More information about text formats
We read with interest the article by Bartle et al suggesting that
most families want correspondence following outpatient appointments.
This question has been discussed in other specialties with studies from
anaesthetics, ophthalmology, psychiatry, and respiratory medicine
 all suggesting that patients do want to receive letters.
However, we believe this discussion fa...
However, we believe this discussion fails to address two important
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
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.
(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.