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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 wording could lead to worse health outcomes, although the survey cannot show that it caused errors or poorer care.
More than one in six adults surveyed said they had seen disrespectful or judgmental language in their own medical records or a loved one’s, according to a nationally weighted survey published in JAMA Network Open. Nearly three-quarters believed such language could lead to worse health outcomes, though the study measured respondents’ reports and views, not whether the wording caused medical errors.
Natasha Steele, MD, MPH, of Stanford University School of Medicine, and colleagues surveyed 500 adults online from November 21 to December 4, 2025. Overall, 17.1% reported encountering disrespectful or judgmental wording in medical records. A similar share, 15.6%, said they had experienced such language during an in-person health care encounter.
Respondents also described possible effects on their future interactions with clinicians. 73.3% believed disrespectful language could lead to worse health outcomes, including examples such as a wrong prescription or a diagnostic error. Another 74.7% said it could influence care from a new clinician, and 85.5% said they would be less likely to return to a clinician who used such language.
The researchers reported associations between some patient characteristics and reported experiences. In adjusted analyses, people with low income had higher odds of reporting disrespectful or judgmental language than those with high income (adjusted odds ratio 2.64, 95% confidence interval 1.18–5.91). People with a chronic pain diagnosis also had higher odds than those without one (adjusted odds ratio 3.25, 95% confidence interval 1.46–7.26). These associations do not establish why the experiences occurred.
How Wording Can Affect Patient Trust
The results point to a potential connection between the language used in care and patients’ trust and willingness to return. If patients feel judged by notes or conversations, they may be less comfortable engaging with clinicians or seeking follow-up. The survey records respondents’ expectations and reports; it does not establish that disrespectful wording caused a particular health outcome or led patients to leave care.
The authors also described possible consequences for health systems if patients disengage, including missed follow-up, duplicated costs, diagnostic delays and problems transferring information between clinicians. Those are concerns raised by the researchers, not outcomes measured by this survey. The findings nonetheless make the issue relevant beyond the wording of an individual note: communication may shape whether patients trust records and continue care.
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Patient Access to Clinical Notes
The study is set against wider patient access to electronic records. A provision of 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. That access can give patients a closer view of how clinicians document their care, the researchers said.
Although stigmatizing language has been described in clinical documentation across health care settings, the authors said there has been limited research focused on patients’ perspectives. In this survey, 71.2% of respondents used a patient portal. The survey also assessed respondents’ experiences with language used during in-person care, allowing the researchers to compare reports about records with those about encounters.
“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 findings are based on a cross-sectional survey, so they cannot establish cause and effect or show that reported language led to worse health outcomes. Responses were self-reported and may be affected by recall or reporting bias. The online survey may also have underrepresented people with limited access to or familiarity with technology.
The study reports how often respondents said they encountered disrespectful or judgmental language and what they thought it might mean for care. It does not identify the specific wording in each record, independently verify individual reports, or measure subsequent prescriptions, diagnostic errors or clinical outcomes. The available findings also do not explain why low-income respondents and people with chronic pain reported these experiences more often.
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Calls for Respectful Documentation Standards
Steele and colleagues called for clear standards for respectful communication and for clinical training to emphasize person-centered language, including attention to populations that may face bias. The study does not set out a timetable for new standards or identify a specific policy change that will follow.
Further research would be needed to test whether training or documentation standards change the language in clinical notes, patients’ trust, follow-up, or health outcomes. For now, the authors frame their results as evidence of patient concerns and a reason for health care organizations to examine how clinicians document and discuss care.
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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 language in their own records or a loved one’s.
Did the survey prove that this language causes worse health outcomes?
No. The survey measured reports and beliefs, and its cross-sectional design cannot establish causation. Nearly three-quarters of respondents believed the language could lead to worse outcomes, but the study did not track whether errors or poorer outcomes followed.
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. This was a reported intention, not a measure of later appointment behavior.
Which groups were more likely to report these experiences?
In adjusted analyses, respondents with low income and those with a chronic pain diagnosis had higher odds of reporting disrespectful or judgmental language than the comparison groups. The study does not establish the reasons for these differences.
What do the researchers recommend?
The authors called for clear standards for respectful communication in records and clinical interactions, along with training in person-centered language. They did not announce a specific implementation plan or deadline.
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