A patient goes home after shoulder surgery with a discharge document that's technically accurate, medically complete, and nearly impossible for a non-clinician to act on — dense paragraphs, terms nobody outside medicine uses casually, and an assumption of background knowledge most patients simply don't have. A few days later they've missed a warning sign because the instructions never made it clear enough, and they're back in the ER. That's not a failure of the patient. It's a failure of the writing.
The numbers behind this are worth sitting with. An estimated 54% of US adults, per the National Assessment of Adult Literacy, can't fully understand basic health information. Research published in the Journal of General Internal Medicine puts medication-dosing confusion at roughly one in three patients. The National Center for Education Statistics has tied poor health literacy to around $290 billion a year in avoidable healthcare costs, and Health Affairs has found that patients with low health literacy get readmitted to the hospital at roughly twice the rate of those with higher literacy. The uncomfortable truth underneath all of that: most medical instructions are written by clinicians, for an audience that reads like clinicians, and most patients don't.
Health literacy isn't a proxy for intelligence — I'd guess most of us, dropped into an unfamiliar medical situation with our stress response fully activated, read at a lower level than we do on an ordinary day. A sharp engineer with zero medical background is often functionally at the same reading level as anyone else the first time they're handed a post-surgical care sheet. The mismatch is that discharge instructions tend to be written for the minority with genuinely high health literacy, while the majority of patients receiving them read somewhere well below that.
Flip the Structure
Traditional technical writing tends to build up to the point — background, then method, then the actual instruction. Medical writing needs to invert that. A patient who just had shoulder surgery does not need three paragraphs on arthroscopic technique before being told what they're allowed to lift.
❌ Traditional approach:
INSTRUCTIONS FOR POST-OPERATIVE CARE OF SHOULDER ARTHROSCOPY
Your physician performed an arthroscopic examination and repair of your shoulder joint. This procedure involves insertion of a small camera (arthroscope) through tiny incisions to visualize and treat specific pathological conditions in the glenohumeral joint. To ensure optimal healing and prevent post-operative complications including infection, hematoma, or re-injury to the repaired structures...
[More technical paragraphs before getting to actual instructions]✅ Health-literate approach:
AFTER YOUR SHOULDER SURGERY
STOP DOING THESE NOW:
• Lifting anything heavier than a cup
• Reaching across your body
• Swimming or immersion in water
DO THIS TO HEAL FASTER:
• Wear your sling at all times (except when sleeping)
• Ice your shoulder: 15 minutes on, 15 minutes off
• Take your pain medication 30 minutes before physical therapy
CALL THE SURGEON IF:
• Your shoulder gets hot, red, or swollen
• You have a fever over 101°F
• Your pain suddenly gets worseRemove Jargon, or Translate It
The test I'd apply to every medical term in a patient-facing document: can someone understand it without reaching for a dictionary? If not, translate it plainly, and if a plainer version exists that's even more concrete, use that instead:
| Medical Term | Patient Language | Better Yet |
|---|---|---|
| Arthroscopic | Using a small camera | Using tiny cameras to see inside |
| Post-operative | After surgery | After your operation |
| Glenohumeral joint | Shoulder joint | Where your upper arm bone connects to your shoulder |
| Hematoma | Blood pooling | A bruise with fluid under the skin |
| Prophylactic antibiotics | Medicines to prevent infection | Antibiotics to keep infection from happening |
| Constipation (pain meds) | Difficulty with bowel movements | Hard, dry stools |
| Diuretic | Water-removing medication | Medicine that makes you pee more |
| Immunosuppression | Weak immune system | Your body's defense system isn't working well |
A rough but useful rule: if you wouldn't say it to a 12-year-old, rewrite it.
Visuals Carry Weight Text Can't
For patients with limited reading ability or limited English proficiency, text-only instructions often just don't land, no matter how simply they're worded. Visuals do a lot of the work text can't:
| Visual Type | Best Use | Example |
|---|---|---|
| Simple icons | Quick reference for do's and don'ts | Check mark for allowed, X for prohibited |
| Step-by-step photos | Physical tasks (dressing wound, taking meds) | Numbered images showing position, technique |
| Color coding | Importance levels | Red=urgent, Yellow=caution, Green=okay |
| Infographics | Timeline and progression | Day 1-3 (bandaged, swollen), Day 4-10 (reduced swelling), Week 3+ (normal) |
| Body diagrams | Specific locations | Arrow pointing to surgical site |
Example: Wound Care Instruction
Instead of: "Change the dressing daily using sterile technique, ensuring that the perimeter remains dry and intact..."
Use: [Photo sequence showing] 1. Hands being washed 2. Old bandage being gently removed 3. Wound being checked (green=good, red=concerning) 4. New bandage being applied 5. Hands being washed again
Write the How, Not Just the What
Clinical writing tends to describe what needs to happen. Patients need to be told how to do it, in a form they can follow without a second reading:
BEFORE (Informational):
"You must monitor your incision for signs of infection including redness, warmth, drainage, or increased pain. Infection risk is highest in the first two weeks post-operatively."
AFTER (Action-Oriented):
"CHECK YOUR INCISION EVERY DAY:
1. Look for redness around the incision
2. Feel if it's warm to the touch
3. Check if there's pus or drainage
4. Is the pain getting worse?
If YES to any of these ➜ CALL YOUR SURGEON TODAY
Most important: First 2 weeks after surgery"A Document Structure That Holds Up
Across the instruction sets I'd consider well-designed, the shape tends to repeat:
| Section | Purpose | Content | Length |
|---|---|---|---|
| Quick Start | Immediate action | 3-5 most important tasks | 1 paragraph |
| Do's List | What to continue | Positive actions (with icons) | 5-7 items |
| Don'ts List | What to avoid | Restrictions (with icons) | 4-6 items |
| Daily Care | Routine tasks | Step-by-step with visuals | 1-2 pages |
| Medications | Drug information | Name, dose, time, side effects | Simple table |
| Warning Signs | Red flags | Symptoms that need immediate care | Highlighted |
| Contact Info | How to reach help | Phone, hours, who to ask for | Visible box |
| When You're Better | Recovery timeline | Milestones and next steps | 1 page |
Example: Post-Medication Instruction (Type 2 Diabetes)
YOUR DIABETES MEDICINE: Metformin
WHAT IT DOES:
Helps your body control blood sugar. Lowers the risk of complications.
HOW TO TAKE IT:
• 500 mg (one tablet)
• Take it with breakfast
• Take it with lunch
• Take it with dinner
[Visual: three times with meal pictures]
WHAT TO EXPECT:
• First week: Stomach may feel upset, take with food
• After 2 weeks: Should feel normal
• You might use the bathroom more (normal)
RED FLAGS - CALL YOUR DOCTOR IF:
🔴 Severe stomach pain or vomiting
🔴 Shortness of breath
🔴 Feeling unusually weak
🔴 Dizziness or confusion
WHAT IF YOU FORGET A DOSE:
✓ If less than 4 hours late: Take it now with food
✓ If more than 4 hours late: Skip and take next dose normally
✓ NEVER double upReadability, Made Concrete
The same underlying idea (Flesch Reading Ease) shows up across a range that's worth knowing in practical terms: a 90-100 score reads like "take your medicine with food," a 60-69 "standard" score reads like "continue current pharmaceutical regimen to manage glycemic control," and anything below 50 starts to look like the language of medical journals rather than patient instructions. For patient-facing writing, I'd aim for a score of 60-70 — roughly an 8th-9th grade reading level — which in practice means short sentences (a plain instruction fits in 8-12 words), one idea per sentence, and complex information broken across two or three short sentences rather than compressed into one long one.
Testing It for Real
Readability scores are a useful proxy, but the actual gold standard is the teach-back method: after giving instructions, ask the patient to explain back, in their own words, how they'll follow them at home. If what comes back doesn't match what you meant, that's not the patient failing a test — it's the instructions telling you exactly where they broke down, so you clarify and try again. No readability tool catches what a real person's confusion catches.
For a first-pass check before it gets to a real patient, Hemingway Editor and Word's built-in Flesch scoring are free and good enough to flag overly long sentences and inflated vocabulary. Grammarly helps with tone and clarity beyond raw readability. None of these substitute for teach-back — they just help you get closer before you test with an actual person.
What This Is Worth
A hospital network that invested in rewriting its patient instructions along these lines saw its surgical site infection rate drop from 12% to 7%, readmissions fall from 18% to 10%, and patient-reported compliance rise from 62% to 89%. The rewrite took roughly 50% longer to produce per document — and by their own accounting, that extra hour and a half more than paid for itself by preventing a meaningful number of infections and readmissions each year. That's the trade-off in one sentence: better patient writing costs more time upfront and saves real money and real complications on the other end.
What I'd Check Before Calling It Done
After giving instructions, ask the patient to teach it back to you:
Doctor: "I've given you information about taking your medicine. Can you explain to me how you'll take it at home?"
Patient explains their understanding. If they misunderstand:
- You clarify
- You rewrite the instruction
- Patient teaches back again- Removed jargon — every term is patient-friendly
- Used action verbs — "do this," not "should be done"
- Kept paragraphs short — no more than 3-4 sentences
- Added visuals — photos, icons, or diagrams where text alone would struggle
- Highlighted warnings so they stand out from routine instructions
- Checked the readability score lands around 60-70
- Tested with a real patient using teach-back, not just a colleague's read-through
- Included clear contact info — who to call, when, and how
- Organized logically: quick start, then daily care, then warnings
Medical technical writing has to serve two masters at once — accurate enough that a clinician would sign off on it, simple enough that a patient under stress, in pain, or reading their third language can actually follow it without a follow-up phone call. Getting both right at the same time is the actual craft here, and it's worth treating as seriously as the medicine itself.