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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 a loved one’s. Nearly three-quarters believed such language could lead to worse health outcomes, though the study measured perceptions and cannot establish that the language caused medical errors.
A nationally weighted survey found that 17.1% of 500 U.S. adults had seen disrespectful or judgmental language in their own medical records or a loved one’s, while 73.3% believed such language could lead to worse health outcomes. The findings, reported by researchers led by Natasha Steele of Stanford University School of Medicine in JAMA Network Open, describe patients’ experiences and concerns; they do not show that disrespectful wording caused errors or poorer outcomes.
The survey was conducted online from November 21 to December 4, 2025. Respondents had a mean age of 48; 51% were women, 60% were White, 11% were Black and 18% were Hispanic. About 71.2% used a patient portal. Researchers also asked about in-person encounters: 15.6% reported experiencing disrespectful or judgmental language during healthcare interactions.
Respondents said they expected such language to affect their care and relationships with clinicians. Nearly three-quarters (74.7%) believed it 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. These figures reflect survey responses about perceived effects and intentions, not observed changes in treatment or follow-up.
In adjusted analyses, people reporting low income had higher odds of reporting disrespectful language than those with high income (adjusted odds ratio 2.64; 95% confidence interval 1.18–5.91). Respondents with a chronic pain diagnosis also had higher odds than those without one (aOR 3.25; 95% CI 1.46–7.26). Reporting stigmatizing language was associated with lower trust in clinicians’ documentation skills (aOR 5.76; 95% CI 2.90–11.46). These associations do not establish why the differences occurred or prove cause and effect.
Patient Trust and Care Continuity
The results point to a potential problem extending beyond how a note makes a patient feel. If patients lose trust in clinicians or avoid returning to a provider, care may become fragmented, with possible consequences for follow-up and communication between clinicians. The study authors said fragmented care could bring risks such as delayed diagnoses, duplicated costs and gaps in preventive care, but the survey did not measure whether those outcomes occurred.
Medical records are also increasingly visible to patients through online portals. That makes the wording clinicians use relevant to both care teams and the people described in the notes. The survey suggests that respondents view disrespectful language as a concern for their care, particularly among groups who may already face barriers to consistent healthcare. It does not quantify how often such language appears across all records or establish that every reported instance was documented in the same way.
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Patient Access to Clinical Notes
The researchers situated the survey in the period after the 21st Century Cures Act information-blocking rule, which requires clinical notes to be made available promptly to patients through electronic health record portals. The authors wrote that stigmatizing language is pervasive in clinical documentation across healthcare settings, while noting that research on patients’ perspectives has been limited.
By asking adults about both written records and in-person interactions, the study examined how respondents encountered and interpreted language in care. The survey was a cross-sectional snapshot, not a review of medical records or a study tracking patients’ health over time. Its findings therefore add information about reported experience and perception rather than a direct audit of clinicians’ notes 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
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Limits of the Survey Evidence
The study’s cross-sectional design cannot establish causation: it cannot show that disrespectful language caused worse health outcomes, reduced trust or changes in care. The responses were self-reported, which can be affected by recall or reporting bias, and an online survey may underrepresent people with limited internet access or digital skills. The researchers also did not establish how frequently such language occurs across all clinical records or independently verify each reported example.
The reported links with low income, chronic pain and trust are statistical associations, not proof that those characteristics caused patients to encounter stigmatizing language. The survey also asked about respondents’ beliefs and intentions; it did not track whether they actually changed clinicians, missed follow-up or experienced medical errors.
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Standards and Training Under Discussion
The authors called for clear standards for respectful communication in clinical documentation and interactions, and for person-centered language to receive emphasis in clinical training. The report does not announce a new policy, timetable or mandated change. Any such steps would require action beyond the survey itself.
Further research could examine clinical notes directly and follow patients over time to test whether wording is linked to changes in trust, engagement or care outcomes. For now, the study provides a national survey snapshot of reported experiences and concerns, with the authors’ recommendations as the stated next step.
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Key Questions
How many respondents reported disrespectful language in medical records?
17.1% of the 500 adults surveyed reported disrespectful or judgmental language in their own records or in a loved one’s. The result comes from self-reported survey responses, not an independent review of medical records.
Did the survey show that disrespectful wording causes medical errors?
No. 73.3% of respondents believed such language could lead to worse health outcomes, but the cross-sectional survey measured perceptions and did not establish that wording caused diagnostic errors, incorrect prescriptions or other outcomes.
Who was more likely to report encountering this language?
In adjusted analyses, respondents reporting low income and those with a chronic pain diagnosis had higher odds of reporting disrespectful or judgmental language than their comparison groups. These are associations, not evidence of cause and effect.
What did the researchers recommend?
The authors called for clear standards for respectful communication in medical records and clinical interactions, and said clinical training should emphasize person-centered language, particularly for populations that may be subject to bias.
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