Table 1. Negative Language Categories^a.

Categories	Definitions	Examplesb
Questioning credibility	Implication of physician disbelief of patient reports of their own experience or behaviors	He insists the pain is behind his knee. He claims that nicotine patches don’t work for him. I listed several fictitious medication names and she reported she was taking them, and that she takes “whatever is written there”
Disapproval	Highlights poor reasoning, decision-making, or self-care, usually in a way that conveys the patient is unreasonable	Reports that if she were to fall, she would just “lay there” until someone found her He was adamant that he does not have prostate cancer because his “bowels are working fine.” Counseled that there is no evidence for this, but patient has strong beliefs. She is adamant that she cannot perform any kind of exercise due to pain and will not change her diet.
Stereotyping	Quoting African American Vernacular English	Chief complaint - “I stay tired” Reports that the bandage got “a li’l wet”
	Quoting incorrect grammar or unsophisticated terms	States that the lesion “busted open” Reports she was unable to fill prescription for the “sugar pill”
Difficult patient	Inclusion of details with questionable clinical significance that depict the patient as belligerent or otherwise suggests that the physician is annoyed	She persevered on the fact that “a lot of stuff is going on at home with my family” but that “you wouldn't understand.” I informed her that this is unlikely to be helped by antibiotics and talked about smoking cessation with her. She said she will ask her ‘sinus doctor’ for antibiotics.
Unilateral Decisions	Language that emphasizes physician authority over patient	She was told to discontinue… I have instructed him to…

^aNote categories are not mutually exclusive and often overlapping.

^bExamples in tables are from actual encounter notes in the study.