{"id":233636,"date":"2025-10-22T23:22:04","date_gmt":"2025-10-22T23:22:04","guid":{"rendered":"https:\/\/www.newsbeep.com\/au\/233636\/"},"modified":"2025-10-22T23:22:04","modified_gmt":"2025-10-22T23:22:04","slug":"language-in-ama-discharge-notes-watch-it","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/au\/233636\/","title":{"rendered":"Language in AMA Discharge Notes: Watch it!"},"content":{"rendered":"

More than 500,000 patients leave US hospitals each year against medical advice (AMA), in the process facing risks<\/a> for readmission and bad outcomes.<\/p>\n

Now, add the risk of feeling stigmatized to the list, as researchers who took a closer look at the notes<\/a> documenting those discharges found the language and tone physicians use often less than supportive and sometimes even angry and ridiculing. The notes often take on a paternalistic or judgmental stance or a defensive attitude, and that can bias future healthcare providers reading them against the patients, as well as discourage the patients from returning for care, the researchers said.<\/p>\n

\"photoMary Catherine Beach, MD, MPH<\/p>\n

\u201cOur analysis joins a growing body of evidence that linguistic choices made by clinicians in the medical record can convey negative attitudes toward patients,\u201d the researchers wrote.<\/p>\n

\u201cIn some ways, this paper is meant to be a call to arms, to rethink how we think about patients who don\u2019t take our advice,\u201d senior author Mary Catherine Beach, MD, MPH, professor of medicine at Johns Hopkins University School of Medicine, Baltimore, told Medscape Medical News.<\/p>\n

While previous research has looked at patient characteristics associated with AMA discharges, much less attention has been focused on the interpersonal clinician-patient dynamics that end in an unadvised discharge, as this new research does.<\/p>\n

\u2018He Said He Could Take His Own Advice\u2019 and Other Stories<\/p>\n

Beach and her colleagues analyzed the notes, looking at what was written and what was documented about the patient and the interaction, as well as howit was written in terms of word choices and how they convey the writer\u2019s stance toward the patient or the events unfolding.<\/p>\n

The data source was the clinical documentation from 362 hospitalizations that ended in an AMA discharge at an urban academic medical center.<\/p>\n

Most (90%) of the 185 notes evaluated were written by hospitalists and other physicians, with the remainder written by nurses, social workers, and other healthcare providers.<\/p>\n

Negative portrayals of patients often were evident through the healthcare providers\u2019 descriptions of anger, ignorance, and unreliability of the patient. For instance, some notes described a patient\u2019s threat to trash a room or patients yelling or becoming verbally abusive. One complained that the patient kept interrupting. One note was \u201cconveyed with subtle ridicule\u201d by stating that the patient said he \u201ccan take his own advice.\u201d<\/p>\n

Another included a description of what a physician called the patient\u2019s long, curse-laden diatribe claiming he was not a \u201cdope fiend.\u201d<\/p>\n

While the data for the study itself was collected in 2017, \u201cMy sense is that this is still a problem,\u201d Beach said. \u201cOn the plus side, I think there is an increasing awareness in the health professions about the power of language.\u201d However, \u201cI don\u2019t know if that\u2019s made a demonstrable impact in how we document and talk about patients, but I think it probably will, and I think it has probably started to.\u201d<\/p>\n

How to Lessen Negativity<\/p>\n

To lessen the stigma and negativity, Beach and her colleagues provide many examples of how to soften the language and what\u2019s best left out when documenting the patient\u2019s decision to leave.<\/p>\n

Coping with AMA discharges are challenging, as Beach knows from her own experiences. \u201cIt\u2019s frustrating for both sides,\u201d she said. Often, the clinicians really care about the person they worked hard to get better, she said. When the patient decides to leave against professional advice, the physician can feel worried or unappreciated, she said. \u201cOr they feel judgmental, like that person is making a terrible decision.\u201d<\/p>\n

Writing notes in more neutral language is the goal, she said. For instance, \u201cyou might consider putting in why the person decided to leave, if they told you,\u201d she said, while omitting phrases like they demanded to leave or insist on leaving. Instead of writing \u201cThe nurse notified me of her demand to leave AMA,\u201d better write \u201cPatient wanted to leave immediately.\u201d<\/p>\n

If patients don\u2019t want to talk about why they made the decision, \u201cthe best thing to do [in the notes] is to leave it alone,\u201d Beach said, rather than saying they refused to say. \u201cThey don\u2019t really owe us an explanation.\u201d<\/p>\n

Among the worst language the researchers found in the notes, Beach said, are those that told the departing patients they can\u2019t come back, which she terms \u201cawful.\u201d<\/p>\n

Healthcare providers who care for the patient in the future and read the stigmatizing language may form negative attitudes<\/a> towards the patient and even manage pain less aggressively.<\/p>\n

Beach said if she read notes documenting an abusive, angry person, she would like to think of herself as a good enough person that it would not affect her care of them. \u201cBut in reality, I would read that and think, \u2018Oh no, I don\u2019t really want to see that person.\u2019\u201d<\/p>\n

Her bottom line: \u201cGive them a little grace. When people are signing out at the hospital, they are often not at their best.\u201d<\/p>\n

The best example of positivity, Beach found, was this note about a departing patient: \u201cAlthough she left her belongings in the room \u2014 and I do hope she returns to the hospital \u2014 we cannot hold her bed any longer.\u201d<\/p>\n

As for healthcare providers who are angry over the AMA discharge decision, she said: \u201cPart of this just represents the way we view people who don\u2019t take our advice.\u201d<\/p>\n

Expert: \u2018Clinicians Are Looking for Recommendations\u2019\"photoVeronica Barcelona, PhD, MSN, RN<\/p>\n

\u201cThis is a new area of research, and in my experience, clinicians are looking for clear recommendations on what language to avoid, and, more importantly, what language to use in its place,\u201d said Veronica Barcelona, PhD, MSN, RN, assistant professor at Columbia University School of Nursing who has also researched the effects of stigmatizing language<\/a> in electronic health records (EHRs).<\/p>\n

She found that stigmatizing language in clinical notes affected birth outcomes, after analyzing data in the EHRs of nearly 19,000 women admitted to two US hospitals from 2017 to 2019 for childbirth.\u00a0<\/p>\n

Compared with patients whose EHRs had no stigmatizing language, those with any had a 36% higher risk for cesarean birth (adjusted odds ratio, 1.36; 95% CI, 1.23-1.50; P < .01), as well as higher risks for postpartum hemorrhage<\/a> and chorioamnionitis<\/a>.<\/p>\n

Barcelona\u2019s advised, \u201cMy recommendation is for clinicians to chart as if the patient is looking over their shoulder, not a lawyer, as many of us were taught in school. As patients have more access to reading their own electronic health records online, clinicians should focus on documentation practices that are patient-centered and respect patient autonomy.\u201d<\/p>\n

Beach and Barcelona had no disclosures.\u00a0<\/p>\n

The study was supported in part by Robert Wood Johnson Foundation and the National Institute on Minority Health and Health Disparities.<\/p>\n","protected":false},"excerpt":{"rendered":"More than 500,000 patients leave US hospitals each year against medical advice (AMA), in the process facing risks…\n","protected":false},"author":2,"featured_media":233637,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[64,63,12954,13534,3326,30723,181,40551,54940,137,500,13533,140276,19900,40550,40549,180,7535,11742,29561,23617,23615,140274,140275,23616,8710,40548,23618,123769],"class_list":["post-233636","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-au","tag-australia","tag-birth","tag-bleeding","tag-career","tag-electronic-health-record-ehr-electronic-health-record-ehr","tag-employment","tag-employment-contract","tag-facial","tag-health","tag-healthcare","tag-hemorrhage","tag-hospitalists","tag-hospitals","tag-job-contract","tag-job-interview","tag-jobs","tag-medical-records","tag-pain","tag-pain-management","tag-postnatal","tag-postpartum","tag-postpartum-bleeding","tag-postpartum-hemorrhage-postpartum-haemorrhage","tag-postpartum-period","tag-pregnancy-pregnant","tag-profession","tag-puerperium","tag-stigma"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/233636","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/comments?post=233636"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/posts\/233636\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media\/233637"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/media?parent=233636"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/categories?post=233636"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/au\/wp-json\/wp\/v2\/tags?post=233636"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}