Your doctor hasn’t walked in yet.
You’re sitting on that paper-covered table, going over what you came to say. Maybe you’re always tired and can’t figure out why. Or there’s a pain in your knee that you keep downplaying, and you’ve finally decided to have a professional look at it instead of Googling it.
But on the other side of that door, your appointment is already underway.
Your medical chart is being read, and in many ways, the conversation has already begun.
Electronic health records (EHRs) are designed to give clinicians a full picture of a patient’s health before a doctor’s visit begins. That includes prior diagnoses, current medications, lab results, imaging, specialist notes, and documentation from every previous encounter in the system.
Dr. Danielle McCamey, DNP, ACNP-BC, FAAN, FAANP, FCCP, FADLN, Assistant Professor and Associate Dean for Clinical Partnerships and Innovation, explains what that review actually looks like in practice:
“We’re trained to review a patient’s story before we ever meet them. That includes prior diagnoses, recent encounters, medications, labs, imaging, and notes from other clinicians. In acute care, nursing notes often capture what isn’t found elsewhere — family dynamics, patient wishes, subtle changes in condition, and observations that add critical context.”
Ideally, that prep leads to sharper questions and more personalized care. But sometimes there’s a gap between the ideal scenario and what really happens.
“Time pressures often limit how thorough that review can be,” Dr. McCamey notes.
In a system built around short visits and productivity metrics, the chart gets a quick scan instead of a full read. This means whatever is most visible, most flagged, or most recently documented on your chart carries the most weight.
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Medical records don’t just store facts. They store interpretations that can follow patients from visit to visit.
A study published in JAMA Network Open found that stigmatizing language appears in clinical documentation and can influence how future clinicians perceive patients before they ever meet them.
Other research published via PubMed confirms that certain language in patient records can shape clinical impressions and potentially affect decision-making in future visits.
Another analysis published in the National Library of Medicine highlights how language in medical records can transmit bias between providers and across care settings.
Even more concerning, further research in the National Library of Medicine has examined how stigmatizing documentation is linked to differences in clinical interpretation and quality of care.
In other words, what gets written down doesn’t just stay in your chart—it moves forward into your future visits, future providers, and future decisions about care.
Dr. McCamey is clear about the responsibility this creates:
“Words matter. Labels can reinforce bias, influence expectations, and ultimately affect clinical interactions. Our responsibility is to describe what we observe — not assign character judgments or perpetuate narratives that may unfairly influence future care.”
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Many patients assume their doctor either knows everything about them or nothing at all before the visit starts. The truth is more complicated — and holds more consequence.
“We often have information from the medical record before we enter the room, but that record never tells the whole story,” Dr. McCamey says.
This is exactly why she emphasizes that the record can’t be the only input:
“Trust isn’t automatic — it has to be earned. Every visit is an opportunity to listen first and avoid making assumptions based solely on what is documented.”
For Black patients navigating a healthcare system with a well-documented history of inequity, that distinction is the difference between being heard and being managed.
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Clinical decisions are supposed to be evidence-based. But care happens inside a system — and the system creates pressure.
Dr. McCamey explains it plainly:
“Previous diagnoses, missed appointments, insurance status, and documentation from other providers can unintentionally influence how clinicians approach a patient. Healthcare is practiced under tremendous pressure for short visits. Documentation requirements, productivity metrics, and insurance constraints all increase the likelihood that providers rely on cognitive shortcuts rather than curiosity.”
Most healthcare organizations have training, patient advocates, and reporting mechanisms to address bias. But Dr. McCamey is honest about where the gaps remain:
“Accountability is inconsistent, and we still have significant work to do to ensure bias doesn’t influence care.”
Medical records don’t just document care. They shape future care.
For Black patients, who have historically faced disparities in diagnosis, pain management, and treatment, the stakes are higher when assumptions get documented and then carried forward.
Dr. McCamey emphasizes that awareness is part of protection:
“Understanding what is written, asking questions, and reviewing your health information are important forms of self-advocacy. For Black patients, being informed about your care can help ensure your story is accurate, complete, and reflective of your lived experience — not just your diagnoses.”
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Patients often don’t know they have the right to engage with what’s written in their own records. They do.
Dr. McCamey’s advice:
“Speak up. Ask your clinician about the documentation and request clarification. If information is factually incorrect, you can ask that it be corrected or amended.”
And if the issue doesn’t get resolved at the provider level:
“Most health systems have a patient advocate or patient relations office that can help navigate the process. Patients have both the right and the responsibility to be active participants in ensuring their medical record accurately reflects their care.”
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The most important thing to understand about medical records is what they can’t capture.
“Your medical record is a living document — not your identity,” Dr. McCamey says. “It contains valuable clinical information, but it doesn’t fully capture who you are, your values, your goals, or your lived experiences. The most important part of the visit is still the conversation. Never assume your chart speaks for you.”
The appointment starts before the doctor enters the room. It starts with scheduling, intake forms, nursing assessments, and chart review … every step adding context before you’ve said a single word.
Understanding that doesn’t make your visit any less personal, but it does make you a better-prepared patient.
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