Your Instructions Are Clear--To You

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.