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• Does readability matter in clinic letters sent to families?
  Alex Henderson
  Published on: 3 November 2004

• Published on: 3 November 2004

  Does readability matter in clinic letters sent to families?

  • Alex Henderson, Specialist Registrar, Clinical Genetics
  • Other Contributors:
    • Sally Ann Lynch

  Dear Editor,

  We read with interest the article by Bartle et al suggesting that most families want correspondence following outpatient appointments.[1] This question has been discussed in other specialties with studies from anaesthetics,[2] ophthalmology,[3] psychiatry,[4] and respiratory medicine [5] all suggesting that patients do want to receive letters.

  However, we believe this discussion fa...

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  Dear Editor,

  We read with interest the article by Bartle et al suggesting that most families want correspondence following outpatient appointments.[1] This question has been discussed in other specialties with studies from anaesthetics,[2] ophthalmology,[3] psychiatry,[4] and respiratory medicine [5] all suggesting that patients do want to receive letters.

  However, we believe this discussion fails to address two important questions.
  1. Are the letters that we send to patients readable?
  2. How are we trained to write comprehensible letters?

  We conducted a study addressing these points: 24 randomly selected letters written to patients after genetics appointments were reviewed by the Campaign for Plain English (CPE). In addition to these, a further 26 letters (total 50) were assessed for length and readability using computer -based readability scores. The Flesch reading ease score and Flesch- Kincaid grade level score indicate how easy it is to understand a document. By obtaining scores for the letters, we were able to compare those written by clinicians with different levels of experience.

  The CPE considered the letters of very high standard. They were particularly pleased with the personalised, conversational style. However, there were specific criticisms: in particular, there were concerns that efforts to simplify very complicated concepts have gone too far in some instances (the example that was used was a 'genetic spelling mistake').

  They also made two main recommendations regarding general principles. Firstly they suggested always to keep the reader, and their level of knowledge, in mind and use a writing style and words appropriate to them. The second suggestion was to keep letters as brief as possible and not overload the reader with too much information and risk confusing them. Information leaflets may be better than writing large amounts of text.

  In the second part of the study, when consultants' letters were compared with those of registrars, the former were shorter and more readable (p<_0.05. however="however" there="there" is="is" evidence="evidence" of="of" a="a" rapid="rapid" learning="learning" curve="curve" as="as" registrars="registrars" letters="letters" written="written" after="after" six="six" months="months" working="working" in="in" genetics="genetics" were="were" not="not" statistically="statistically" different="different" from="from" those="those" consultants.="consultants." we="we" believe="believe" this="this" has="has" implications="implications" regarding="regarding" training="training" and="and" supervision="supervision" writing.="writing." p="p"/> In conclusion, we believe that attention should be paid to the quality of letters written to families and young people after clinic appointments. Our study demonstrates that clinicians can write good, understandable letters and the quality of letters improves after a short period of practice.

  References

  (1). Bartle G, Diskin L, Finlay F. Copies of clinic letters to the family. Arch Dis Child 2004;89:1032-1033

  (2). Trentman TL, Frasco PE, Milde LN. Utility of letters sent to patients after difficult airway management. J Clin Anesth. 2004;16:257-61

  (3). Krishna Y, Damato BE. Patient attitudes to receiving copies of outpatient clinic letters from the ocular oncologist to the referring ophthalmologist and GP. Eye. 2004 advance online publication

  (4). Dale J, Tadros G, Adams S, et al. Copying letters to patients: Doctors should tailor their practice to cater for individual patients' needs Br Med J 2003;327:450-451.

  (5). O'Driscoll BR, Koch J, Paschalides C. Copying letters to patients: Most patients want copies of letters from outpatient clinics and find them useful. Br Med J 2003;327:451.

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  Conflict of Interest:
  None declared.

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