JAMA network open · 2026
Patient Experiences of Disrespectful or Judgmental Language in Medical Records.
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Steele Natasha, Maitra Amrapali, Dong Zhiyong, Wachenheim Deborah, Nair Vishnu, Reyes-Guzman Alfredo, Narayan Aditya, Schillinger Erika, Basaviah Preetha, Hom Jason, Bell Sigall K
Аннотация
IMPORTANCE: The 21st Century Cures Act made clinical notes broadly accessible to patients. However, the frequency and patient-perceived consequences of disrespectful or judgmental language (DJL) in medical records among the general US population remain unknown.
OBJECTIVES: To (1) quantify the frequency of participant-reported DJL in medical records; (2) characterize patient-anticipated consequences; and (3) examine factors associated with DJL and documentation trust in clinicians.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, nationally weighted survey of 500 US adults conducted from November 21 to December 4, 2025, using YouGov's nonprobability-based online panel.
MAIN OUTCOMES AND MEASURES: Descriptive statistics characterized experience of DJL in medical records (patient portal users) or health care (nonportal users) and patient-anticipated consequences. Adjusted odds ratios (aORs) and 95% CIs were estimated using multivariable logistic regression including sociodemographics and clinical factors for 2 outcomes: DJL and documentation trust.
RESULTS: Among 500 respondents (mean [SE] age, 48.0 [0.9] years; 253 [51.0%] women, 53 [11.0%] Black, 80 [18.0%] Hispanic [any race], and 315 [60.0%] White, 358 portal users [71.2%]), a total of 83 participants reported DJL: 58 of 358 (17.1%) portal users in their own medical records and/or that of a loved one, and 25 of 142 nonportal users (15.6%) in health care encounters. Patient-reported consequences included 377 of 500 respondents (74.7%) who anticipated DJL would influence subsequent care from a new clinician, and 373 (73.3%) who anticipated worse health outcomes, such as wrong medication prescribing or diagnostic errors. Furthermore, 435 of 500 respondents (85.5%) anticipated they would be less likely to return to the clinician. In adjusted analyses, patients who reported low income (compared with high income: aOR, 2.64; 95% CI, 1.18-5.91; P = .03) had a greater likelihood of reporting DJL, as did those with a diagnosis of chronic pain (compared with no diagnosis of chronic pain: aOR, 3.25; 95% CI, 1.46-7.26; P = .004). The experience of DJL was associated with diminished documentation trust in clinicians (aOR, 5.76; 95% CI, 2.90-11.46; P < .001).
CONCLUSIONS AND RELEVANCE: In this survey study, 1 in 6 US adults reported DJL in medical records (or in health care experiences for nonportal users), disproportionately affecting those with low income or chronic pain, and DJL was associated with diminished clinician documentation trust. Patient-anticipated consequences such as diminished intent to return to clinician suggest important quality of care and system-level implications. Realizing the promise of health information transparency will require concurrent reform in respectful language in clinical documentation and health care encounters.
OBJECTIVES: To (1) quantify the frequency of participant-reported DJL in medical records; (2) characterize patient-anticipated consequences; and (3) examine factors associated with DJL and documentation trust in clinicians.
DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, nationally weighted survey of 500 US adults conducted from November 21 to December 4, 2025, using YouGov's nonprobability-based online panel.
MAIN OUTCOMES AND MEASURES: Descriptive statistics characterized experience of DJL in medical records (patient portal users) or health care (nonportal users) and patient-anticipated consequences. Adjusted odds ratios (aORs) and 95% CIs were estimated using multivariable logistic regression including sociodemographics and clinical factors for 2 outcomes: DJL and documentation trust.
RESULTS: Among 500 respondents (mean [SE] age, 48.0 [0.9] years; 253 [51.0%] women, 53 [11.0%] Black, 80 [18.0%] Hispanic [any race], and 315 [60.0%] White, 358 portal users [71.2%]), a total of 83 participants reported DJL: 58 of 358 (17.1%) portal users in their own medical records and/or that of a loved one, and 25 of 142 nonportal users (15.6%) in health care encounters. Patient-reported consequences included 377 of 500 respondents (74.7%) who anticipated DJL would influence subsequent care from a new clinician, and 373 (73.3%) who anticipated worse health outcomes, such as wrong medication prescribing or diagnostic errors. Furthermore, 435 of 500 respondents (85.5%) anticipated they would be less likely to return to the clinician. In adjusted analyses, patients who reported low income (compared with high income: aOR, 2.64; 95% CI, 1.18-5.91; P = .03) had a greater likelihood of reporting DJL, as did those with a diagnosis of chronic pain (compared with no diagnosis of chronic pain: aOR, 3.25; 95% CI, 1.46-7.26; P = .004). The experience of DJL was associated with diminished documentation trust in clinicians (aOR, 5.76; 95% CI, 2.90-11.46; P < .001).
CONCLUSIONS AND RELEVANCE: In this survey study, 1 in 6 US adults reported DJL in medical records (or in health care experiences for nonportal users), disproportionately affecting those with low income or chronic pain, and DJL was associated with diminished clinician documentation trust. Patient-anticipated consequences such as diminished intent to return to clinician suggest important quality of care and system-level implications. Realizing the promise of health information transparency will require concurrent reform in respectful language in clinical documentation and health care encounters.