Many of us will have had a letter like it. You’ve just been for a check-up and your doctor has sent a letter summing up the results.
But you just don’t understand it. It’s not only the medical jargon, it’s the whole way it’s written.
The problem is so well-recognised that the Academy of Royal Medical Colleges has just released guidance to help doctors write clearer letters to patients.
We thought we’d go one further. We took a real doctor’s letter and rewrote it to make it clearer and simpler. We cut out the waffle and focused on the reader.
The Academy’s guidance says a doctor’s letter “should enhance the relationship between doctor and patient”. We hope we would have done just that.
This is what the original letter said:
Dear Mr Smith,
I reviewed you after initially seeing you as an emergency after your recent accident.
Reviewing the situation at the moment, you have considerable pain from your chest wall, both on the right side posteriorly and also anteriorly, both worse on inspiration and both worse on rolling over in bed, ie classic fractured ribs.
Over the last few weeks you have had slightly more shortness of breath on exertion. Your discharge summary note states you had a small right pneumothorax as well as a pericardial effusion. You saw a cardiologist who said you had increased pulmonary artery pressures in your echocardiogram. This is not unexpected, in view of your multiple pulmonary emboli in the past.
Today, a chest x-ray showed a tiny pleural effusion on the right, but generally, it was near normal. An ECG showed some minor anterior lateral ischaemia. As you are taking quite a while to resolve from your rib fractures, we have switched you to Clexane as you are more likely to heal on this.
You are in considerable pain from your rib fractures and paracetamol can also be taken. We will have another look at your pulmonary artery pressures when you have recovered from your rib fractures in the next few weeks.
It seems to me you have spent your life being a very active and robust individual and you find it difficult to cope with taking it slowly. We have had a chat about this today. We will see you again on 1 October 2018 for review.
And this is our clearer, simpler version:
Dear Mr Smith,
Thank you for coming to the clinic today. This was so I could check how you were after your recent accident.
I was sorry to hear the front and back of your chest is still very painful. You told me the pain is worse when you breathe in. It’s also worse when you roll over in bed. These are classic symptoms of fractured ribs.
Over the last few weeks you’ve also being getting out-of-breath a bit more easily.
The notes from your accident say you had a small right pneumothorax. That means you had a slight build-up of air between your right lung and your ribcage. You also had some excess fluid round your heart.
You saw a cardiologist who gave you a scan to look at your heart. It showed higher pressure in the blood vessels going to your lungs. This isn’t surprising because you’ve had blockages in these blood vessels in the past.
When I checked you today you had slightly slower blood flow to your heart. The medical term for this is ischaemia. Your chest x-ray also showed a tiny amount of excess fluid on your right lung. Generally though, the x-ray was near normal.
I’ve switched your medication to Clexane. This will help your heart get better more quickly while you’re still recovering from your fractured ribs.
You can also take paracetamol when you are on Clexane to ease your rib pain. I’ll check the blood pressure to your lungs again when you have recovered from your fractured ribs. I hope this will be in the next few weeks.
I understand how difficult it is for you to take things slowly when you’re usually so active and healthy. I hope the chat we had today helped. But please let me or your GP know if we can help more with this.
I look forward to seeing you again on 1 October 2018 for your next check-up.
Why is it clearer and simpler?
- We used plain English
- More specifically, we cut out the medical jargon. Or, if the patient needed to know a term that may crop up again, we explained it in everyday language.
- We also cut out doctorese. “You have considerable pain from your chest wall” became “Your chest wall is very painful”.
- We used the active not the passive voice. This is more direct and easier to understand. We replaced “Paracetamol can also be taken” to “You can also take paracetamol”.
- We used ‘You’ and ‘I’ to make the letter sound human.
- We avoided anything that could be seen as judgemental. “As you are taking quite a while to resolve from your rib fractures” became “while you’re still recovering from your fractured ribs”.
- We injected a bit of warmth. We replaced “you find it difficult to cope with taking it slowly” to “I understand how difficult it is for you to take things slowly”.
Most importantly we put ourselves in Mr Smith’s shoes. We wanted to enhance our relationship by making sure he understood what we were saying, and that he felt understood.
That doesn’t just apply to doctors writing to patients. An empathetic bedside manner is at the heart of all good communication.
And the proof?
Confession time. We have our own jargon. This particular bit of jargon is the SMOG index. It’s short for Simple Measure of Gobbledegook.
It measures how easy a letter, email or any communication is to read. It does this through a formula that looks at how complicated and long the sentences and words are.
It’s so useful and important for making things readable that the NHS uses it and recommends it for health information.
According to the SMOG index, only 57% of the UK’s working population would be able to understand the original letter. Yet 85% would understand the rewritten version.
Bearing in mind we kept in words like pneumothorax and ischaemia, in case the patient needed to know them, we think that’s a pretty good result.