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How to write medical information in plain English

Introduction

This guide gives you an idea of how the plain English approach can make your notices, letters and medical information clearer.


The guide will be useful if you work for:


  • the Health Service;
  • an NHS Trust; or
  • a company in the health sector.


Ten tips for clearer writing

These are recommendations, not rules: be flexible!


Think of your audience, not yourself.

Don't try to impress people by using your language to show off: keep it as straightforward as possible. Imagine you are speaking to someone, and write in that more relaxed way.


Use short sentences.

A good average sentence length ('ASL') is 15 to 20 words. Use shorter ones for 'punch'. Longer ones should not have more than three items of information; otherwise they get overloaded, and readers lose track.


Be careful with technical language.

Be prepared to explain any technical language and acronyms - will your audience know them? (See the A to Z.)


Use 'active' verbs mainly, not 'passive' ones.

Using the active is shorter and clearer; using the passive can be longer and sometimes confusing. Try to write 90% in the active. The other 10% - yes, you will find the passive more suitable.


  • 'A report will be sent to your doctor.' (passive)
  • 'We will send a report to your doctor.' (active)


Don't underline.

It is tempting to do this, but it achieves very little. It can be distracting, making the text harder to read. Proper spacing does the job. And :


Use lower case bold for emphasis, not block capitals.

Block capitals are hard to read, so don't put text in upper case. Use lower case bold. For headings, if need be, use large lower case bold.


Put complex information into bullet points.

Plan and draft your writing. If you have a lot of information to convey, make it easier for the reader by breaking it up into logical 'stepping stones'.


Use everyday words.

Big words, foreign phrases, bursts of Latin and so on usually confuse people. Consequently, it is a sine qua non of plain English not to write too polysyllabically! So, for plain English, use everyday words.


Write small numbers.

In text, write numbers one to nine as words; with 10 and upwards, put the figure. But be flexible. Probably with medicines it is clearer to write 'Take 2 tablets 4 times a day.'


Use the 'personal touch'.

Any organisation, however grand, can quickly become 'we'. Then the 'customer', 'client' or 'patient' simply becomes 'you'.


  • 'An information helpline is also operated by ABC Hospital Trust for the convenience of patients.'
  • becomes:
  • 'We also operate an information helpline for your convenience.'


Online communication/records

Communication between medical professionals and patients has changed, with all official correspondence now available online. This means you need to take more care than ever over how you communicate a medical issue. The results will form a permanent digital record, and will often have to stand alone as an explanation or interpretation of a patient’s health. There is no room for error or ambiguity – patients may read the information alone without any further information or re-explanation.


Notices

Here is an example of plain English in action.

This notice was put up by a hospital administrator. Below is the same notice, but put into plain English.


Dear Colleague


RE: CAR PARKING - OUTSIDE WARD 10 AND 11 AREA OF HOSPITAL

It is fully acknowledged that on site car parking is currently very limited and in this respect plans are currently being examined with a view to alleviating the problems.


One current area of concern is the area adjacent to Wards 10 and 11, and during a recent fire alarm call, which fortunately turned out to be an non emergency, the fire vehicles had extreme difficulty in manoeuvring in this area. In the event of a real fire you can rest assured that these vehicles would take whatever steps were necessary to reach their destination as quickly as possible, and therefore it is imperative that the perimeter road around the hospital site is left as clear as is possible. To help us with these problems both members of staff or visitors to the hospital who normally park in that area will now be able to park their vehicles in the Hospital Transport compound between the hours of 8.15 a.m. until 4.00 p.m. The gates of the compound will be left open and I ask that this space is utilised. May I also ask that it is important that no private vehicles remain in the compound after 4.00 p.m., due to the fact that transport Department vehicles will return to the site after that time and need to be in a secure area overnight.


The assistance of everybody in this matter is very much appreciated.


For the revised version, we have:


  • removed the heading (with its block capitals and underlining);
  • put the topic into the first sentence (now 19 words, not 29);
  • shortened the sentences in paragraph two;
  • used 'active' verbs; and
  • put the main instructions in bullet points.


Dear Colleague


We realise that car parking on site is very limited, and we are making plans to solve the problem.


One main difficulty is the area next to wards 10 and 11. During a recent fire alarm call (which turned out not to be an emergency) the fire engines had extreme difficulty getting through this area. In a real fire, they would take whatever action they needed to reach the emergency. So, you must keep the road around this area clear.


To help solve these problems, please:


  • park your vehicle in the Hospital transport compound, between 8.15am and 4pm; then
  • remove your vehicle by 4pm, as we need the compound overnight for Transport Department vehicles.

Thank you for your co-operation.


Comments

The revised version is easier to take in because it is more direct.


  • The original (ignoring the heading) was much longer: 230 words, with an average sentence length ('ASL') of about 33 words. The second is 119 words, with an ASL of 13 words.
  • Passive verbs have become active. For example:
  • 'it is fully acknowledged...' becomes 'we acknowledge (realise)...'
  • 'plans are currently being examined...' becomes 'we are making plans...'
  • Wordiness has been pruned. For example:
  • the repeating of 'currently' and 'current'
  • 'It is imperative that...' becomes 'you must...'
  • 'due to the fact that...' becomes 'as...'
  • 'To help with these problems both members of staff or visitors...' reads as though only two people work there. Remove 'both'


Overall, the second version gives you and your busy colleagues an easier ride. You don't have to fight your way through the words to get to the message.


Letters

On the next page is a 'standard letter' sent out by a hospital to patients telling them when they were due to come into hospital.


  • If you received this, would you be clear about what was happening? See if you can rewrite it using plain English, so that it answers these questions.
  • Is it one appointment or two?
  • Would two separate letters be better?
  • What is 'pre-assessment'?
  • Will having a cough or cold mean I can't come?
  • What if I fail to keep the pre-assessment appointment?


ADMISSION TO HOSPITAL

Dear


The following date for your operation has now been booked:-

CONSULTANT MR SMITH

HOSPITAL NUMBER G 12345

OPERATION DATE 9-11-00

WOMEN'S HEALTH UNIT (Ward 17/18)


Should there be any difficulties regarding the date of your surgery please telephone 76543 Monday-Friday, between 10.00 - 15.00 when someone will be available to take your call.


Your pre-assessment appointment is enclosed. The exact day of your admission will be confirmed at pre-assessment and is most likely to be the day prior to your operation.


We must, however, point out that at this stage we cannot guarantee bed availability. Will you therefore please telephone 76542 a couple of hours before your admission to confirm this arrangement. If you are unable to attend please telephone us as soon as possible to enable us to offer the bed to someone else.


If you develop a cough or cold prior to admission, please contact us as soon as possible.


Please report directly to the ward.


If you fail to arrive for this admission, you will not automatically be sent another admission date.


Yours sincerely


Can you do better than this?


You can get help from our website - download 'How to write letters in plainEnglish'.



Or come on the medical writing course to see how you and others would tackle it.

Over-the-counter (OTC) medicines

Information about OTC medicines needs to be easy to understand.


Here are some tips, followed by difficult examples from various medicines.


  • Use a reasonable type size on bottles and leaflets. Older people especially have trouble with tiny type. Some bottles, where space is tight, have labels that fold out into leaflets.
  • Use lower case bold for emphasis, not block capitals. And avoid italics, even though the EU guidelines recommend them!
  • Use ordinary words as far as possible. If complex medical words are needed, be prepared to explain them.
  • Use 'expiry dates' that are easy to read. Some are stamped so small that people can't find them, let alone make out the date.
  • Use plenty of white space, and don't cloud the message with watermarking (pictures faded in under the text).


Examples

The following is a random selection taken from labels on common painkillers, ear drops and so on. Many people would know some of the language through having spoken to a doctor. But many would find the labelling puzzling or alarming.


(The A-Z of medical terms covers most of the medical words used here.)


  • 'These tablets are for oral use...'
  • 'Five drops to be instilled...'
  • 'Could cause dyspepsia...'
  • 'Consult your doctor first if you are already taking medication for fluid retention using diuretics...'
  • 'Do not take these tablets if you are already taking another non-steroidal anti-inflammatory drug (NSAIDs)...'
  • 'More severe reactions may include blood in your vomit or black-looking stools, ulceration, vertigo, myocarditis, oedema, mental confusion, blood dyscrasias (disorders), increased bleeding time and gastro-intestinal irritation.'
  • 'This adult nasal spray is for local application in the nose to give symptomatic relief of nasal congestion (including in colds), perennial and allergic rhinitis (including hayfever) and sinusitis.' [30 words]


(A plainer version)

  • 'Use this spray on adults only. It will help relieve stuffed-up nose, inflamed sinuses and hay fever. Spray directly into the nose.'


And finally...

  • 'Do not take this product if your doctor has told you that you have phenylketonuria...'


A to Z of medical terms

Medical terms or phrases can often baffle your patients or customers. Try to watch out for this, and use ordinary language where possible. Be prepared to explain technical terms if you need to use them. What follows in this A to Z is a selection of words that people may find troublesome. It is not a 'correct' medical dictionary, and it is by no means complete, but it's a start!



A and E                                     accident and emergency

AID                                             artificial insemination by a donor

AIDS                                          acquired immune deficiency syndrome

amnesia                                       loss of memory

analgesic                                something that lessens pain

anastomosing                       joining together

aneurysm                               a swelling in an artery

antibiotic                               a chemical used to inhibit or stop the growth of bacteria

antipyretic                            substance that reduces temperature

arthroplasty                         repairing a joint (such as a hip replacement)

astigmatism                             uneven curvature of the eye that can lead to blurring or lack of focus

atrophy                                        a wasting away (of tissues, such as muscles)

biopsy                                          removing a small amount of tissue for examination in the laboratory

booked admissions            allowing patients to arrange with the hospital a date to come in for an operation

bronchoscopy                      examining the bronchial tubes with a small flexible camera tube (an endoscope)

cardiology                                  study and treatment of the heart

cardiothoracic                     to do with the heart and lungs

chemotherapy                      treatment (usually of cancer) by drugs

chronic                                        a long-lasting disease that changes slowly

cirrhosis                                 progressive disease of the liver (often associated with alcohol abuse)

coeliac                                     to do with the abdomen (usually the small intestine)

colonoscopy                            examining the colon (bowel) with an endoscope

colorectal                               to do with the colon and rectum

colposcopy                            examining the vagina or cervix with an endoscope

CPM                                          continuous passive motion: a machine with a motor to help flex limbs

CT scan                                        computerised tomography is a type of three-dimensional X-ray giving far more information than a                                                           normal X-ray

cystoscopy                              examining the bladder with an endoscope   

D and C                                        dilation and curettage: widening of the cervix to take a sample scraping of the lining of the womb

dialysis                                        filtering the blood, cleansing it

discharge                                  'going home' is more reassuring; keep 'discharge' for running sores!

diuretic                                        a drug that helps to remove excess water from the body

dysfunction                              not working properly

dyspepsia                                  indigestion; upset stomach

ECT                                           electroconvulsive (electroshock) treatment

ectopic                                    outside (ectopic pregnancy; a baby developing outside the womb)

electrocardiogram              a graph showing the electrical activity of the heart, including the heartbeat

electrocardiograph            a machine used to produce an electrocardiogram

embolism                                    blocking of an artery (by a blood clot or air bubble)

encephalitis                          inflammation of the brain

endometriosis                      the presence of tissue similar to the lining of the womb at other sites in the pelvis

endoscope                             various types of flexible tube with a fibre-optic camera for seeing inside organs

enuresi    s                                  bed-wetting

epidural                                   usually refers to an injection in the lower spine, often given during childbirth to reduce pain

faeces                                            solid waste from the bowel; motions; stools

femur                                             thigh bone

fracture                                        a broken bone:

  • 'compound'- with a skin wound
  • 'closed' - without a skin wound
  • 'comminuted'- in many pieces


gastroenterology                study and treatment of the stomach and intestines. The disease is 'gastroenteritis'

GU                                              genito-urinary (as in 'GU' department); urogenital; to do with reproduction and urination; dealing also                                                      with sexually transmitted diseases

gynaecology                          study and treatment of the female genital tract, including reproduction

haematology                         study of the blood

haemophilia                              severe bleeding, without clotting; so, 'haemophiliac': a person with this problem

haemorrhoids                          piles

hepatic                                          to do with the liver; so, hepatitis: liver disease HIV human immunodeficiency virus; can lead to AIDS

ICU                                             intensive care unit

image intensifier                  instant x-ray images on a TV monitor

jaundice                                        a yellowing of the skin or the whites of the eyes due to liver disease

jugular                                          of the neck or throat; so, jugular vein

keratic                                      horny, hardening of the skin

keratitis                                        inflammation of the cornea of the eye

kidney                                       organ that filters blood and excretes urine

kymograph                                  instrument that measures blood pressure

labial                                                relating to lips

labyrinthitis                              inflammation of the inner ear, causing dizziness

lachrymal duct                        the channel near the eye that produces tears

lactation                                      production of milk to breast-feed babies

laparoscopy                                examining the abdomen with an endoscope

laryngitis                                 inflammation of the vocal chords (larynx)

laxative                                          treatment for constipation

lithotripsy                               breaking up kidney or gall stones using ultrasound

mammography                        examining the breasts by x-ray

maxillofacial                           to do with the face or jaw; (removing a wisdom tooth)

metastasis                              the spreading of tumour cells round the body

miscible                                        able to be mixed with another liquid

MMR                                                measles, mumps, rubella: the three-in-one vaccination for children

motor neurone disease     a progressive wasting of the nerves that control your muscles

myocardial infarction        a heart attack; seizure of heart muscle

nasal                                              to do with the nose

nauseous                                    feeling like you are going to be sick

necrotic                                   used to describe dead cells or tissue

neoplasm                                    new and abnormal growth; tumour

neurology                                    study of the nervous system

neurophysiology                  study of the changes associated with the activity of the nervous system

obstetrics                               care and control of pregnancy and childbirth

oedema                                          swelling caused by fluid

oncology                                      study and treatment of tumours

ophthalmic                                  to do with the eye; ophthalmology - its treatment

orthodontics                              dentistry specialising in correcting teeth problems

orthopaedics                            treatment of bones and muscles (originally, in children)

osteopathy                                 treatment by manipulation and massage of muscles and bones

osteoporosis                              brittle bones; weakening of the bones

otolaryngology                     treatment of diseases of the ear and throat

paediatrics                                  study and treatment of children and their diseases

palliative care                        lessening pain without curing the symptoms

paraplegia                                    paralysis of the legs

patella                                       the kneecap

pathology                                    study of the causes of disease; the testing (biopsy) of tissue to check for disease

pertussis                                 whooping cough

phenylketonuria                      inherited difficulty in processing an amino acid; can lead to learning difficulties (mental handicap)  physiotherapy                       use of physical methods to promote healing such as massage, manipulation and exercise

podiatry                                        a branch of chiropody

post-op                                          after the operation

post operative                       after the operation

pre-assessment                      a hospital appointment before the operation date to check details

pre-med                                   drug given before an anaesthetic to calm the nerves before an operation

prophylactic                           something taken to prevent disease

quadriplegia                               paralysis of all four limbs

quarantine                                   isolation of someone with an infectious or contagious disease (originally for 40 days)

quinsy                                            abscess on or near the tonsils

radiography                            taking x-rays; the x-ray department

radiotherapy                              using radiation for treatment (especially of cancer)

renal                                                to do with the kidneys

rhinitis                                            inflammation in the nose

sigmoidoscopy                          examining the inside of the colon (bowel)

sinusitis                                   inflammation of the sinuses ('tubes'), usually around the nose

sutures                                          stitches

syndrome                                    the set of symptoms associated with a particular disease

thrombolysis                         dissolving a blood clot

tomogram                                    the image produced by a computerised tomography (CT) scan, a very detailed three-dimensional                                                              X-ray

trachea                                    the windpipe

trauma                                          a wound or injury (usually); emotional shock

triage                                              sorting out patients according to how urgently they need treatment ('A and E')

urethra                                    'tube' from the bladder, carrying urine

urology                                          study and treatment of the urine system

venereal disease                    'VD'; sexually transmitted disease

ventricle                                      a cavity or chamber in the heart or brain

xanthoderma                            yellowing of the skin

xeroderma                                  dry skin ('ichthyosis')

yellow fever                           mosquito-borne hepatitis, causing jaundice, maybe death   


Copyright

Plain English Campaign owns the copyright to this guide. You can save one copy of the guide to disk, and print one copy out for your personal use. You must not make more than one copy without our permission.