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College-level documents for 8th grade readers
17 February 2009
Springer Science+Business Media
Study shows patients unable to read or understand their rights
Patients hoping to find out about their rights are unlikely to get the
information they need from hospital documents designed precisely for
that purpose. In reality, patients are presented with information
written in legal jargon that the majority of them can neither read nor
understand. These findings1 by Dr. Michael Paasche-Orlow from Boston
University's School of Medicine in the US, and his team, were just
published online in Springer's Journal of General Internal Medicine.
Some forty years ago, notions of informed consent and autonomy were
first officially endorsed and the concept of patients' rights emerged.
In 1990, a condition of hospital accreditation was to inform every
patient about their rights. Then in 2001, the US House of
Representatives and US Senate passed bills to create a Federal Patients'
Bill of Rights (PBOR). Many states now have Patients' Bill of Rights
laws in place.
Ironically, these efforts to progress patients' rights are being held
back by the use of overly complex language which far exceeds patients'
average reading capacity, which is at the 8th grade level. Paasche-Orlow
and his team analyzed PBOR statutes for general patient populations in
23 states and 240 hospital PBOR documents from 50 states. They assessed
their readability by looking at a combination of reading level,
complexity of sentences and vocabulary, and quality of writing style.
The hospital PBOR documents had an average readability at the level of
the second year of college. In the nine states that stipulate that PBOR
texts are to be distributed to patients, the average reading grade level
of the materials was that of a college junior. Not only was the language
patients are presented with extremely complex, it was also usually
exclusively in English.
These findings show that an advanced college reading level is routinely
required to read PBOR documents. Bearing in mind that the average
reading level of an American adult is 8th grade, it is clear that the
written information patients are given in US hospitals far exceeds their
The authors highlight several reasons why clinicians and patient
advocates should be concerned about the readability and accessibility of
the language in PBOR documents. In essence, giving patients unreadable
legal jargon is a missed opportunity to present the patient care mission
in a clear manner.
Paasche-Orlow concludes that: "Patients' rights statutes are designed to
promote the ethical and humane treatment of patients. These goals will
not be realized by presenting patients with documents they are not able
to read and understand."