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Readability – writing letters to patients in plain English

  • Nikhil Bhandari (a1)
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Abstract
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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1 Department for Education and Skills. Skills for Life: The National Strategy for Improving Adult Literacy and Numeracy Skills. Department for Education and Skills, 2003.
2 Leitch, S. Leitch Review of Skills: Prosperity for All in the Global Economy – World Class Skills: 61. HMSO, 2006.
3 Christensen, RC, Grace, GD. The prevalence of low literacy in an indigent psychiatric population. Psychiatr Serv 1999; 50: 262–3.
4 Department of Health. Copying Letters to Patients: Good Practice Guidelines. Department of Health, 2003.
5 National Institute of Adult Continuing Education. Readability: How to Produce Clear Written Materials for a Range of Readers. NIACE, 2009.
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BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
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Readability – writing letters to patients in plain English

  • Nikhil Bhandari (a1)
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eLetters

More can be done to improve readability

Elizabeth A O'Mahony, Speciality Registrar
21 October 2010

The quality of communication with our patients is of paramountimportance and it is crucial to promoting successful therapeutic engagement.

We recently completed a similar study exploring the readability of assessment letters being produced by adult community mental health teams (CMHTs).

We looked at all new assessment letters produced over a three-month period by a CMHT in the South West of England. As the community mental health team assessment appointment is usually the first point of contact with services, we felt that the readability of assessment letters was particularly important with regards to engagement and promoting a shared understanding of a patient’s difficulties.

In our study we used readability software available as standard with Microsoft Word (Microsoft, 2007), to establish the Flesch Reading Ease1. This is a widely used, validated tool used to assess readability based on the syllabic and sentence structure of the text. Reading ease on this scale ranges from 0 to 100, with specific intervals categorised from ‘veryeasy’ (90-100) to ‘very difficult’ (0-29).

Like Bandari, we found that no letters were ‘easy’ or ‘very easy’ to read. However, what our study adds is that we found that letters were significantly more readable (p = 0.004) if they were addressed to the patient with the GP copied in, rather than vice versa. We speculate that this is because when dictating a letter to the patient, the patient and their understanding is borne in mind to a greater extent than when addressing a colleague.

In addition, in our study the readability of letters varied by professional group. While there was no significant difference in readability between junior doctor, occupational therapists’ and social workers’ letters in terms of readability, community mental health nurses and consultants produced significantly less readable letters (p = 0.001; p= 0.000).

That no letters reached the standard of ‘easy’ or ‘very easy’ may reflect the difficulty of using simple terms to describe psychopathology. However some authors produced much more readable letters than others whichsuggested to us that improvement is possible.

We found it interesting that junior doctors wrote more readable letters than their consultant colleagues. We speculated that corresponding directly with patients is an art form with which consultantsmay lack historical experience as they have spent more of their careers corresponding principally with fellow health professionals. As a result they may be less familiar with methods employed to make letters more readable to the general public.

From our study we concluded that assessment letters produced by community mental health workers do not score well for readability. We feel is of the utmost importance that the reading ability of our patients is borne in mind during communication. Simple changes such as addressing the patient directly may help improve readability.

To aid truly collaborative engagement with services, correspondence should always be clear and accessible. Both our study and Bandari’s suggest that more can be done to provide readable information to our patients.

1. FLESCH, R. (1973) The Art of Readable Writing. Harper & Row.
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Conflict of interest: None Declared

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