ArticleJournal of hospital medicine2026
"He said he could take his own advice": Stigmatizing language in notes documenting discharges against medical advice.
Article in Journal of hospital medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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
2 citing papers in PubMed.
- How words discredit: A taxonomy of stigmatizing language in the electronic health record.Patient education and counseling · 2026Article
- Words Matter: Content Analysis of Language Used When Documenting in the Medical Records of Patients in Mental Health.Journal of multidisciplinary healthcare · 2026Article
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundAgainst medical advice (AMA) discharges are associated with adverse clinical outcomes and can be stigmatizing to patients. Most prior work has described patient characteristics associated with AMA discharges, with little attention to interpersonal clinician-patient dynamics that culminate in a discharge being designated AMA.
objectiveTo describe clinical documentation about patients whose hospitalizations ended in an AMA discharge, attending to both what was written and how it was written.
methodsWe performed a qualitative description using inductive thematic analysis of 185 free-text notes from hospitalizations administratively identified as ending with an AMA discharge from Internal Medicine services at an urban academic medical center in the mid-Atlantic region in 2017.
resultsCommon features of notes regarding patients leaving AMA included documentation of: (1) the clinician becoming aware of the patient leaving before planned discharge, (2) the patient's reasons for leaving, (3) the clinical team's response to a patient's decision to leave, (4) the patient's capacity, and (5) insinuation of the patient's character flaws. While some note writers conveyed neutrality, we found extensive evidence of adversarial relationships with patients with unnecessary details and language that could stigmatize patients and bias future readers.
conclusionsMany notes documenting AMA discharges contain stigmatizing language, with writers frequently taking a defensive or paternalistic stance toward their interactions with patients. Our findings reflect a lack of clarity about what should be documented in the medical record regarding the events surrounding this type of contentious discharge.
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Registered trials
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