Should doctors have to write in plain English? I'm not so sure

Here's an article explaining the recommendation of the Academy of Medical Royal Colleges that doctors should write to patients in plain English. It also contains a video demonstrating why – though the level of ignorance by some of those surveyed is rather worrying.

The idea seems uncontroversial enough, doesn’t it? On the one hand, write complex medical terminology and have your patients worriedly rushing to Google to make sure they’re not going to die in agony or grow two heads. On the other, use good old no-nonsense terms that everyone can understand. But I, for one, am concerned.

Don’t get me wrong, I hate waffle and babble as much as the next person. Having spent time working in the NHS, I know that it’s got jargon down to a mighty fine art. But here’s what worries me.

First, I don’t have enough faith in the medical profession. Of course, there are some amazing clinicians, but there are some terrible ones too – not terrible at treating people, but terrible at communicating with them. In 2003 I was diagnosed with a serious and progressive eye disease. This had apparently become evident during the consultation, but the findings were never explained to me. Then the clinic letter duly turned up a few days later, spelling out to my GP what was wrong. Off to Google I went. In 2015 I was diagnosed with glaucoma. A registrar then proceeded to tell me that the indications had been there for years but that they probably didn’t think it was important to tell me given that I had no vision to be affected – never mind the awful headaches I’d worried about for years and the simple fact that it’s my right to know. Far more alarmingly, thinking of people close to me, conditions as serious as MRSA and sepsis have been revealed by slips of the tongue or notes carelessly placed on the end of the bed and scrutinised by anxious relatives-turned-detectives. And if that’s just me, there have got to be many others who have experienced the very mixed bag that is medical communication. At least in a letter, doctors can express themselves in their own words. Adjusting one’s writing style is hard. You should never assume any of us has the ability to simplify our language and find it just as easy to get down all the key information. Why take the risk?

Next, plain English can only serve to benefit the patient. This is, in my view, to misunderstand the purpose of the letter. It is not, and should not, be the place to explain things to a patient. This needs to be done in a consultation, where adjustment can be made for the sensitivity of the situation and the emotional needs of the patient. Stressed and under intolerable pressure, it’s not unreasonable to imagine doctors leaving some of the explanation to the letter if it’s to be written to the patient himself. It is there to give the facts, and to support GPs and other care professionals to meet the on-going needs of that patient. For this purpose, your classic clinic letter works fine.

And finally, when all is said and done, we do have Google. I’m afraid the great and the good of the medical world sometimes still think of the passive patient turning up to be told what’s wrong, what to do and what to be aware of. They look upon self-help and searching the internet with anything from astonished bewilderment to snobbish disdain. In this, they make a mistake. The need to dumb down for us puts us at risk of missing information, is another burden for overworked and busy doctors and is just patronising.  I want my builder to be good at making walls that stay upright; my barber to be half-decent at cutting hair, and my doctor to know a thing or two about the body. I don’t expect or care if any of them don’t always express themselves that well, or write with the plain-speaking brilliance of a blog like this. (Joking of course).

I can’t sum it up more succinctly than this: if it ain’t broke, don’t fix it!