Michelle Kavouras, Dr. Nichole Nidey, and Dr. Sunny Kung, Why Language Matters in Documentation

In this episode, we dive into why language in client and patient records matters—and how it can shape care experiences. We explore practical ways to use non-stigmatizing language in health records and discuss the role of electronic health record (EHR) in shaping documentation. Who designs these systems, and how can they be improved? We also examine real-world case scenarios where stigmatizing notes have had lasting impacts on individuals. Whether you're a provider, policymaker, or advocate, this episode offers insight into making health records more respectful, equitable, and aligned with patient-centered care.

Learning Objectives

• Recognize how the electronic health record (EHR) can negatively impact individuals.
• Implement changes to existing EHR systems to incorporate strength-based, person-first, and non-stigmatizing language
• Reflect on the importance of self-awareness when writing notes and consider the potential uses and impacts of those records.

Host & Guest Bios

1. Sunny Kung, MD is the medical director of the Mass General Brigham Merrimack Valley Bridge Clinic in Haverhill, MA. She completed her addiction medicine fellowship at Massachusetts General Hospital and her internal medicine residency at Brigham and Women's Hospital in Boston, MA. She is a dedicated primary care and addiction medicine clinician who specializes in caring for people who use substances, those who are unhoused, immigrants, people with limited English proficiency, and other marginalized folks. As a staunch believer in harm reduction, she believes in allowing people to live their lives with dignity and safety.
2. Michelle Kavouras is a highly credentialed leader in addiction counseling, recovery support, and harm reduction with nearly a decade of experience training professionals in evidence-based care. She serves on multiple boards and commissions, including the NAADAC National Certification Commission for Addiction Professionals and Sitka’s Health Needs and Human Services Commission, and co-chairs the Southeast Alaska Alcohol Alliance. A dedicated harm reduction advocate, she collaborates on patient-centered research and works to advance stigma-free, person-centered care.
3. Dr. Nichole Nidey is a maternal-child health epidemiologist and assistant professor at the University of Iowa College of Public Health. Nidey founded the EMPOWER Project in 2019, which is a patient-centered collaborative of persons with lived experience of substance use during pregnancy. Through the EMPOWER Project, Nidey leads patient-centered research focused on improving healthcare for pregnant and postpartum individuals with substance use.

Timestamps:

• [00:45] Why documentation language matters more than we think
• [03:00] How EHRs can perpetuate stigma
• [05:43] The harm of "non-compliance" and labeling
• [08:45] How bias spreads through copy-pasted notes
• [12:15] When your own notes hurt your recovery
• [17:00] Empowering patients with MyChart (and its limits)
• [23:45] The ripple effects of biased documentation
• [29:30] Co-writing medical notes with patients
• [35:00] Shifting from “what’s wrong” to “what’s strong”
• [42:45] Practical s

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Funding for this initiative was made possible by cooperative agreement no. 1H79TI086770 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

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