Building Rapport

That prescription-drug info from the pharmacy can fall short

The LA Times has reported that the legally required type of medical information given out by pharmacies is not doing the job of communciating risk.

Researchers at the University of Florida found shortcomings in the written information for on “directions for use” and “comprehensibility/legibility”.

They wrote: “Many leaflets failed to meet the minimum requirements, such as provision of a complete list of absolute contraindications, and more than half lacked specific directions that would allow patients to manage problems. Because CMI [consumer medical information] was the sole written information dispensed, some patients had no information about the risk of lactic acidosis associated with metformin or related warning signs or action steps. The high reading level required to comprehend the presented information and the inadequate formatting suggest additional shortcomings.”

Drugstores are for ‘One-Document Solution’ for patient information

The National Association of Chain Drug Stores says pharmacy and consumer groups should collaborate with the government to develop a “one-document solution” for information provided to patients regarding prescription drugs.

NACDS submitted its letter in response to an August 9, 2010, article in the newspaper that was critical of such information. NACDS President and Chief Executive Officer Steven C. Anderson says:

“Pharmacy is working with the government to help provide enhanced user-friendly information to patients about their prescription drugs. The National Association of Chain Drug Stores submitted a Citizen Petition to the Food and Drug Administration (FDA) in June 2008. Seven additional organizations, including other pharmacy and consumer groups, joined in the petition.

“The petition requests FDA guidance describing the parameters for a voluntary, FDA-approved, concise, plain-language document for patients. Such a format could consolidate and replace the multiple written communications pharmacies must now distribute to patients.

“This ‘one-document solution’ could harmonize multiple documents that arise from different FDA-imposed legal requirements or information interpretations, and from different offices and constituencies within FDA.

The Los Angeles Times article is available by clicking here http://www.latimes.com/health/boostershots/la-heb-prescription-information-20100809,0,3840303,print.story

Plain language writers can benefit from these insights, even when delivering information important to daily life from business or government to the public.

Tips for storytellers
from Spark Now
http://www.sparknow.net/tips.html

Here is an extract from the Story Guide we produced for the Swiss Agency for Development and Cooperation.

• Only tell stories that matter to you.
• Know your audience and the reaction you seek. This will help you shape your story.
• Put yourselves in the shoes of a particular member of the audience and imagine the ears they will be listening through.
• Tell a story about a particular time, place and event. Weave in small details that bring the whole scene to life using vivid language (generalised concepts will lose listeners).
• Paint pictures in the mind of your listener. People will remember sequences of images and not the words.
  Rehearse with a partner. Tell the story. Ask them to tell it back to help you assess whether your structure, messages and images are clear enough.
• Think about your relationship to the story. Are you a character in it? Are you telling somebody else’s story? Do you need to be clear that you have ‘borrowed’ the story? Do you need to tell it anonymously to protect the original teller or characters?
• Disguise locations and names where the material is sensitive.
• Think about what props you could use – images, sounds and objects.
• Think about whether you are going to introduce the story or just slide it into the proceedings without announcing it.
• Avoid too much explanation and heavy-handed lessons and morals that ‘close’ the story, rather than leaving it open to the listener to choose how to take it on.

© 2010 Sparknow LLP some rights reserved under a creative commons attribution-noderivs 3.0 unported license

So-named because they are examples of zealous over-editing, whiz deletions happen when the editor strikes out the relative pronouns which and that.

Dominique Joseph has commented on these elsewhere:

As a Francophone and a translator, I can confirm that keeping the “whiz” words in makes the text clearer and easier to understand. When “whiz” words are deleted, it can be tricky to figure out the underlying structure of the sentence and the relationships between words or ideas.

1. From “Rules for writing plain English”, by Bill Lutz (http://www.plainlanguagenetwork.org/Resources/lutz.htm#anchor)

Bill Lutz says we should avoid “whiz deleletions”, which he explains as follows:

Subordinate clauses are often introduced by such words as “which is,” “who was,” “that are,” etc. Deleting these words (the relative pronoun and linking verb) is known as “whiz-deletion.” For example:

1.The supervisor wants the report which was written by the Purchasing Office.
With a whiz-deletion we get:

2.The supervisor wants the report written by the Purchasing Office.
The whiz-deletion makes sentence 2 ambiguous. Does the supervisor want the Purchasing Office to write the report, or does she want the report that the Purchasing Office has already written? Generally, it’s a good idea to avoid whiz-deletions.

(source: http://www.plainlanguagenetwork.org/Resources/lutz.htm#anchor)

2. From “Revisiting Plain Language”, by Beth Mazur (http://www.plainlanguage.gov/whatisPL/history/mazur.cfm)

One such guideline is the suggestion to “avoid whiz deletions.” A whiz deletion is the absence of introductory text for subordinate clauses. The Guidelines offer the comparison between the sentence “The director wants the report which was written by the Home Office.” and “The director wants the report written by the Home Office” (Felker and others 1981, pp. 39-40). This guideline was based on direct research done by Charrow and Charrow (1978). In their extensive study of jury instructions, these authors found that whiz deletions made jury instructions harder to understand (Felker and others 1981).

The last defence of the nervous lawyer is “the judge won’t like it.” Guess what she will like plain language.

Joe Kimble and others conducted studies in Michigan, Florida, and Louisiana more than twenty years ago. Robert W. Benson and Joan B. Kessler conducted another study in Los Angeles, California. The results indicate that the participants found the Legalese passage to be less persuasive than the Plain English version. The respondents also believed the Plain English author was more believable, well-educated, and worked for a prestigious law firm. All of these studies compared only sentences or paragraphs and included both lawyers and judges.

A new study compared actual pleading documents, surveyed only judges, and asked directly and only about persuasiveness. Of 800 judges mailed the survey, 292 responded. This survey was conducted by Sean Flammer, a trial attorney at a Texas litigation firm. He had previously clerked for a judge of the United States Court of Appeals for the Eleventh Circuit.

The study has been reported in the Journal of the Legal Writing Institute and has become available online:

PERSUADING JUDGES: AN EMPIRICAL ANALYSIS OF WRITING STYLE, PERSUASION, AND THE USE OF PLAIN ENGLISH
Sean Flammer
The Journal of the Legal Writing Institute [Vol. 16] 212
also: http://www.journallegalwritinginstitute.org/archives/2010/183.pdf

Flammer survey shows:

The results are clear: judges prefer Plain English to Legalese. Whether a judge is an appellate or trial judge or a federal or state judge plays no role in whether the judge prefers Plain English. Nor does the judge‘s gender, age, years of judicial experience, or years of experience in the legal profession. Whether a judge‘s district is rural or urban plays no role, either. Judges—by a two-thirds margin—find Plain English more persuasive than Legalese. Thus, it is in the litigator‘s interest to submit pleadings in Plain English.

Flammer worked with 3 samples drawn from an actual court pleading:

1. a 3-page excerpt from the original pleading
2. a plain language revision, following the advise of experts in legal writing
3. an “informal” version taking plain language plainer, using contractions and colloquialisms

Each judge saw either #1 and #2 or #1 and #3. A majority of judges preferred 2 or 3 over the legalese of #1.

Flammer reports:
The judge‘s age, number of years spent in the judiciary, number of years spent in the legal profession, and gender had no correlation with whether the judge preferred Plain English or Legalese. Further, whether the trial judge was from a rural or urban district did not matter.

Some judges elaborated on their preference with these remarks about the the Plain English sample:

• more persuasive because of the succinctness of the argument.
• easier to understand, more clear and straightforward, and therefore, more persuasive.
• simpler, more direct prose. Getting to the point trumps pontificating any day.
• easy reading. It goes directly to the point.

Judges appreciated:

• brevity
• use of lists
• deletion of the opening paragraph‘s gobbledygook language

These judges found the Plain English sample to be ―cleaner, leaner, and more effective and understandable.

The bad news for legalese writers is that they won’t be read carefully:

The convoluted style led me to skimming for its essence. This was not the only judge who stated that the writing style in the Legalese sample inspired him to pay little attention to the document‘s logical intricacies. These comments make clear that an indirect and convoluted writing style is likely to make the document go unread. An unread document cannot be persuasive.

The minority of judges who preferred legalese, liked that it was
―more polished
―formal
―easier to read

What about the “cranky” judges (my soulmates)? They said that the two plain language versions did not go far enough. Those writings were

• too wordy
• poor writing
• too verbose and filled with formal legalese
• not punchy enough
• capable of being made more succinct

The data show that judges—as a group—would much rather have an attorney err on the side of informality than err on the side of being too stilted and formal. One judge made a fair criticism of this Plain English sample in that it was not plain enough and was too wordy. Another said, “Short and direct is almost always more persuasive.”

More evidence is in, judges are sold on plain language, so why not be brave and use it.

Read my books, Plain Language Legal Writing and Plain Language in Plain English, both available with free U.S. shipping this summer at Plain Language Wizardry.