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A nationally weighted survey of 500 adults found that 17.1% reported disrespectful or judgmental language in their own medical records or a loved one’s. Nearly three-quarters believed such wording could contribute to worse health outcomes, though the cross-sectional, self-reported study cannot show that it caused harm.
A nationally weighted survey of 500 U.S. adults found that 17.1% had encountered disrespectful or judgmental language in their own medical records or those of a loved one, researchers reported in JAMA Network Open. Nearly three-quarters of respondents said they believed such wording could lead to worse health outcomes, but the survey measured perceptions and experiences, not whether the language caused clinical harm.
The researchers, led by Natasha Steele, MD, MPH, of Stanford University School of Medicine, surveyed adults online from November 21 to December 4, 2025. The respondents had a mean age of 48; 51% were women, 60% were white, 11% were Black and 18% were Hispanic. About 71.2% said they used a patient portal, through which many patients can read clinical notes.
Alongside the 17.1% who reported language in medical records, 15.6% said they had experienced disrespectful or judgmental language during an in-person health care encounter. The survey did not establish that these were the same people or that the experiences had the same effects. Overall, 73.3% believed such language could lead to worse health outcomes, including errors such as receiving the wrong medication or a diagnostic mistake.
Other responses pointed to possible effects on patients’ relationships with care providers: 74.7% believed the language could influence subsequent care from a new clinician, while 85.5% said they would be less likely to return to a clinician who used it. These figures describe respondents’ stated beliefs and intentions, not observed changes in care or health.
How Wording Can Affect Patient Trust
The findings matter as more patients can read clinicians’ notes through electronic health record portals. Language that patients experience as dismissive or judgmental may affect how they view their care and whether they feel comfortable returning to a clinician. The study’s results suggest that the issue may touch both written records and in-person communication.
The authors also raised a potential effect on continuity of care. If patients avoid a clinician after encountering stigmatizing language, care could become fragmented; the researchers said that fragmentation may contribute to missed preventive care, delays, repeated costs or problems transferring information. Those are possible consequences discussed by the authors, not outcomes measured by this survey.
In adjusted analyses, respondents with low income were more likely than those with high income to report such language (adjusted odds ratio 2.64; 95% confidence interval 1.18–5.91). Those with a chronic pain diagnosis were also more likely to report it than those without one (adjusted odds ratio 3.25; 95% confidence interval 1.46–7.26). The associations identify groups reporting different experiences; they do not establish why those differences occurred.
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Patient Access to Clinical Notes
The survey was conducted against a change in how patients encounter medical documentation. A provision in the 21st Century Cures Act, known as the information-blocking rule, requires clinical notes to be made available to patients promptly through electronic health record portals. The researchers said this increased visibility makes the language used in notes more directly relevant to patients’ experience of care.
Prior research has described stigmatizing language in clinical documentation across health care settings, according to the study authors. They said there has been less research on patients’ perspectives. Their report addresses that gap by asking adults whether they encountered disrespectful or judgmental wording in records and care encounters, and how they thought it might affect future care.
The authors called for clear standards for respectful communication in medical documentation and clinical interactions. They also said clinical training should emphasize person-centered language, with attention to groups that may face bias based on social identity. The survey did not test whether particular standards or training programs would change documentation or patient outcomes.
“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.”
— Steele and co-authors
Limits of the Survey Findings
The study used a cross-sectional design, so it cannot establish whether disrespectful language caused lower trust, changes in care or worse health outcomes. Responses were self-reported and may be affected by recall or reporting bias. The online survey could also underrepresent people with limited access to or familiarity with technology.
The findings reflect what this sample reported and believed; they do not verify the wording in medical records or measure subsequent diagnoses, prescriptions, visits or health outcomes. The reported associations with income and chronic pain likewise do not explain the reasons behind those patterns. The study authors said the results were consistent with broader research on stigma and health communication, but the survey itself cannot establish cause and effect.
Standards and Training Under Discussion
The authors’ proposed next steps are to develop clear expectations for respectful language in both records and clinical interactions, and to reinforce person-centered communication in clinical training. Their call gives health systems and educators a practical area to address, particularly as patients gain access to more of their notes.
The report does not announce a new policy, implementation schedule or follow-up study. It is not yet clear whether health systems will adopt specific standards or how any changes would be evaluated. Further research would be needed to test whether documentation or training changes affect patient trust, engagement and measurable care outcomes.
Key Questions
How many people reported disrespectful language in medical records?
17.1% of the 500 survey respondents said they had encountered disrespectful or judgmental wording in their own records or those of a loved one.
Did the survey show that the language caused worse health outcomes?
No. 73.3% said they believed such language could lead to worse outcomes, but the study measured reported experiences and perceptions. Its cross-sectional design cannot establish that the language caused clinical harm.
How many respondents reported disrespectful language in person?
15.6% reported disrespectful or judgmental language during an in-person health care encounter. The survey did not establish whether those respondents were the same people who reported wording in medical records.
What limitations did the researchers identify?
The study relied on self-reported responses and a single point-in-time survey, which limits conclusions about cause and effect and can introduce recall or reporting bias. Its online format may also have underrepresented people with limited technology access or fluency.
Source: rss
