Discharge Handout Revision Under Word and Readability Limits
You are reviewing two drafts of a discharge-instruction handout for patients leaving the emergency department after a concussion. The handout must be written at or below a sixth-grade reading level, stay within 160 words, and include a mandatory warning verbatim: 'Call 911 if you vomit repeatedly or cannot stay awake.' Draft A is 212 words, scores at a ninth-grade level, and includes the sentence: 'If the patient has a headache that will not go away after taking the medicine, they should call the clinic because it can be serious.' Draft B is 143 words, scores at a sixth-grade level, and says: 'Take acetaminophen as directed. Rest. See your doctor in two days.' The warning is legally required and cannot be paraphrased. The committee will approve only one draft after revisions. You have 20 minutes to recommend a path forward.
1. Which draft should the committee revise, and what specific changes are necessary before it can be approved? Explain your reasoning against all three constraints.
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Draft B is the better starting point because it is closest to meeting all three constraints; revising Draft A would require cutting 52 words and lowering readability by three grade levels, which is more work and higher risk.
- Word limit: Draft B is 143 words. Adding the required warning verbatim (12 words) yields 155 words, within the 160-word limit.
- Readability: Draft B already scores at a sixth-grade level. The warning uses short, common words ('Call 911,' 'vomit,' 'stay awake'), so it is unlikely to raise the score above sixth grade.
- Mandatory content: Draft B currently omits the warning entirely, so it cannot be approved as written. The warning must be inserted exactly, not paraphrased.
Draft A cannot be approved without major cuts and simplification, and its pronoun ambiguity would still need repair. The recommendation is to add the warning to Draft B, recheck the word count and readability, and send it for approval.
2. Identify the ambiguous pronoun reference in Draft A and explain how it could confuse a patient. Provide a revised version of that sentence that removes the ambiguity.
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The sentence is: 'If the patient has a headache that will not go away after taking the medicine, they should call the clinic because it can be serious.' The pronoun 'it' has two possible antecedents: the headache or the medicine. A patient could read 'it can be serious' as a warning that the medicine is dangerous, or as a warning that the headache is dangerous. The singular 'they' is also less clear in a handout written for patients, though it is grammatically acceptable. Revised: 'If your headache does not improve after you take the medicine, call the clinic. A headache that will not go away can be serious.' This replaces third person with direct address, removes 'it,' and states the serious condition explicitly.