@inproceedings{dahal-etal-2026-investigating,
title = "Investigating Stigmatizing Language in Clinical Documentation with Open-Source Large Language Models",
author = "Dahal, Rajashree and
Hosseinpour, Pardis and
Kamishetty, Pranithi and
Pamulaparthy, Satwik and
Tizpaz-Niari, Saeid and
Parde, Natalie",
editor = "Demner-Fushman, Dina and
Ananiadou, Sophia and
Roberts, Kirk and
Tsujii, Junichi",
booktitle = "{B}io{NLP} 2026",
month = jul,
year = "2026",
address = "San Diego, California",
publisher = "Association for Computational Linguistics",
url = "https://aclanthology.org/2026.bionlp-1.39/",
pages = "490--501",
ISBN = "979-8-89176-434-7",
abstract = "Clinical documentation is essential for patient care, billing, and medical research, but it is subject to entrenched bias. While manual chart reviews can identify such bias, they are labor-intensive and expert-dependent. We introduce and evaluate StigMAD, a Multi-Agent Debate framework leveraging open-source Large Language Models (LLMs) to detect stigmatizing language in clinical documentation. We investigate reasoning (multi-agent debate), self-reflection, and self-consistency within this framework. Extensive experiments on clinical notes and patient summaries demonstrate that our framework provides significant advantages over rule-based and supervised baselines. A domain-specific LLM (MedGemma) achieved its highest performance using the StigMAD reasoning framework, while a general-purpose LLM (Llama) showed superior results with the self-consistency framework. These findings suggest that open-source LLMs, steered by structured prompting and reflective reasoning, can effectively support the scalable auditing of stigmatizing language, marking a critical step toward more equitable clinical NLP systems."
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<abstract>Clinical documentation is essential for patient care, billing, and medical research, but it is subject to entrenched bias. While manual chart reviews can identify such bias, they are labor-intensive and expert-dependent. We introduce and evaluate StigMAD, a Multi-Agent Debate framework leveraging open-source Large Language Models (LLMs) to detect stigmatizing language in clinical documentation. We investigate reasoning (multi-agent debate), self-reflection, and self-consistency within this framework. Extensive experiments on clinical notes and patient summaries demonstrate that our framework provides significant advantages over rule-based and supervised baselines. A domain-specific LLM (MedGemma) achieved its highest performance using the StigMAD reasoning framework, while a general-purpose LLM (Llama) showed superior results with the self-consistency framework. These findings suggest that open-source LLMs, steered by structured prompting and reflective reasoning, can effectively support the scalable auditing of stigmatizing language, marking a critical step toward more equitable clinical NLP systems.</abstract>
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%0 Conference Proceedings
%T Investigating Stigmatizing Language in Clinical Documentation with Open-Source Large Language Models
%A Dahal, Rajashree
%A Hosseinpour, Pardis
%A Kamishetty, Pranithi
%A Pamulaparthy, Satwik
%A Tizpaz-Niari, Saeid
%A Parde, Natalie
%Y Demner-Fushman, Dina
%Y Ananiadou, Sophia
%Y Roberts, Kirk
%Y Tsujii, Junichi
%S BioNLP 2026
%D 2026
%8 July
%I Association for Computational Linguistics
%C San Diego, California
%@ 979-8-89176-434-7
%F dahal-etal-2026-investigating
%X Clinical documentation is essential for patient care, billing, and medical research, but it is subject to entrenched bias. While manual chart reviews can identify such bias, they are labor-intensive and expert-dependent. We introduce and evaluate StigMAD, a Multi-Agent Debate framework leveraging open-source Large Language Models (LLMs) to detect stigmatizing language in clinical documentation. We investigate reasoning (multi-agent debate), self-reflection, and self-consistency within this framework. Extensive experiments on clinical notes and patient summaries demonstrate that our framework provides significant advantages over rule-based and supervised baselines. A domain-specific LLM (MedGemma) achieved its highest performance using the StigMAD reasoning framework, while a general-purpose LLM (Llama) showed superior results with the self-consistency framework. These findings suggest that open-source LLMs, steered by structured prompting and reflective reasoning, can effectively support the scalable auditing of stigmatizing language, marking a critical step toward more equitable clinical NLP systems.
%U https://aclanthology.org/2026.bionlp-1.39/
%P 490-501
Markdown (Informal)
[Investigating Stigmatizing Language in Clinical Documentation with Open-Source Large Language Models](https://aclanthology.org/2026.bionlp-1.39/) (Dahal et al., BioNLP 2026)
ACL