounters.

Among all 500 respondents, 74.7% believed such language would influence subsequent care from a new clinician, and the vast majority (85.5%) said they would be less likely to return to the clinician who used that language -- thus having larger implications.

"Fragmented care may exacerbate individual preventive care among patient groups already at risk for care discontinuity and worsen financial implications for health systems due to loss to follow-up, duplication costs, diagnostic delays, or other errors stemming from inadequate information transfer," Steele and co-authors wrote.

In adjusted analyses, patients who reported low income had a greater likelihood of reporting disrespectful or judgmental language compared with those with high income (aOR 2.64, 95% CI 1.18-5.91, P=0.03). The same was true for those with a diagnosis of chronic pain compared with no chronic pain diagnosis (aOR 3.25, 95% CI 1.46-7.26, P=0.004).

Experiencing stigmatizing language was also associated with diminished trust in clinicians' documentation skills (aOR 5.76, 95% CI 2.90-11.46, P<0.001).

The study was limited by its cross-sectional design, which limits causal inference. Also, it relied on self-reported data, which could introduce potential recall and reporting biases. Finally, the online survey method used may underrepresent those with limited technological access or fluency, the researchers noted.

Still, they concluded that the findings are "consistent with a broader literature on stigma and health communication, demonstrating that [disrespectful or judgmental language] can undermine trust, reduce patient engagement, and negatively influence patient perceptions of health outcomes."