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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. Most respondents said such language could worsen health outcomes or affect future care, but the survey cannot establish that it caused those effects.
A nationally weighted survey of 500 U.S. adults found that 17.1% reported disrespectful or judgmental language in their own medical records or those of a loved one. Nearly three-quarters said they believed such language could lead to worse health outcomes, raising concerns about trust and patient engagement as more people can read clinical notes through online portals.
The survey was conducted from Nov. 21 to Dec. 4, 2025, by researchers led by Natasha Steele, MD, MPH, of Stanford University School of Medicine. The findings were published in JAMA Network Open. Respondents were asked about language in medical records and about disrespectful or judgmental language during in-person health care encounters.
Among respondents, 15.6% reported disrespectful language during an in-person encounter. A total of 73.3% believed disrespectful or judgmental language could result in worse health outcomes, such as an incorrect prescription or diagnostic errors. Separately, 74.7% thought 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. These are respondents’ reported experiences and views, not measured rates of medical errors or changes in care.
In adjusted analyses, people reporting low income were more likely than those reporting high income to say they had encountered disrespectful or judgmental language (adjusted odds ratio 2.64; 95% confidence interval 1.18-5.91). The same association was found for people with a chronic pain diagnosis compared with those without one (adjusted odds ratio 3.25; 95% confidence interval 1.46-7.26). Reporting this language was also associated with lower trust in clinicians’ documentation skills (adjusted odds ratio 5.76; 95% confidence interval 2.90-11.46). The results show associations, not proof of cause.
How Language May Affect Patient Trust
The findings point to a potential problem beyond patients feeling offended: respondents said judgmental language could shape whether they trust records, seek care from a clinician again, or believe their future care will be safe. If patients disengage or switch providers, their care may become less continuous. The study authors said this could have consequences for follow-up, information transfer and health systems, though the survey did not measure those downstream effects.
The results also raise an equity concern. Low-income respondents and respondents with chronic pain were more likely to report such language in the adjusted analysis. The survey does not explain why those differences appeared, but they add to the authors’ call for attention to groups that may face bias based on social identity or health circumstances.
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Patient Access to Clinical Notes
The researchers conducted the survey against a backdrop of expanded patient access to electronic health records. 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. In the survey, 71.2% said they used a patient portal.
The authors said stigmatizing language has been reported in clinical documentation across health care settings, while research has paid less attention to patients’ experiences of reading it. They argued that greater visibility of notes makes respectful wording in both documentation and clinical interactions more relevant. Their study adds patient survey data, but it does not establish how often such language appears across all records or care settings.
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Limits of the Survey Evidence
The survey measured self-reported experiences and beliefs, not a review of medical records or an assessment of actual clinical outcomes. Its cross-sectional design captures responses at one point in time and cannot show that disrespectful language caused errors, reduced trust, or changes in care. The researchers also said recall and reporting biases could affect responses.
The online survey may have underrepresented people with limited access to technology or lower digital fluency. The source report describes 500 respondents but does not establish how often disrespectful wording appears in the wider population’s records, which terms respondents encountered, or whether the reported language was documented by clinicians or other staff. Those questions remain open.
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Standards and Training Under Discussion
The study authors call for clear standards for respectful communication and for clinical training that emphasizes person-centered language. They also recommend particular attention to patients who may be subject to bias. The report does not announce a new policy, implementation schedule or planned follow-up study, so it is not clear whether health systems or training programs will adopt these proposals.
For now, the survey adds evidence about how some patients say they experience clinical language and how they think it may affect care. Further research would be needed to compare patient reports with actual record content and to determine whether particular language is linked to measurable changes in trust, follow-up or health outcomes.
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Key Questions
What did the survey find about medical records?
17.1% of 500 respondents said they or a loved one had encountered disrespectful or judgmental language in medical records.
Did the study show that this language causes medical errors?
No. Respondents said they believed the language could contribute to worse outcomes, but the survey did not measure medical errors or establish cause and effect.
Who was more likely to report disrespectful language?
In adjusted analyses, respondents reporting low income and those with a chronic pain diagnosis were more likely to report encountering such language than their comparison groups. These are associations, and the study does not explain their cause.
What changes did the researchers recommend?
The authors called for clear standards for respectful communication in records and clinical interactions, along with training in person-centered language and attention to groups that may face bias.
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