Roger E. Alexander, DDS
Dallas, Texas
I would like to comment on the well-intentioned article by Dr. John Maggio in your February 1999 issue ("Written Post-op Expectations"). Although I agree with the substance of the article - that patients who receive written post-treatment guidance have fewer problems and a smoother clinical course - his example and guidance suffer from a common "doctor deficiency"- overwriting!
It has been estimated that more than 40 million Americans are functionally illiterate and unable to read and comprehend most of the written materials provided by doctors. Although understood by media writers and those in the pharmacy and nursing professions, this issue has been introduced to the dental profession for the first time in a recent article (Alexander RE. "Patient Understanding of Postsurgical Instruction Forms." Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87:153-158).
Dr. Maggio indicates that he prefers the terms "restoration" and "maintenance" over "filling" and "cleaning" In reality, it is probable that more of his patients understand the latter terminology than the former, unless he has an atypical patient population. The use of medical jargon, instead of language that patients understand, is a common problem in medicine and dentistry. Many patients (regardless of educational level) do not understand terms such as "administered," "subside," "preclude," "gastrointestinal," and other terms used so freely. Functional illiteracy is an increasing problem in this country. These patients conceal their illiteracy well; they will nod their heads when you talk to them, but they do not understand what you say or give them to read.
I ran a computer check on the example that Dr. Maggio used in his article. His example advisory on endodontic therapy reads at the 10th-grade level on the Flesch-Kincaid Scale (see the cited article for an explanation of what that is), and it would be understandable to only 56 percent of the public. It needs to be reworded to read at the sixth- to eighth-grade level if he wishes to reach to the majority of his patients.
Written advisories are wonderful tools, but they must be written with great care. The overwriting of information is a major problem in health care today. Many patients are incapable of understanding the advisories that are given to them. While I applaud his concern, I would urge Dr. Maggio to review the literature on writing for patients, and then to go back and rework his advisories so that they are understandable to a larger majority of his patients.
