Words That Heal: A Quality Improvement Intervention to Reduce Stigmatizing Language in Gastroenterology Documentation

Document Type

Journal Article

Publication Date

3-23-2026

Journal

American journal of medical quality : the official journal of the American College of Medical Quality

DOI

10.1097/JMQ.0000000000000297

Keywords

Boston Bowel Preparation Scale; equity; obesity; poor prep; stigmatization

Abstract

INTRODUCTION: Stigmatizing language in medical documentation can erode patient trust and worsen health disparities. Gastroenterology (GI) notes often include descriptions of weight, substance use, bowel preparation, and adherence, making them prone to biased phrasing. METHODS: In this retrospective quality improvement study at an urban academic center, 3417 outpatient and colonoscopy records were reviewed over 4 months (pre- and postintervention). Clinicians received a single educational session promoting evidence-based, patient-centered terminology (eg, body mass index instead of adjectival "obesity," Boston Bowel Preparation Scale instead of "poor prep," person-first substance use language). Frequencies of stigmatizing versus recommended terms were compared using Fisher exact test, stratified by race and gender. RESULTS: Use of adjectival "obesity" declined from 5.6% to 3.6% (P = 0.012), while body mass index documentation increased from 8.8% to 16.6% (P < 0.001). "Poor prep" decreased from 51.5% to 23.2% (P = 0.002), and Boston Bowel Preparation Scale use rose from 48.5% to 76.8% (P = 0.001). Racial disparities improved; gender differences persisted. DISCUSSION: A single educational session was associated with reductions in certain stigmatizing or subjective terms and increased use of objective alternatives in gastroenterology documentation, though changes varied across domains. Sustained training may further improve equity and patient-centered care.

Department

Medicine

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