Good points. I think everyone agrees an informal approach is best. But it can and should be grammatically correct as well. 

The AMA refers to "living room language" and that's a good way to think about it. But speaking is quite a bit different from writing, so we can be a lot more informal when we talk, including using incomplete sentences. There is a lot more happening during a face to face conversation than when someone is reading a handout. Ideally, both forms of communication are used during a patient's visit. The health care provide speaks casually and in some cases intimately with the patient. A handout may provide more information and it should reinforce, repeat, expand upon the conversation the patient had with their provider (hmmm, I really don't like the plural "their" used that way... )

One thing to keep in mind is the concept of universal design. That's really what we're aiming for. Produce written handouts and other resources that can benefit the most people. When I bought my computer, it came with a user's manual, and all the steps for hooking it up were provided. But all the cords and plugs were also color coded, so I didn't even need to read the manual to figure out what went where. Was I offended? Did I think the computer company was talking down to me? No. I appreciated the clear, simple directions.  Most people do. 

The best thing we can do in health care is provide a range of educational resources. The bulk of what we use and/or produce should be accessible to about 80% of the population---simple, clear information. But we also need to have other tools available for those who may not speak English, for example. I pictogram that tells a story of how to take a medication, or restrictions for after a procedure (no heavy lifting, for example) works great, but it may not be appropriate to use with someone who can read fairly well.  At the same time, there is plenty of higher level information for those patients who want to learn more, who want to read about the latest drug trials, or who want a detailed explanation of how the heart works so they can better understand their condition. 

I guess my point in all this is that we shouldn't worry about offending someone by offering education materials that follow the plain language guidelines. I think there are study's out there that show people prefer and appreciate information that is clear, brief, and easy to understand and act on.

Doug Seubert
Quality Improvement & Care Management
Family Health Center/Community Heath Access

Marshfield Clinic
1000 N Oak Avenue
Marshfield, WI 54449
www.marshfieldclinic.org/quality

(715) 387-5096 (1-800-782-8581 ext. 75096)
seubert.douglas at marshfieldclinic.org

------Original Message------
From:	"Searing, Margaret" <SearingM at co.clinton.ny.us>
Date:	Fri May 16, 2008 -- 08:43:50 AM
To:	healthliteracy at nifl.gov
Subject:	[HealthLiteracy 2002] Re: Wednesday Question: Writing how we talk:	better or wor

Alex brings up a point about formality/ informality of language which reminded me of Economic Class based work done on the register of language. I think this is written up in a book by Ruby K Payne called "A Framework for Understanding Poverty."  Language, whether spoken or written, comes in five registers - Frozen ( think of the Lord's Prayer recited from the King James version); Formal ( the standard sentence syntax and word choice of work and school ( think standardized testing ); Consultative, another formal register which is not quite as direct as the formal; Casual ( think language between friends in conversation, where sentences are often incomplete or rambling, vocabulary limited to 400- 800 words, and a long-winded story-telling style is employed); and Intimate ( the language between lovers, twins, and those using language to sexually harass).  One can comfortably move between only two registers along the register scale in the continuum of the same conversational sit
 uation.  Class-wise, the ability to be flexible between these language registers is a Middle Class standard, not one of Poverty.   Typically, those in the Poverty Class are most conversant in the casual and intimate registers, which when involved in an interaction with a physician about a health care issue creates quite a disadvantage (the casual style does not "get to the point" quickly but engages in story-telling around it, and the Intimate register is completely inappropriate).   The reason I bring this Language register research up is two fold: to be aware of our own Class bias when developing and evaluating patient education resources, and (while in no way implying diminished Health Literacy is a reality limited to only one economic class, since it clearly is not) Class may well play a largely unacknowledged role in judgemental attitudes towards materials written in the limited vocabulary and story-telling form of the casual register.

Margaret Searing RN,BS
Inservice Education
Clinton County Health Department
133 Margaret St.
Plattsburgh, NY 12901
518 565-4848


-----Original Message-----
From: healthliteracy-bounces at nifl.gov [mailto:healthliteracy-bounces at nifl.gov] On Behalf Of alex.friesen at sickkids.ca
Sent: Thursday, May 15, 2008 12:50 PM
To: The Health and Literacy Discussion List
Subject: [HealthLiteracy 1994] Re: Wednesday Question: Writing how we talk: better or worse?

Hello good people of the list,

With regards to writing how we talk, that's a huge topic, and there's no
definitive black-and-white conclusion.

Using our examples, I would have no qualms about writing "Your dominant
hand is the one you write with," but using "their" as singular jolts me
like an unexpected speed bump.

Obviously, writing and speaking differ in many ways, and of course we all
speak and write differently in different situations.  For example, you talk
to your mother differently from how you talk in a job interview, and you
write a note to this list differently than you write a postcard to a loved
one.  (I'm rashly assuming.)

Still, I don't think that styles of writing and styles of speaking can
necessarily substitute for one another, meaning that a casual tone in
conversation still doesn't match that same casual tone in writing.  A big
part of the difference comes from the reality that a listener gets only one
chance to hear and interpret a spoken sentence, while a reader can peruse
the same text over and over.  If a listener wants to hear the sentence
again to increase understanding, it's extremely likely that the speaker
will rephrase it, or at least put stresses in different places.  With
writing, of course, we have the opportunity to think in great detail about
what we're typing, which, in the hands of a good writer, increases the
opportunity for clarity up front.

So I'm all for a casual tone in the type of writing we're discussing,
because I believe that formal writing styles are often somewhat stilted and
more difficult to understand*, but I think that writing in the same way we
speak is neither better nor worse: the two modes of communication are not
interchangeable, so writing-as-speaking does not necessarily lead to
increased intelligibility in low-literacy material.

     ...Alex...


* e.g., that sentence.






             "Julie McKinney"
             <julie_mcKinney at w
             orlded.org>                                                To
             Sent by:                  <healthliteracy at nifl.gov>
             healthliteracy-bo                                          cc
             unces at nifl.gov
                                                                   Subject
                                       [HealthLiteracy 1990] Wednesday
             2008-05-15 11:57          Question: Writing how we talk:
                                       better or worse?

             Please respond to
              The Health and
                 Literacy
              Discussion List
             <healthliteracy at n
                 ifl.gov>






I agree with Kristina that writing "the way we talk" is usually clearer,
even if it is technically grammatically incorrect. It's an interesting
concept that well educated people talk in a certain way, which is
grammatically correct, but may be more confusing to people with literacy
or English challenges. And this way is usually how we are "supposed" to
write.

The gender question that we've been discussing is one example of that,
but there are many others. For example, the rule that no sentence can
end with a preposition. Which is clearer:

Your dominant hand is the one you write with.
or
Your dominant hand is the one with which you write.

(I know we could say ..."the one you use to write", but sometimes, the
sentence structures abobe seem to be the only choices.)

What do the plain language folks think about this? And others? Can we
write more colloquially, and is it clearer or not?

All the best,
Julie



Julie McKinney
Health Literacy List Moderator
World Education
jmckinney at worlded.org



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