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A 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 harm.
A nationally weighted survey found that 17.1% of 500 U.S. adults said they 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 in JAMA Network Open, capture patients’ experiences and perceptions; they do not show that the wording caused medical errors or poorer health.
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% said they used a patient portal, through which patients can view clinical notes. The survey also asked about disrespectful or judgmental language during in-person care: 15.6% reported experiencing it in a healthcare encounter.
Respondents described possible consequences as well as past experiences. Nearly three-quarters (74.7%) thought such language could affect 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 report what respondents believed they would do or what they thought might happen, not measured changes in care or health.
In adjusted analyses, people reporting low income had higher odds of reporting disrespectful or judgmental language than those reporting 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 such language was associated with lower trust in clinicians’ documentation skills (aOR 5.76; 95% CI 2.90–11.46). These statistical associations do not establish why the differences occurred.
Patient Trust and Continuity of Care
The findings matter because medical notes are both records used by care teams and information patients can increasingly read themselves. If patients encounter language they consider judgmental, the survey suggests some may lose trust in the documentation or avoid returning to that clinician. The researchers say those responses could have implications for patient engagement and continuity of care, although this survey did not track whether respondents actually changed providers or missed care.
The authors also point to possible consequences for health systems if patients disengage, including loss to follow-up, duplicated costs, diagnostic delays or errors tied to incomplete information transfer. Those are potential risks discussed by the researchers, not outcomes established by the survey. The reported associations involving low income and chronic pain also make the issue relevant to discussions about bias and respectful communication in clinical settings.
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Why Patients Can Read Clinical Notes
The study was conducted against the backdrop of 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 gives patients more opportunity to see how clinicians describe their symptoms, circumstances and care.
The researchers said stigmatizing language has been reported in clinical documentation across healthcare settings, but that patients’ perspectives have received less study. Their work examines those perspectives as note access expands. The survey’s results provide a snapshot of respondents’ reported experiences and views; they are not an audit of medical records or a measure of how often particular phrases appear across all U.S. healthcare systems.
“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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Survey Limits and Causation
The study’s cross-sectional design cannot establish whether disrespectful language caused reduced trust, changes in care or worse health outcomes. Its findings rely on respondents’ recollections and judgments, which may be affected by recall or reporting bias. The researchers also cautioned that an online survey could underrepresent people with limited access to technology or less familiarity with it.
The results reflect reports from 500 survey respondents, not an independent review of their medical records. The material provided does not specify which words respondents encountered, how often they saw them, or whether all experiences concerned the same types of care. It also does not show whether respondents who said they were less likely to return later changed clinicians.
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Calls for Respectful Documentation Standards
The researchers call for clear standards for respectful communication in clinical notes and in-person interactions, along with person-centered language in clinical training. The report does not announce a new policy, a deadline for standards or a planned follow-up study. Whether healthcare organizations or training programs adopt changes in response remains unknown.
Further research could examine records directly, follow patients over time and assess whether language changes affect trust, follow-up or health outcomes. For now, the study documents reported experiences and patient perceptions, while leaving the size and direction of any effects on actual care unresolved.
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Key Questions
How many respondents reported disrespectful language in medical records?
17.1% of 500 adults said they had encountered disrespectful or judgmental language in their own medical records or a loved one’s.
Did the survey show that this language caused worse health outcomes?
No. 73.3% believed the language could lead to worse outcomes, but the cross-sectional survey measured perceptions and cannot establish cause and effect.
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 study did not establish how many later changed clinicians.
What were the study’s main limitations?
The study relied on self-reported experiences and an online survey, and its cross-sectional design cannot show causation. The online method may also have underrepresented people with limited technology access or fluency.
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