How words discredit: A taxonomy of stigmatizing language in the electronic health record (June 2026)

Summary

Language in electronic health records (EHRs) can transmit stigma, discrediting patients in ways that undermine the clinician-patient relationship and compromise future care. The authors of this study sought to develop a taxonomy of stigmatising language in EHRs to understand what patients are being stigmatised for, how that stigma is conveyed linguistically, and why.

Content

The authors identified six categories of stigmatising sentiments characterising patients as: (1) Socially undesirable, (2) Difficult to interact with, (3) Incompetent, (4) Manipulative, (5) Noncompliant, and (6) Not credible. These were implied through negative descriptions of patient behaviour portraying them as, e.g., Demanding, Adversarial, Deceptive, etc. Linguistic mechanisms extended beyond keywords, including practices for emphasising the intensity of patient behaviour (e.g., intensifiers), marking distance or divergence from the patient’s perspective (e.g., skeptical evidentials) and casting the clinician as the neutral or rational party (e.g., euphemisms).

Stigmatising language in EHRs is not limited to discrete terms but is embedded in broader linguistic practices that shape how patients are represented and understood, particularly those describing how they fail to align with clinical expectations. This language may serve to document professional challenges, but it nonetheless reinforces paternalistic norms and compromises care. Understanding these dynamics is critical for moving toward patient-centered documentation and reducing harm in the EHR.