SHM Converge Scientific Abstract ePoster Gallery-Stigmatizing Language Patterns in Self-Directed Discharges: Words That Matter.

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This study examined stigmatizing language in self-directed discharge (SDD) documentation, which occurs in about 1–2% of hospitalizations and can create high-stress situations that may increase provider bias. The authors reviewed 165 SDD cases selected from 1,126 discharges between 2017 and 2023, using a language model with five categories of stigmatizing language.<br /><br />They found biased language in 82% of charts. The most common theme was disapproval (64.8%), where clinicians expressed frustration or disagreement with the patient’s choice to leave. Other common patterns included difficult patient language (29%), questioning credibility (23%), unilateral decision making (13.3%), and racial/social class stereotyping (5.4%).<br /><br />The study also provided examples of how stigmatizing statements can be revised into neutral, patient-centered documentation by removing subjective judgments, redundant quotation marks, and unnecessary detail. For example, instead of writing that a patient “still continues to want to leave” after being warned of risks, a neutral version would simply state that the patient was informed of the risks and chose to leave. Similarly, descriptions of agitation or dialect were reframed in objective terms.<br /><br />The authors conclude that stigmatizing language is common in SDD notes and may reflect the tension of these encounters. They recommend using concise, factual, and neutral wording to support patient-centered care and reduce bias in the medical record. Future work will continue chart review to reach thematic saturation and develop clearer guidelines for neutral documentation.

Asset Subtitle

Hadi Roudsari

Meta Tag

Author List Hadi Roudsari, Karishma Patel, Molly A. Kantor, Monisha Bhatia, Sandra Oreper

Category Research

Concept Stigmatizing Language

Concept Neutral Documentation

Concept Self-directed Discharge

Concept Park et al Model

Concept Stigmatizing Language Categories

Distinguished Non-Finalist

Presenter Organization University of California San Francisco

Presenting Author Hadi Roudsari

Track Outcomes Research

Keywords

stigmatizing language

self-directed discharge

medical documentation

provider bias

patient-centered care

neutral wording

chart review

biased language

hospital discharge

clinical notes

Stigmatizing Language

Neutral Documentation

Self-directed Discharge

Park et al Model

Stigmatizing Language Categories