1 in 4 mental health patients hurt by wording in electronic health records, finds study

Notes about one’s own health can feel offensive even when, from a clinical perspective, the information is relevant. This emerges from a study led by Aalto University surveying nearly 4,700 patients about how they experienced health professionals’ notes in the MyKanta national online service maintained by the Social Insurance Institution of Finland. 

Most respondents – almost 87 percent (3,973) – did not feel offended by entries concerning them. However, 13 percent (617) reported being offended by some information in their electronic health records. Among those who had received mental health care (654 respondents), upset was much more common. More than one in four mental health care patients (25.4 percent) reported feeling offended by their clinician’s notes. 

‘Patients with experience of mental health care were particularly sensitive to the content and tone of the notes,’ says Aalto University’s Saija Simola, who led the study. ‘Mental health is often linked to other conditions, and many felt that previously raised mental health care surfaced in the notes even when they had sought care for a physical problem.’  

Experiences of accessing electronic health records (EHRs)have been studied before, but this is one of the first studies to compare multiple patient groups within the same survey. For example, the research compared the experiences of those who received care for mental health, cancer, combined mental health and cancer care, or care for other conditions. Respondents also described their experiences in their own words rather than selecting from predefined options. 

The sting of being labelled a ‘difficult patient’  

According to respondents, notes they found offensive most commonly contained errors, perceived unnecessary information and disrespectful language. 

‘Examples included being labelled a ‘difficult patient’, a hypochondriac, or a drug addict. People also felt offended when intimate details of their sex life or marital status were recorded in an irrelevant context, or when their mental state was mentioned unnecessarily,’ Simola says.  

The style of writing was sometimes experienced as dismissive or blaming. Some felt the notes misrepresented what they had said, or that important information had been omitted. Respondents also reported that correcting erroneous entries afterwards was difficult. 

Simola notes that feeling heard and avoiding surprises could reduce the likelihood of patients feeling offended.  

‘If a clinician raises, for example, weight during the consultation, the patient is less likely to be surprised by its mention in the record. But if a note about weight appears “out of the blue” in the documentation, it can feel hurtful,’ she explains. 

According to the study, women, younger respondents, those reporting bad or very bad health, and those with higher education were more likely than others to feel offended. 

Finland leads on openness 

Simola notes that Finland and the Nordic countries are pioneers in providing patients with access to their electronic health records via national portals. In Finland, most people can access medical entries concerning them, including mental health records. 

‘This level of openness is not universal. In many countries, professionals still debate whether access to notes about mental health does more harm than good – even though prior research shows record access can increase patients’ trust in health care,’ says Simola. 

Simola’s next research project will examine how mental health professionals view the openness of health records in Finland. 

The study was published in the Journal of Medical Internet Research on May 14, 2026.  

Researcher recommendations for better clinical documentation 

1. Ensure records are accurate and coherent and make corrections possible. Patients should be able to report errors and omissions to professionals, as uncorrected entries were explicitly identified as offensive. 
2. Explain relevance. Tell patients which information is necessary and why. This is especially important if past mental health care is clinically relevant to current treatment. Patients should be able to limit sharing of their information or receive notifications if their information needs to be shared. 
3. Use neutral, person-centred language and support professionals with training and tools. Avoid labels and judgemental terms; for example, write ‘a person with schizophrenia’ instead of ‘a schizophrenic’. Word lists and standard phrases should be co-developed with patients, caregivers and professionals. 

4. Use records to support communication. Explain your conclusions and assessments, particularly in mental health contexts. Feeling heard matters to patients, and clear documentation can strengthen the patient–professional relationship.

   Read the full paper:

   Simola S, Kujala S, Cajander Å, Kharko A, Kane B, Wang B, Åhlfeldt RM, Hägglund M. Understanding Patient-Reported Offenses in Electronic Health Records: Cross-Sectional Mixed-Methods Survey. J Med Internet Res 2026;28:e86178. doi: 10.2196/86178