Using hard words (or, if you prefer, complex verbiage)

A colleague of mine was recently preparing a document for inpatients and family members to read. Her hospital, she told me, mandates that all such documents be at a fifth-grade reading level. Her first draft, according to analysis by Microsoft Word, came out around grade 10. She reworked it to simplify the language and found it now to be at eighth-grade level. After a great deal of additional time, she finally got it down to 5.9, and left it there.

“It’s almost impossible to write about something substantive at a fifth-grade level,” she concluded.

Readability level

The Flesch-Kincaid (F-K) readability grade level was developed under contract to the U.S. Navy in 1975. The F-K formula was adopted by the U.S. Army for assessing the difficulty of technical manuals in 1978 and soon became the standard for the Department of Defense. Pennsylvania was the first state to require that automobile insurance policies be written at no higher than a ninth-grade level (14 to 15 years of age) of reading difficulty, as measured by the F-K formula. This requirement has been adopted by many other states and for other legal documents such as insurance policies.

Institutional review boards typically have a similar requirement for informed consent forms for clinical trials. But it can be very challenging to write at low grade levels. According to Wikipedia, by the criteria of readability tests like the F-K reading level, many Wikipedia articles are “too sophisticated” for their readers.¹

It makes sense that written materials be intelligible to those who need to review and sign them, or who must follow the instructions therein to do their work. Rudolph Flesch, PhD, who worked for the Associated Press, is credited with reducing the difficulty of reading newspapers by several grade levels. A 1948 study in the Journalism Quarterly showed that lowering reading difficulty from the 13th grade to the sixth grade increased the number of paragraphs read by 93%.² Supposedly, the typical newspaper is today written at an eighth-grade level.

At what grade level?

I had two questions:

• What is my own reading grade level?

• What is the F-K grade level of my editorials in Ophthalmology Times?

Adding up my years in grammar school (8), high school (3), college (3), medical school (4), and residency (3)-Note: I had no time to read during my internship-I logically conclude that I should be at a 21st-grade level. To find out if all those years of schooling are reflected in my writings, I checked a half dozen of my past editorials. The F-K grade level of a document can be determined using the Review function in Microsoft Word. What I discovered is that my editorials are consistently in the 12th- to 13th-grade range.

Until actually checking, I had assumed that my contributions to Ophthalmology Times were at a fairly low grade level. My intent was always that they be simple, and hopefully, humorous reads for my ophthalmologist colleagues, in contrast to the denser scientific articles elsewhere in this publication. By avoiding complicated words, like “Constantinople” and “anti-disestablishmentarianism,” I was hoping to keep things light.

Also, some of my family members and friends are orthopedic surgeons, and I don’t want them to be left behind. According to the F-K system, however, my writings are accessible to only a minority of Americans.

Thanks to this research, I comprehend why some people insist they don’t find my columns to be particularly insightful or humorous. It’s not their fault. I blame myself. My writing is just too gosh-darned sophisticated.

References

1.     http://en.wikipedia.org/wiki/Flesch%E2%80%93Kincaid_readability_tests

2.     http://www.impact-information.com/impactinfo/newsletter/plwork15.htm