Write Medicine in Plain English: Keep the Precision, Lose the Priesthood

Here is a sentence of the kind that leaves hospitals every day: The patient was commenced on anticoagulation therapy following confirmation of the diagnosis, and arrangements were made for the undertaking of outpatient monitoring of the relevant haematological parameters. Now the plain version: We started her on a blood-thinning medicine and arranged blood tests to check it is working. Same facts. Half the words. Nothing true has been lost — and a great deal that was never doing any work has been thrown away.

That pair is the whole argument, and everything below is commentary on it. Most writing about medical language frames the choice as jargon versus accessibility, expert versus public, rigour versus reach. That framing is wrong, and it is wrong in a way that licenses bad writing on both sides. Jargon excludes the reader. Dumbing-down misleads them. Plain English is neither — it is the discipline of keeping the precision while losing the priesthood, and it is harder to write than the jargon it replaces, not easier.

The two failure modes

Medical writing fails its readers in two opposite directions, and most writers only fear one of them.

The first is jargon. Jargon is not a moral failing; it is compression. Pre-prandial hyperglycaemia refractory to titration is admirably exact for two endocrinologists who share the codebook, and it would be perverse to make them spell it out to each other. The failure is one of audience, not vocabulary. Jargon is precision for insiders and noise for everyone else, and the writer who reaches for it in front of a patient, a commissioning editor, or a product team has misjudged the room — usually without noticing, because the words feel precise in the writer's own head.

The second failure is the one writers congratulate themselves for avoiding while walking straight into it: dumbing-down. Told to simplify, the anxious writer reaches for the folk paraphrase — and the folk paraphrase frequently changes the claim. Anticoagulants become blood thinners, which is fine as a handle and false as a mechanism: the drug does not thin anything, and the patient who believes it does will reason wrongly about bruising, about diet, about what the morning blood test is for. The biopsy was negative becomes the results were normal, which is not what negative means and is occasionally the opposite of what the clinician needs the reader to understand. Simplification that survives only by quietly editing the facts is not accessibility. It is a different error wearing accessibility's clothes.

Plain English is the third path, and it is defined precisely against the other two. It keeps the claim the jargon was protecting and carries it in language the reader can actually lift. Same proposition; clearer carriage. The skill is not knowing easier words. It is knowing exactly what must be preserved and exactly what was only ever ceremony — and that judgement requires understanding the medicine better than either of the failures demands.

What actually changes in a plain rewrite

The most useful thing I can say about plain English is that it is not a vocabulary exercise. Swapping long words for short ones is the least of it, and a writer who believes that is the whole job will produce prose that is shorter and no clearer. The real work happens at the level of sentence mechanics, and it is mostly the same handful of moves.

The first is recovering verbs that have been frozen into nouns. Clinical prose has a compulsion to nominalise — to turn doing-words into thing-words and then prop them up with a limp verb. We undertook an assessment of is we assessed. Initiation of treatment was carried out is we started treatment. There was a deterioration in is she got worse. Every nominalisation buries the action the sentence is actually about under an abstract noun and forces the reader to dig it back out. Recovering the verb is the single highest-yield edit in medical writing, because the verb is where the meaning was hiding all along.

The second move is restoring the actors. Clinical writing loves the passive voice because the passive voice lets you describe an event without committing to who caused it: the medication was stopped, it was decided that, the patient was deemed unsuitable. Sometimes the actor genuinely doesn't matter and the passive is correct — use it on purpose, not by reflex. But a reader who cannot tell who did what cannot tell what happened, and "it was decided" is a sentence with the responsibility surgically removed. Put a person back at the front of the sentence and the prose stops floating.

The third is treating sentence length as load management rather than style. A long sentence is not wrong, but every clause you add is a weight you ask the reader to carry to the full stop, and clinical writers routinely stack four or five before setting any of them down. Break the load and comprehension recovers — not because short sentences are inherently virtuous, but because the reader has a finite carrying capacity and good writing respects it. This matters more, not less, when the reader is frightened, distracted, tired, or unwell, which describes most people receiving medical information most of the time.

There is a literacy point underneath all this, and it deserves stating without condescension. A substantial share of any general readership reads less fluently than professionals assume — health information is routinely pitched well above the level at which much of its audience reads comfortably, and the gap is real enough that the major health systems treat it as a design constraint rather than a nicety. Plain English is the response, and the response is not contempt for the reader. It is the opposite: the assumption that the reader is busy and intelligent and entitled to have the work done for them, rather than handed a paragraph and a dictionary.

Why plain is harder than jargon

Here is the part that surprises people who think plain writing is the lazy option. It is the demanding one.

Jargon is compression for an audience that already holds the context. The technical term is a pointer to a shared body of understanding, and it works because both ends of the conversation can dereference it. Strip the jargon out for a reader who does not hold that context and you have to rebuild the context in the prose — which means you, the writer, must actually possess it, in full, well enough to reconstruct it from the ground up. The jargon let you gesture at understanding. The plain sentence makes you supply it.

Which is why plain English is merciless about gaps. Ambiguity hides comfortably inside technical phrasing; a sufficiently grand sentence can sound authoritative while concealing that its author is not entirely sure what happened. The patient was managed conservatively can mean a clear plan or a shrug, and the phrasing protects both equally. Force the same thought into plain words — we decided not to operate and watched her closely — and any vagueness has nowhere to live. Every gap in the writer's understanding shows up as a gap in the plain sentence, glaring, where the jargon would have papered over it. Plain writing is a test the writer takes in public.

There is a maxim that if you cannot say a thing plainly you do not understand it yet, and it is mostly true — true often enough to be the most useful working assumption in the craft. It is occasionally unfair: some ideas are irreducibly technical, and some plain renderings genuinely cost a sliver of precision that a specialist reader needs kept. But the maxim earns its keep because the far commoner situation is the reverse — the writer who hides behind the jargon precisely because the plain version would expose that the thinking underneath was never finished. The difficulty of writing plainly is not a writing difficulty. It is the difficulty of understanding the thing completely, surfacing as prose.

Where the stakes stop being aesthetic

For most prose, the cost of failing at this is mild — a bored reader, a re-read, a point that lands softly. In a specific band of medical writing, the cost is harm, because comprehension is not a courtesy extended to the reader. It is the entire outcome the writing exists to produce.

Consent material is information whose only purpose is to be understood well enough to decide on; if the reader cannot follow it, it has not informed anything, whatever the signature says. Discharge instructions are a set of actions a person has to perform correctly, often alone, often unwell, frequently the morning after the conversation that should have explained them — and a discharge instruction misread is a readmission waiting to happen. Safety information lives or dies on whether the one sentence that matters survived contact with a tired reader. In all three, plain English is not a stylistic preference applied after the fact. It is the safety intervention. The writing is the mechanism by which the clinical work either reaches the patient or fails to, and prose that reads beautifully to a clinician and incomprehensibly to the person it was written for has failed at the only job it had.

The point sharpens as more health content is drafted by machine. Generated medical prose has a characteristic and dangerous default: fluent vagueness. It produces text that is grammatical, confident, plausibly toned, and frequently empty at exactly the load-bearing moment — the hedge with no number, the instruction with no threshold, the reassurance with its conditions quietly dropped. It reads like understanding and is sometimes a very good imitation of understanding with no understanding inside. Plain English is the antidote, because the plain-English discipline is precisely the one that fluent generated text cannot fake: it demands that every sentence commit to a specific, checkable claim, and a vague sentence forced into plain words simply collapses, revealing that there was never anything underneath. The writer supervising the machine needs the discipline more than ever, not less — because the machine's failure mode is exactly the failure plain English is built to catch.

What this means

Plain English in medicine is widely mistaken for writing down to the reader, and it is closer to the opposite. The jargon writer asks the reader to learn the codebook. The dumbing-down writer slips the reader a paraphrase that is easier and slightly false. The plain-English writer keeps the claim whole and absorbs the difficulty themselves — does the work of understanding completely, then the further work of building the carriage that gets it across intact. That is why the plain version of the discharge sentence is the hard one to write and the easy one to read, and why those two facts are the same fact viewed from the two ends of the page. The effort does not disappear when prose gets simpler. It moves — off the reader, onto the writer, where in medicine it has always belonged.