Survey Links Judgmental Clinical Language to Lower Patient Trust

Following expanded patient access to clinical notes under the 21st Century Cures Act, researchers examined experiences of disrespectful or judgmental language and anticipated consequences for care. The nationally weighted, cross-sectional survey included 500 US adults recruited through YouGov’s nonprobability online panel from November 21 to December 4, 2025. Outcomes included reported language experiences and trust in clinicians’ documentation.

Among 358 patient portal users, 58 reported such language in their own or a loved one’s records (weighted prevalence, 17.1%). Among 142 nonportal users, 25 reported it in health care encounters (15.6%). Across all respondents, 74.7% anticipated that judgmental language would influence care from a new clinician, 73.3% anticipated worse health outcomes, and 85.5% anticipated being less likely to return to the clinician.

Low income versus high income was associated with greater odds of reporting judgmental language (adjusted odds ratio [aOR], 2.64; 95% CI, 1.18–5.91), as was chronic pain (aOR, 3.25; 95% CI, 1.46–7.26). Reported experiences were associated with diminished documentation trust (aOR, 5.76; 95% CI, 2.90–11.46).

The findings highlight the clinical importance of respectful documentation and communication. However, the cross-sectional, self-reported survey cannot establish causation, and its nonprobability sampling limits generalizability. Portal and nonportal users reported different types of experiences, and anticipated harms were not measured clinical outcomes.