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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 survey cannot establish that it caused harm.
A nationally weighted survey of 500 U.S. adults found that 17.1% had seen 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 language could contribute to worse health outcomes, raising concerns about trust and patient engagement as clinical notes become available through online portals.
The survey was conducted from November 21 to December 4, 2025, by a team led by Natasha Steele, MD, MPH, of Stanford University School of Medicine. Of the 500 respondents, the mean age was 48; 51% were women, 60% were white, 11% were Black and 18% were Hispanic. About 71.2% said they used a patient portal.
Alongside the 17.1% who reported seeing disrespectful or judgmental wording in medical records, 15.6% reported encountering such language in person during healthcare visits. The survey also found that 74.7% thought the language could influence care from a new clinician, while 85.5% said they would be less likely to return to a clinician who used it.
In adjusted analyses, respondents with low incomes were more likely than those with high incomes to report encountering the language, as were people diagnosed with chronic pain compared with people without that diagnosis. The researchers also found an association between reporting stigmatizing language and lower trust in clinicians’ documentation skills. These are associations reported by the study; the survey does not show that income, chronic pain or the language itself caused the reported outcomes.
How Wording May Affect Patient Trust
The findings matter because medical records are used to communicate information among healthcare professionals and increasingly are read by patients themselves. If a patient believes a note is disrespectful or judgmental, that may affect their trust in the clinician and the record, or their willingness to continue care. In the survey, 85.5% said they would be less likely to return to a clinician who used such language, indicating a possible risk of disrupted follow-up.
The study authors said fragmented care could make it harder to maintain continuity, particularly for groups already at risk of gaps in care. They also pointed to possible consequences for health systems, including missed follow-up, duplicated costs and delays. Those consequences are concerns raised by the authors, not outcomes measured or proven by this survey. Likewise, the 73.3% who anticipated worse health outcomes were reporting their beliefs; the survey did not track medical errors or patient health outcomes.
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Patient Access to Clinical Notes
The researchers framed the study against 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. Wider access means patients can read the wording clinicians use in documentation, making the tone and phrasing of notes more visible to them.
The authors wrote that stigmatizing language has been documented across healthcare settings, while patient perspectives on that language have received less research attention. Their survey adds patients’ reported experiences and perceptions, but it does not establish how often such language appears in records overall: the 17.1% figure is the share of survey respondents who said they had encountered it, not an audit of medical notes.
“Clinical training programs should emphasize person-centered language, particularly since written notes are increasingly visible to patients.”
— Steele and co-authors
What the Survey Cannot Establish
The study used a cross-sectional design, capturing responses at one point rather than following patients over time. It therefore cannot show that disrespectful language caused lower trust, changed care decisions or led to worse health outcomes. Responses were self-reported and may be affected by recall or reporting bias; researchers also cautioned that an online survey may underrepresent people with limited access to or familiarity with technology.
The survey does not identify the specific wording respondents encountered or independently verify their records. It also does not measure whether respondents’ anticipated effects—such as diagnostic errors, prescriptions for the wrong medicine or changes in care—actually occurred. The results describe the experiences and beliefs reported by this sample, not a direct assessment of clinical harm.
Standards and Training in Focus
The researchers argue for clear standards for respectful communication and for clinical training to emphasize person-centered language, with attention to groups that may be subject to bias based on social identity. The report does not announce a new policy or specify a timeline for implementing such changes.
Further research could examine medical records directly, follow patients over time and test whether changes in documentation practices affect trust, engagement or health outcomes. Until such evidence is available, the current findings are best read as a measure of what respondents reported and believed, rather than proof that language in a note caused a particular clinical result.
Key Questions
How many respondents reported disrespectful language in medical records?
17.1% of the 500 adults surveyed said they had encountered disrespectful or judgmental language in their own records or a loved one’s.
Did the survey show that the language caused worse health outcomes?
No. 73.3% of respondents believed such language could lead to worse outcomes, but the cross-sectional survey did not measure or establish that it caused medical errors or poorer health.
Who was more likely to report encountering the language?
In adjusted analyses, people with low incomes were more likely than those with high incomes to report it. Respondents diagnosed with chronic pain were also more likely to report it than those without a chronic pain diagnosis. These are associations, not evidence of cause.
Why are patients seeing more of their medical notes?
The report points to the information-blocking rule under the 21st Century Cures Act, which requires clinical notes to be made available promptly to patients through electronic health record portals.
What did the researchers recommend?
The authors called for clear standards promoting respectful language in records and clinical interactions, and for training that emphasizes person-centered communication. The report does not set a timeline for those changes.
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