Clinical Report: Clinicians’ Awareness and Use of Stigmatizing Language

Overview

The article describes a cross-sectional, multicenter survey and knowledge test designed to characterize internal medicine residents’, faculty members’, and advanced practice providers’ knowledge, experiences, and values regarding stigmatizing language in clinical documentation. The supplied article excerpt reports the study rationale and methods but does not provide participant numbers, survey results, or study conclusions.

Background

Stigmatizing wording in medical records can characterize patients as manipulative, not credible, difficult to engage with, non-compliant, incompetent, or socially undesirable. The article’s introduction cites evidence linking such language with clinicians’ attitudes and behaviors, and notes that it has been reported more often in records of Black patients, women, people with substance use disorders, and people with public insurance. Patients may also encounter wording in their notes through immediate access under the 21st Century Cures Act; one cited study found that 10.5% reported feeling offended or judged by note content. The article identifies a gap in direct medical-education attention to documentation word choice and in knowledge about clinicians’ awareness and practices.

Data Highlights

The supplied excerpt describes a cross-sectional survey and knowledge test administered electronically through REDCap between April and September 2025. Participants were internal medicine residents, hospitalist faculty who routinely supervise residents at two academic departments, and clinically documenting APPs who supervise APP students at one institution. Six cognitive interviews were conducted, three at each site; Stanford participants were offered a $15 gift card. No response counts or outcome data are included in the supplied excerpt.

Key Findings

• The study was designed to assess knowledge, skills, and attitudes concerning stigmatizing language among internal medicine residents, faculty, and APPs.
• Survey and knowledge-test items were developed by the study team after reviewing literature and applying established survey-design practices; the authors report that validated instruments were unavailable for this emerging area.
• Six cognitive interviews, three at each participating site, were conducted to assess item comprehensibility.
• The article’s introduction defines stigmatizing language through descriptions such as manipulative, not credible, difficult to engage with, non-compliant, incompetent, or socially undesirable.
• The introduction cites prior evidence that stigmatizing language has been reported more often in records of Black patients, women, people with substance use disorders, and people with public insurance; it also cites a study in which 10.5% of patients reported feeling offended or judged by note content.
• Related current guidance from ACOG describes documentation as a mode of communication and calls for respectful wording that conveys accurate information without stigmatization or bias.

Clinical Implications

The article frames patient-centered, non-stigmatizing documentation as an educational concern for residents, faculty, and APPs, while noting that documentation practices may be learned implicitly through observation. ACOG’s cited guidance explicitly calls for respectful, accurate documentation without stigmatization or bias; the supplied study excerpt does not report tested educational interventions or clinical outcomes.

Conclusion

The supplied material establishes the rationale and methods for a multicenter assessment of clinicians’ knowledge and practices but does not include its results. It also situates respectful documentation within current professional guidance and the broader concern about how clinical wording may affect patients and clinicians.

Related Resources & Content

1. Journal of General Internal Medicine, 2026 — Hospital-Based Clinicians’ Knowledge and Practices Regarding Stigmatizing Language in Clinical Documentation: A Multicenter Survey
2. American College of Obstetricians and Gynecologists, 2025 — Effective Patient-Physician Communication
3. Journal of General Internal Medicine, 2026 — Identifying Patterns of Stigmatizing Language Use in the Safety Net
4. ASCO Publications, 2023 — Words matter: How clinical encounters can be unknowingly stigmatizing to some patient communities
5. JMIR Medical Informatics, 2026 — Exploratory Study on Using Semantic Similarity to Identify Stigmatizing and Positive Language in Obstetric Clinical Documentation
6. MDSpire News — Lack of Widespread Adoption of Nonstigmatizing Language on Liver Transplant Center Websites
7. Hospital-Based Clinicians’ Knowledge and Practices Regarding Stigmatizing Language in Clinical Documentation: A Multicenter Survey
8. Effective Patient-Physician Communication | ACOG
9. Identifying Patterns of Stigmatizing Language Use in the Safety Net
10. Words matter: How clinical encounters can be unknowingly stigmatizing to some patient communities
11. Exploratory Study on Using Semantic Similarity to Identify Stigmatizing and Positive Language in Obstetric Clinical Documentation
12. Effective Patient-Physician Communication | ACOG
13. Hospital-Based Clinicians’ Knowledge and Practices Regarding Stigmatizing Language in Clinical Documentation: A Multicenter Survey | Journal of General Internal Medicine | Springer Nature Link
14. Documentation of Stigmatizing Language in Electronic Health Records and Birth Outcomes - PMC