An analysis of more than 4.6 million ophthalmic clinical letters has found that overall readability has decreased, with more than 95% less readable than recommended for patient-facing information.
And the study authors found that readability declined over the 12-year study period, despite efforts to promote patient-centred communication.
The study, published in BMJ Health and Care Informatics, analysed more than 4.6 million outpatient clinic letters written for almost 805,000 patients at Moorfields Eye Hospital in the United Kingdom between 2013 and 2025.1 The letters represented 17 ophthalmic subspecialty services, and a variety of scales were used to evaluate linguistic complexity.
“Poorly readable clinical correspondence has direct patient-centred consequences – when letters are not written for the reader, they may undermine informed consent, shared decision making, engagement, and equitable access to care, thereby widening existing health disparities,” the study authors wrote.1
… when letters are not written for the reader, they may undermine informed consent
The authors suggest implementing letter templates to help guide clinicians. This would allow clinicians to “separate the medical record from the patient-facing explanation while keeping both aligned,” the study authors said.
The authors also suggested the use of large language models (LLMs) to efficiently translate medical notes to patient-friendly language, although they acknowledged the potential risks of such an approaching, including the potential to compromise patient privacy.
Reference
- Ong AY, Kiire CA, Keane PA, et al. How well do we write for patients? Longitudinal analysis of the readability and complexity of 4.6 million ophthalmic clinical letters. BMJ Health Care Inform. 2026;33(1):e102086. doi: 10.1136/bmjhci-2026-102086
