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A nationally weighted survey of 500 adults found that 17.1% had encountered disrespectful or judgmental language in their own medical records or a loved one’s. Nearly three-quarters believed such language could contribute to worse health outcomes, though the study cannot establish that it caused them.
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, and 73.3% believed such language could lead to worse health outcomes. The findings, published in JAMA Network Open, capture patient reports and perceptions; they do not show that the language caused medical errors or poorer outcomes.
The survey was conducted from November 21 to December 4, 2025, by researchers led by Natasha Steele, MD, MPH, of Stanford University School of Medicine. Respondents were 48 years old on average; 51% were women, 60% were white, 11% were Black and 18% were Hispanic. About 71.2% said they used a patient portal, through which patients can access electronic health records.
Respondents also described experiences during in-person care: 15.6% reported disrespectful or judgmental language in a healthcare encounter. Overall, 74.7% believed such language could influence subsequent care from a new clinician, and 85.5% said they would be less likely to return to a clinician who used it. Those figures report participants’ expectations and intentions, not measured changes in care or follow-up.
In adjusted analyses, respondents with low incomes had higher odds of reporting such language than those with high incomes (adjusted odds ratio 2.64; 95% confidence interval 1.18–5.91). Respondents with chronic pain had higher odds than those without a chronic pain diagnosis (aOR 3.25; 95% CI 1.46–7.26). Reporting stigmatizing language was also associated with lower trust in clinicians’ documentation skills (aOR 5.76; 95% CI 2.90–11.46). These associations do not establish that income, chronic pain or the language itself caused the reported experiences or trust levels.
Patient Trust and Continuity of Care
The results point to a potential tension as patients gain more access to the notes clinicians write about them: documentation can support communication, but patients may also encounter wording they view as judgmental. The finding that 85.5% said they would be less likely to return to a clinician using such language raises a concern about trust and continuity, although the survey did not track whether respondents actually changed clinicians or missed care.
The researchers said fragmented care could affect preventive care and create costs for health systems through lost follow-up, duplicated services, diagnostic delays or errors linked to inadequate information transfer. Those are potential consequences described by the authors, not outcomes measured in this survey. The reported associations among low-income respondents and people with chronic pain also underscore why researchers called for attention to groups who may be more exposed to bias.
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Patient Access to Clinical Notes
The study was prompted in part by the 21st Century Cures Act’s information-blocking rule, which requires clinical notes to be made available to patients promptly through electronic health record portals. The expanded visibility of notes gives patients greater access to documentation, while making the language clinicians use more directly relevant to the patient experience.
The authors described stigmatizing language in clinical documentation as pervasive across healthcare settings, but said research on patients’ perspectives has been limited. Their survey adds reported experiences and perceptions to that discussion. It was a cross-sectional online survey, so it offers a snapshot rather than a record of changes over time or proof of cause and effect.
“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
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Limits of the Survey Findings
The study relied on self-reported experiences, which may be affected by recall or reporting bias, and its cross-sectional design cannot establish causation. An online survey may also underrepresent people with limited access to technology or less familiarity with it. The source report does not provide enough detail here to assess how respondents interpreted the terms “disrespectful” or “judgmental.”
The survey records participants’ perceptions that language could affect outcomes, trust or future care; it does not verify errors, compare clinical outcomes, or show that respondents actually left a clinician. The sample demographics and portal-use figures describe the respondents, but do not by themselves establish whether the results apply equally to every patient group.
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Calls for Respectful Documentation
The researchers called for clear standards for respectful communication and for clinical training programs to emphasize person-centered language, with particular attention to patients who may face bias tied to social identity. The report does not announce a new policy, implementation plan or timeline, and it does not specify which organization would set or enforce such standards.
Further research would be needed to test whether changes to documentation practices alter patient trust, follow-up or clinical outcomes. For now, the survey offers a patient-reported snapshot of the issue, while leaving open how often the language appears across the wider healthcare system and what effects it has in practice.
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Key Questions
How many respondents reported disrespectful language in medical records?
17.1% of the 500 survey respondents said they had encountered disrespectful or judgmental language in their own records or a loved one’s records.
Did the study show that the language caused worse health outcomes?
No. 73.3% believed the language could lead to worse outcomes, but the cross-sectional survey measured perceptions and reported experiences. It did not establish a causal link or track medical errors and outcomes.
What did respondents say about returning to a clinician?
85.5% said they would be less likely to return to a clinician who used disrespectful or judgmental language. The survey measured stated intentions, not whether respondents actually changed clinicians.
Who reported higher odds of encountering such language?
In adjusted analyses, respondents with low incomes and those with a chronic pain diagnosis had higher odds of reporting disrespectful or judgmental language than their respective comparison groups. The associations do not prove why those reports differed.
What did the researchers recommend?
The authors called for clear standards for respectful communication in medical records and clinical interactions, and for training that emphasizes person-centered language.
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