Instead of spending more on ways to answer patient questions, how about reducing the need for so many questions in the first place?

By C, Anthony Jones

In health care, when patients miss a step, call with questions, or don’t follow instructions, the blame often falls on them: “They weren’t paying attention.” “They didn’t read what we gave them.” “They weren’t motivated.”

But the real problem isn’t the patient. It’s the design.

Most patient instructions today aren’t built for understanding. They’re built for compliance—dense, transactional documents optimized to check legal boxes, not to support people navigating complex and often frightening moments in their lives.

The result? Patients are confused, and systems absorb the cost: avoidable phone calls, delayed procedures, unnecessary complications, and staff time spent untangling issues that never should have occurred.

And all of that has a measurable financial impact.

The Cost of Clarity Gaps
When instructions aren’t clear, the downstream effects can be costly:

• Cancellations and no-shows disrupt OR and clinic schedules.
• Pre-op errors lead to delays or rescheduling.
• Post-op confusion results in non-adherence, higher readmission risk, and avoidable complications.

A multicenter study of outpatient surgical patients found that patients with low health literacy were significantly less likely to comply with preoperative instructions, leading to procedural delays and cancellations (1).

Meanwhile, the 2003 NAAL—the most comprehensive U.S. health literacy assessment—revealed that only about 12% of adults have proficient health literacy, while over one-third scored in the basic or below-basic range (2).

These may show up as clinical problems—but the causes are operational. Every rescheduled surgery or extended phone call adds friction and costs money.

Time Is Money—Especially for Staff
Administrative staff and nurses often bear the brunt of poor instructional design. When instructions are unclear, the phones light up while portal messages and emails rush in. And while patient calls are important, most health systems don't have enough staff to keep absorbing work that shouldn’t exist in the first place.

Unnecessary calls pull attention away from more urgent (and profitable) clinical tasks and fuel burnout—already a major issue among health care workers. In large practices and health systems, even modest improvements in communication design can reclaim hours of staff time every week.

And that time is valuable. Whether it’s being redirected to higher-value clinical care, new patient intake, or reducing overtime, it contributes directly to both patient experience and staff retention—key drivers of systemwide performance and Star ratings (3).

Patient Experience Is Operational Strategy
Clearer communication doesn’t just reduce friction. It improves satisfaction, which has direct revenue implications. CMS Star ratings, value-based reimbursement models, and online reputation all hinge in part on how well patients feel informed, supported, and respected.

In this context, “clarity” isn’t a soft metric. It’s an operational lever.

And clarity doesn’t require a new EHR or AI overhaul. It starts with rethinking how instructions are organized, when they’re delivered, and how well they match the patient’s real-world experience.

Good Design Is Good Business
If your instructions read like a liability waiver, patients will treat them like one.

But when instructions are designed for clarity—timed to the patient’s journey and written with their perspective in mind—adherence improves, complications drop, and staff are freed up to do the work that actually requires a human touch.

In a field where margins are tight and burnout is high, investing in clarity isn’t just a better experience. It’s better business.

Sources
​
1. Müller R, et al. “Outpatients’ perception of their preoperative information… processes.” Medicine (Baltimore). 2021.
2. Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy. U.S. Department of Education, National Center for Education Statistics.
3. CMS. Overall Hospital Quality Star Rating: Methodology Report. Centers for Medicare & Medicaid Services.

The case for combining structured guidance with unstructured AI chat—because not everything should be a dialogue

By C. Anthony Jones

Ever since HAL in 2001: A Space Odyssey or Jarvis in Iron Man, we’ve been fascinated by the idea of conversational machines—AI that talks like a person and understands us effortlessly. And now, with real-world advances in AI agents, that science fiction is quickly becoming reality.

But in the rush to embrace conversational AI—either with basic chat or speech—it’s easy to forget that not every patient interaction needs to be, or should be, a conversation.

Some questions have clear answers. Some steps just need to be followed. In those cases, structured guidance is faster, simpler, and less prone to misinterpretation. The future of patient support isn’t fully automated or fully scripted. It’s both.

The Temptation of the “Uber” AI Agent

You can’t scroll a feed or skim a headline without running into hype about AI. In healthcare especially, the buzz feels breathless—an infatuation with the idea that a single, omnipotent AI agent will soon manage everything from diagnosis to discharge and beyond.

It’s easy to see the appeal. Clinical encounters—appointments, phone calls, consults—are often conversations. They’re about translating symptoms into a diagnosis and then mapping that to a treatment. This is where AI agents can (and will) do remarkable things.

But just because some clinical interactions are conversational doesn’t mean they all should be. Once a diagnosis is made or a procedure performed, most follow-up activities are highly structured. Forcing that structure into a conversational template doesn’t enhance the experience—it slows it down.

When Structure Works Best

Surrounding those clinical conversations is a long tail of action-oriented care:

• Time-sensitive prep instructions
• Medication reminders
• Fasting rules
• Physical therapy protocols

These are rule-based, time-bound, and specific. Patients don’t need a dialogue—they need clarity, timing, and confidence.

Imagine if every time you bought something that needed assembly, the instructions were delivered through a chatbot—no diagrams, no bullet points, just a meandering conversation. It wouldn’t be helpful. It would be maddening.

There’s a reason we prefer diagrams over dialogue for instructions:

• We read nearly twice as fast as we speak or listen(1)
• We process visual information in as little as 13 milliseconds(2)
• And we retain more when presented with structured, scannable content rather than a linear verbal stream(3)

For step-based medical tasks, structure isn’t just clearer—it’s cognitively lighter.

Where Conversations Are Essential

But not everything can be reduced to a checklist.

Healthcare is full of emotional ambiguity—patients who are confused, anxious, hesitant, or overwhelmed. Someone worried their pain is abnormal. Someone unsure if they followed instructions correctly. Someone afraid to admit they didn’t understand.

That’s where unstructured, conversational AI can shine.

It provides space for patients to express what’s bothering them, ask sensitive questions, or work through internal resistance. It uncovers barriers. It offers reassurance. It helps people keep going when structure alone isn’t enough.

The Risk of Over-Reliance on Either Approach

• Structured-only = efficient, but cold and brittle; difficult to capture and/or deliver important nuances.
• Chat-only = empathetic, but slow and sometimes confusing; inefficient for some communication; forces a slower, more methodical pace.
• Neither is sufficient on its own for complex, longitudinal care

Real support means knowing when to guide and when to listen.

The Hybrid Advantage

At Frontive, we’ve built our platform around this dual model:

• Structured, protocol-based guidance for delivering clear, timely, and actionable steps
• Unstructured, AI-based conversations for when patients need context, reassurance, or help making sense of what’s next

This hybrid approach offers scalability without sacrificing empathy. It lets each type of content be delivered in the form that works best—whether that’s a checklist or a conversation.

More importantly, it reflects how real people actually navigate complex care: Step-by-step when they’re confident. Back-and-forth when they’re not.

AI Should Fit the Patient—Not the Other Way Around
The goal isn’t to replace everything with conversational AI. The goal is to use it intentionally—to extend what works, fill in the gaps, and adapt to how patients actually think and behave.

The future of patient support doesn’t belong to conversational AI alone.
It belongs to clarity, empathy, and thoughtful design.

Sources:

1. Sticht, T. G., & James, J. H. (1984). Listening and Reading: Comprehension of Oral and Written Language.
2. Potter, M. C., Wyble, B., Hagmann, C. E., & McCourt, E. S. (2014). Detecting meaning in RSVP at 13 ms per picture. Attention, Perception, & Psychophysics, 76(2), 270–279.
3. Mayer, R. E., & Moreno, R. (2003). Nine ways to reduce cognitive load in multimedia learning. Educational Psychologist, 38(1), 43–52.

When documentation replaces communication, patients get lost

By: C. Anthony Jones

Most medical instructions aren’t written to be understood.
They’re written to be defensible(1).

Whether it’s a pre-op checklist, discharge packet, or post-op recovery guide, the primary goal isn’t clarity. It’s liability coverage. Documentation. Proof that the information was delivered—even if it wasn’t absorbed.

That’s not a knock on clinicians. It’s a consequence of the system they work in.

The real purpose of most patient instructions
Open most surgical or complex procedure instruction handout and you’ll find:

• Dense formatting
• Passive voice
• Legal disclaimers
• And wording designed more for the chart than for the patient

Most are cobbled together in Word documents, turned into PDFs, and handed out at the front desk or uploaded to a portal. Many haven’t been reviewed in years.

Take a look at most discharge instructions or pre-op packets. They're often written at a 10th-grade reading level or higher. They use compound sentences, undefined medical terms, and formatting that actively discourages comprehension.

Research confirms this: most patient education materials exceed recommended reading levels and fail to support health literacy or actionability(2).

Why?

Because instructions are treated like forms, not like content. And in medicine, once something is documented and approved, there’s a built-in (albeit understandable) reluctance to changing it.

The assumption is: we’ve already told the patient what they need to know.
If they didn’t follow it, it’s a compliance issue—not a communication one.

Clinicians aren’t trained to write. And it shows.
Clinicians are trained to diagnose, to treat, to operate—not to write for comprehension.

And yet, they’re responsible for creating and distributing complex instructions that patients are expected to follow perfectly, often under stress, pain, or sedation.

Studies show that most medical education offers little to no training in health communication—especially in writing or designing discharge materials(3).

In any other high-stakes field—aviation, military, emergency response—communication design is its own discipline. There are experts whose job is to ensure that protocols are clear, usable, and adaptable to real-world situations.

In medicine, we’ve largely outsourced that role to Microsoft Word and risk management.

Static instructions in a dynamic world
The way instructions are created and maintained is fundamentally broken.

• Stored as PDFs
• Buried in portals
• Rarely personalized
• Rarely updated

These documents are hard or impossible to search, harder to track, and completely disconnected from how patients actually move through a procedure or recovery.

Even when errors or confusion are identified, changing the instructions can feel like opening Pandora’s box—introducing version control headaches, legal reviews, or pushback from internal stakeholders.

So most clinics leave them alone. Even if patients are getting stuck.

Patients don’t need documentation. They need direction.
When patients ask the same questions over and over, it’s not because they’re lazy or inattentive. It’s because the information wasn’t delivered in a way they could process and retain.

Static instructions—no matter how well intended—don’t adapt to timing, context, or confusion. They’re one-size-fits-all in a world that demands nuance.

And they don’t earn trust. They assume it.

How Frontive approaches it differently
At Frontive, we treat clinical instructions as living content, not static files.

• Delivered step-by-step, in the moment they're needed
• Written and reviewed for comprehension, not just compliance
• Flexible enough to adjust to a patient’s pace, context, and concerns

Our platform makes it easy for clinics to update protocols without creating chaos, while also capturing which instructions patients engage with, and which ones need better support.

In a system optimized for documentation, we optimize for understanding.

Closing Thought: If your instructions haven’t changed in years…
It’s not because they’re perfect.
It’s because your system made it too hard to improve them.

Fortunately…that’s fixable.

Sources:

1. Siegler, E. L. (2010). The evolving medical record. Annals of Internal Medicine, 153(10), 671–677.
2. Wilson, E. A. H., et al. (2012). Literacy and patient instruction: An analysis of the readability of patient education materials. Academic Emergency Medicine, 19(4), 407–415.
3. Weiss, B. D. (2007). Health literacy and patient safety: Help patients understand. AMA Foundation.

Why patients nod and smile--even when they're lost

By: C. Anthony Jones

The last thing anyone wants is to look dumb. Especially in a high-stakes setting like a medical visit.

When someone is on step five of a set of instructions and we’re stuck back on step two, most of us do something that transcends language and culture:

We smile and nod.

It signals that we’re tracking—even when we’re not. More than that, it signals that we’re smart enough to track. That we belong in the conversation.

Yep. I got it!
Before smartphones and GPS (yes, they weren’t always here), getting directions meant asking a stranger. If you’ve ever stopped at a gas station and asked for help, you know the moment: you’re following the explanation, turn by turn, until somewhere around “take the second left after the fork,” you lose the thread.

Did you ask them to repeat it?

Probably not. You smiled, nodded, and drove away.
Then promptly got lost.

It’s not defiance. It’s self-preservation.
Even when we’ll never see someone again, we still don’t want to look foolish. And when the stakes are higher—like in a clinic or hospital—it’s even harder to admit confusion.

Psychologists refer to this dynamic as social desirability bias: the tendency to present ourselves in a favorable light, especially to authority figures(1). In healthcare, that bias can override a patient’s need for clarity(2).

And clinicians rarely catch it—because nodding, smiling, and polite affirmation look like understanding.

What we heard from real patients
In our early trials with post-op patients, we interviewed users at the end of their surgical protocol. We could see from our logs how often they logged in, which instructions they viewed, how long they spent with each step.

And they consistently told us how much they appreciated being able to get their questions answered through the app rather than calling the surgeon’s office.

But not for the reason you might expect.

It wasn’t about convenience. It wasn’t about after-hours access.

It was about dignity. “I didn’t want my doctor to think I wasn’t smart enough to get it the first time.”

The hidden cost of silence
Clinicians often feel overwhelmed by repetitive patient questions. But those questions are just the tip of a much larger iceberg. Below the water line are all the patients who never ask—they Google it. Or they ask a friend. Not because they think that’s better—but because it feels safer.

In fact, health-related searches have consistently ranked among the top three most common online queries since the early days of the internet(3,4). That self-service instinct isn’t irrational—but it is risky.

Because without context, a search result might be close, but not quite right.

Maybe your surgeon modified the standard protocol for your case. Maybe you had a comorbidity they didn’t mention. Maybe what seemed like a minor detail changed everything.

That’s the problem with internet reassurance: You don’t know if it applies to your situation.

And that can lead to anxiety at best—or dangerous errors at worst.

The fix isn’t more information. It’s better support.
We’re not going to change human nature. Patients will continue to avoid looking uninformed. And clinicians—pressed for time—will continue to misread signals of politeness as understanding.

But we can close the communication gap.

Technology, especially when paired with AI, can help deliver clinician-approved instructions in ways that are easier to understand, better timed, and more personalized to how patients actually experience their care.

Unlike clinicians, technology has the luxury of near-infinite time and patience. It can explain, repeat, clarify—without judgment.

And if that helps more patients feel confident, capable, and informed?

That’s not just a better experience. That’s better medicine.

Sources:
1. Grimm, P. (2010). Social desirability bias. Wiley International Encyclopedia of Marketing.
2. Frosch DL, May SG, Rendle KA, Tietbohl C, Elwyn G. Authoritarian physicians and patients’ fear of being labeled ‘difficult’ as barriers to shared decision-making. Health Aff (Millwood). 2012;31(5):1030–1038.
3. Fox, S., & Duggan, M. (2013). Health Online 2013. Pew Research Center.
4. McCarthy DM, Waite KR, Curtis LM, et al. What did the doctor say? Health literacy and recall of medical instructions. Med Care. 2012;50(4):277–282.

Why the more clinicians know, the harder it becomes to communicate with patients

By C. Anthony Jones

In medicine, expertise saves lives. But it also creates a blind spot.
The deeper a clinician’s knowledge, the harder it becomes to imagine not knowing. That’s the paradox: the very mastery required to deliver excellent care can make it nearly impossible to communicate that care clearly to the people who need it most.

Expertise rewires how you think—and speak
One of my attending physicians said something I never forgot: “In medicine, you spend your career learning more and more about less and less.”

The deeper you go in a specialty, the more your thinking—and communication—gets shaped by that depth.

Years of training in an increasingly narrow field rewires how information is processed. Medicine stops being a language and becomes a reflex. Acronyms replace explanations. The difference between probability and possibility is deeply understood (if not always clearly communicated). Protocols become muscle memory. What once required careful thought becomes instinct.

But for patients, none of that exists.

They don’t think in differential diagnoses. They don’t distinguish side effects from adverse events. They hear, “You may experience some discomfort” and assume a dull ache—until the anesthesia wears off and they’re curled up in agony, wondering what went wrong.

You can’t “unknow” what you know
This isn’t about empathy. It’s about cognition.

Psychologists call it the “curse of knowledge”. Once you know something, it becomes incredibly difficult to imagine what it’s like not to know it. One study found that experts consistently overestimate how well others will understand their explanations—by a wide margin(1).

That’s a problem when you're talking to patients, many of whom are hearing these terms, instructions, and risks for the first time.

A systematic review in BMJ Quality & Safety found that 40% to 80% of medical information is forgotten immediately after it’s delivered—and nearly half of what’s remembered is wrong(2). It's not because patients aren't trying—it's because the system assumes understanding instead of ensuring it.

This isn’t a bedside manner problem
We’ve all encountered clinicians who could improve their bedside manner—or who simply lack the emotional intelligence to connect on a human level. But this goes far beyond listening skills.

This is a design problem. A systems problem. And it’s getting worse, not better.

When the entire care experience is built around expert workflows, expert language, and expert pacing, patients fall through the cracks—not because they’re “non-compliant,” but because they were never truly on the same page to begin with.

And the one thing that might help? Time.
Sadly, the system has stripped that away too.

If we want better outcomes, we need better translation
That starts by recognizing that patient understanding isn’t a given—it’s a goal.

It means rethinking how we deliver instructions, how we check for actual understanding vs. the ubiquitous head nod, and how we support patients in the days and weeks after they leave the clinic. Not by dumbing things down—but by structuring guidance the way patients actually process and act on information: clearly, incrementally, and in context.

Because no amount of clinical brilliance matters if the patient can’t follow the plan.

Sources:
1. Hinds, P. J. (1999). The curse of expertise: The effects of expertise and debiasing methods on prediction of novice performance. Journal of Experimental Psychology: Applied, 5(2), 205–221.

2. Kessels, R. P. C. (2003). Patients' memory for medical information. Journal of the Royal Society of Medicine, 96(5), 219–222.