Most clinical letters too difficult for patients – and getting more complex

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By Daniel Pye

An analysis of more than four million outpatient clinic letters found almost all were more difficult to understand than recommended for patients.

The research, which analysed updates written for more than 800,000 patients at Moorfields Eye Hospital Foundation Trust, found on average they were around college-level readability which is significantly more complex than recommended by national guidance.

The letters, which were sent between 2013 and 2025, got more difficult to understand over the study period, researchers found.

Published in BMJ Health and Care Informatics, the researchers said that an analysis on this scale had never been done before.

Studying the readability of clinical correspondence is important as 18% of adults in England are functionally illiterate, and low literacy has been associated with poor health outcomes, they added.

Unlike many other health systems, the UK maintains the practice of sending letters to patients following an outpatient appointment. These used to be copies of those sent to the GP, but the focus is now on making the letters patient centred.