ArticleJournal of general internal medicine2021
Words Matter: What Do Patients Find Judgmental or Offensive in Outpatient Notes?
Article in Journal of general internal medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 58 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
58 citing papers in PubMed, 105 citations in OpenAlex.
- Providing Mobile Patient Access to Their Electronic Secondary Care Patient Record in Adults With Cystic Fibrosis: Results of a Prospective, Parallel, Randomized Open-Pilot Quantitative Study.JMIR formative research · 2025Trial
- Smarter Documentation: Measuring and Improving the Quality of Progress Notes Written by Hospitalists.Journal of general internal medicine · 2025Trial
- Hospital-Based Clinicians' Knowledge and Practices Regarding Stigmatizing Language in Clinical Documentation: A Multicenter Survey.Journal of general internal medicine · 2026Article
- Patient Experiences of Disrespectful or Judgmental Language in Medical Records.JAMA network open · 2026Article
- Stigmatizing language in alcohol-associated cirrhosis open notes: Persistent but declining.Hepatology communications · 2026Article
- It's Not Really the Words; It's How They Land: Lived Experience Perspectives on the Use of Language and Labels in Mental Health.International journal of environmental research and public health · 2026Article
- The Use of Biased Language in the Care of Seriously Ill Children: A Pilot Study.The American journal of hospice & palliative care · 2026Article
- Identifying Patterns of Stigmatizing Language Use in the Safety Net.Journal of general internal medicine · 2026Article
- How words discredit: A taxonomy of stigmatizing language in the electronic health record.Patient education and counseling · 2026Article
- Understanding Patient-Reported Offenses in Electronic Health Records: Cross-Sectional Mixed Methods Survey.Journal of medical Internet research · 2026Article
- Patient Preferences for Plain-Language Alternatives to Medical Jargon in Clinical Notes.Journal of general internal medicine · 2026Article
- Article
- Chaplains' Charting in the USA in the Era of "Open Notes:" Recommendations from a Quality Improvement Project.Journal of religion and health · 2026Article
- Mitigating Bias in Machine Learning Models with Ethics-Based Initiatives: The Case of Sepsis.The American journal of bioethics : AJOB · 2026Article
- Educating Medical Trainees About Patient-Centered Documentation in the Time of Open Notes.Annals of family medicine · 2026Article
- Words Matter: Content Analysis of Language Used When Documenting in the Medical Records of Patients in Mental Health.Journal of multidisciplinary healthcare · 2026Article
- An educational video to promote the use of stigma-free language by primary care clinicians in interactions with adults with type 2 diabetes: a qualitative study.Primary health care research & development · 2025Article
- Identifying Bias at Scale in Clinical Notes Using Large Language Models.Mayo Clinic proceedings. Digital health · 2025Article
- Patient Disability Status and the Use of Stigmatizing Language in Clinical Notes During Hospital Admission for Birth.Journal of obstetric, gynecologic, and neonatal nursing : JOGNN · 2025Article
- Identifying and Reducing Stigmatizing Language in Home Health Care With a Natural Language Processing-Based System (ENGAGE): Protocol for a Mixed Methods Study.JMIR research protocols · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSharing outpatient notes with patients may bring clinically important benefits, but notes may sometimes cause patients to feel judged or offended, and thereby reduce trust.
objectiveAs part of a larger survey examining the effects of open notes, we sought to understand how many patients feel judged or offended due to something they read in outpatient notes, and why.
designWe analyzed responses from a large Internet survey of adult patients who used secure patient portals and had at least 1 visit note available in a 12-month period at 2 large academic medical systems in Boston and Seattle, and in a rural integrated health system in Pennsylvania.
participantsAdult ambulatory patients with portal accounts in health systems that offered open notes for up to 7 years. APPROACH: (1) Quantitative analysis of 2 dichotomous questions, and (2) qualitative thematic analysis of free-text responses on what patients found judgmental or offensive. KEY
resultsAmong 22,959 patient respondents who had read at least one note and answered the 2 questions, 2,411 (10.5%) reported feeling judged and/or offended by something they read in their note(s). Patients who reported poor health, unemployment, or inability to work were more likely to feel judged or offended. Among the 2,411 patients who felt judged and/or offended, 2,137 (84.5%) wrote about what prompted their feelings. Three thematic domains emerged: (1) errors and surprises, (2) labeling, and (3) disrespect.
conclusionsOne in 10 respondents reported feeling judged/offended by something they read in an outpatient note due to the perception that it contained errors, surprises, labeling, or evidence of disrespect. The content and tone may be particularly important to patients in poor health. Enhanced clinician awareness of the patient perspective may promote an improved medical lexicon, reduce the transmission of bias to other clinicians, and reinforce healing relationships.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.