More can be done to improve readability of patient letters

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

We recently completed a study, similar to that by Bhandari, ¹ exploring the readability of assessment letters being produced by an adult community mental health team (CMHT) in south-west England. We looked at all new assessment letters produced over a 3-month period. As the CMHT assessment is usually the first point of contact with services, we felt that the readability of assessment letters was particularly important with regard to engagement and promoting a shared understanding of a person's difficulties.

We used readability software available as a standard with Microsoft Word 2007 to establish the Flesch Reading Ease. ² This is a validated tool widely 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 ‘very easy’ (90-100) to ‘very difficult’ (0-29).

Like Bandari, we found that no letters were ‘easy’ or ‘very easy’ to read. However, we found that letters were significantly more readable (P = 0.004) if they were addressed to the patient with the general practitioner 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, the readability of letters varied by professional group. Whereas there was no significant difference in readability between junior doctors’, occupational therapists’ and social workers’ letters, community mental health nurses and consultants produced significantly less readable letters (P = 0.001 and P = 0.000 respectively). The fact 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, which suggests 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 a skill with which consultants may 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 to make letters more readable to the general public.

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 when writing such letters. Simple changes such as addressing the patient directly may help improve readability.