Can your patients actually read your consent information?

Every surgeon writes a patient information leaflet believing it explains the operation. The harder question is whether the patient in front of you can read it — and whether the material risks are where they can find them.

Two things tend to be true of a typical surgical leaflet. It is written several reading-ages above the people it is for, and the risks appear a long way down the page, after the anatomy, the benefits and the logistics. Neither is anyone’s fault. They are simply what happens when a document is written by an expert, for experts, and then handed to a patient.

The reading-age gap

NHS guidance recommends writing patient-facing information for a reading age of around 9 to 11. Many surgical leaflets are nowhere near that. Clinical writing carries long sentences, embedded sub-clauses, Latinate vocabulary and numbers presented as bare percentages — each of which pushes the reading age up.

The gap matters because a large share of the population reads below the level clinical documents assume. In a study of English health materials, Rowlands and colleagues (2015) found that around four in ten working-age adults (43%) fell below the literacy threshold needed to understand text-based health information. That rose to around six in ten (61%) once numbers were added — and a risk paragraph is exactly text-plus-numbers. A leaflet pitched several reading-ages too high is not a neutral document for that group; it is one they will skim, or quietly set aside.

This is sharper still for neurodivergent patients, who in some surgical cohorts are more common than in the general population, and whose needs standard leaflets rarely meet. Dense prose, figurative language and unpredictable structure are exactly the features that make information harder to use.

Where do the risks actually appear?

Reading age is only half of it. The second question is structural: how far down the page does a patient have to read before they reach the risks?

Open a few of your own leaflets and measure it. Very often the material risks — the ones most relevant to a patient’s decision — sit in the final third, beneath benefits and preparation instructions. A confident reader reaches them. An anxious or low-literacy reader may not. If the risk disclosure is the part most likely to be skimmed, that is a communication problem regardless of how complete the paragraph itself is.

Completeness and findability are different properties. A leaflet can contain every risk and still bury them. Checking one without the other gives a false sense of safety.

The Montgomery standard is a communication standard

Montgomery v Lanarkshire Health Board [2015] UKSC 11 reframed consent around the patient. A clinician is expected to take reasonable care to ensure the patient is aware of the material risks of the proposed treatment, and of any reasonable alternatives. Whether a risk is “material” is judged by what a reasonable patient in that position — or this particular patient — would want to know.

Read carefully, Montgomery is not really a documentation standard. It is a communication standard. The test is whether the patient was made aware — not whether a complete leaflet existed somewhere in the pathway. A document written above a patient’s reading level, with the risks placed where they are least likely to be read, is weaker evidence of communication than the same content made legible and surfaced early.

None of this is a promise that better-written information changes clinical outcomes or removes legal risk — it doesn’t, and nobody can claim it does. But the artefacts you hand patients are part of how you demonstrate the disclosure Montgomery describes. Making them readable, and making the risks easy to find, is a reasonable and defensible thing to be able to show.

What “good” looks like in practice

A few concrete markers, none of which require a rewrite from scratch:

• Reading age near 9 to 11. Short sentences, one idea per sentence, plain-English equivalents for clinical terms at first use.
• Risks surfaced early and clearly signposted, not stranded at the foot of the page.
• Numbers with their source. A complication figure should carry its origin — the guideline or study it comes from and its year — rather than appearing as an unattributed percentage. A figure a reader can trace is a figure a reader can believe.
• A parallel easy-read track, so the accessible version is a first-class option rather than an afterthought.

Check your own leaflet in a couple of minutes

You can measure most of this yourself. We built a free tool — the Leaflet Stress Test — that reads a leaflet the way a patient might. Paste your own text (or a PDF) and it reports the reading age, the sentence-length mix, how far down the page the risks appear, and any claims made without a source. For clinicians, it also runs a five-reader panel that simulates how different readers might experience the same words. It stores nothing you paste, and it makes no clinical or legal judgement — it simply shows you what is on the page.

It is a fast way to see the gap between what you wrote and what your patient reads.

Patient Compass Suite is a clinician-led surgical-pathway suite from GGO Systems. It is a delivery layer for information a clinical team has already approved — not a clinical system — and it holds no patient accounts, and no directly identifying patient information. Founder: Mr Giangiacomo Ollandini, FRCS (Eng), MD, MSc.