Case Study 1: The Discharge Instruction No One Could Follow

⚠️ Disclaimer: Educational only; not medical advice. This is a composite, fictional-but-realistic scenario; clinical details are illustrative.

A jargon-dense discharge instruction, rewritten into plain language with a teach-back check. This is the chapter's anchor before/after, walked through end to end.

The setup

A patient—call her Marisol—comes to an urgent-care clinic after slicing her forearm on a broken glass. A clinician cleans the wound, places a few stitches, and the team prints the standard wound-care discharge sheet. Marisol is rattled, her arm aches, and she has her two kids in the waiting room. She nods at everything, signs where she's told, and leaves.

Here is the instruction she was handed. It is accurate. Every word is clinically correct.

Wound Care Instructions

Keep the laceration site clean and dry. Apply topical antibiotic ointment BID and re-dress with sterile gauze. Monitor for signs of infection including erythema, purulent discharge, increasing edema, or febrile episodes. Suture removal in 10–14 days. Return for any signs of dehiscence or systemic symptoms. Resume activity as tolerated.

The clinician who wrote it would call it complete. And as a record, for another clinician, it nearly is. As an instruction, for Marisol, it is a locked door.

What goes wrong, line by line

Read it the way Marisol does—once, fast, frightened, then again at her kitchen table that night.

• "laceration site." Marisol has a cut. "Laceration" is the first small stumble; nothing in her life has taught her it's a synonym.
• "BID." This is Latin shorthand (bis in die, twice a day). Marisol has no possible way to know it. She might guess "as needed," "before bed," or simply skip the ointment because the instruction is opaque. A safety-relevant action just became a coin flip.
• "erythema, purulent discharge, increasing edema, febrile episodes." Four clinical terms naming four things Marisol could absolutely recognize if described—redness, pus, swelling, fever—and absolutely cannot act on as written. The instruction names the warning signs in a language the patient doesn't read.
• "dehiscence." The wound reopening. This is one of the more important things to watch for, and it's hidden behind the hardest word on the page.
• "systemic symptoms." Feeling sick all over. Vague even in clinical use; meaningless to Marisol.
• "Resume activity as tolerated." Sounds reassuring, tells her nothing. Can she lift her toddler? Wash dishes? Go to the gym? The phrase gives a vibe, not a boundary.

And the deepest problem isn't any single word. It's that no one is in the room when Marisol reads this. The writing is the clinician now (this chapter's opening claim, and its whole point). If the writing can be misread, it will be—because that's what ambiguity does under stress. The threshold concept is not abstract here: in medicine, ambiguity is a safety hazard, and this sheet is full of it.

The rewrite

Now apply the chapter's discipline: plain language at a 6th–8th-grade level (36.2), structured for a reader who scans (Chapter 4), with the three answers a patient needs and a teach-back loop built in (36.3).

How to care for your cut at home

Keep it clean and dry. - For the first 24 hours, keep the bandage on and keep it dry. - After that, put a thin layer of the ointment we gave you on the cut 2 times a day — once in the morning, once at night. Then cover it with a clean bandage.

Watch for signs of infection. Call us or see a doctor if you notice any of these: - The skin around the cut turns red, feels warm, or gets more swollen. - Yellow or green fluid (pus) comes out of the cut. - The cut opens back up. - You get a fever (temperature over 38°C / 100.4°F), or you feel sick all over.

Come back in 10 to 14 days to have the stitches taken out.

What you can do: Go back to your normal day when you feel up to it. But don't lift anything heavy and avoid anything that pulls on the cut until the stitches are out.

Questions? Call [clinic number].

Before you go, the nurse will ask you to tell them, in your own words, how you'll care for your cut and when you'll call us. This isn't a test of you — it helps us make sure we explained it clearly.

The teach-back catches what the rewrite missed

Marisol reads the new version and the nurse runs the teach-back: "Tell me how you'll care for your cut and when you'd call us."

Marisol says: "Keep it dry today, then ointment twice a day with a clean bandage. Come back in about two weeks for the stitches. Call if it gets red or oozes or opens up."

Strong—but the nurse notices one gap: Marisol didn't mention fever. So the nurse adds, gently: "Right—and one more: call us if you spike a fever or feel sick all over, even if the cut looks okay." Marisol nods and repeats it.

That gap is the whole argument for teach-back. The rewrite was good. It still had a hole, and the hole was invisible from inside the writer's head (the curse of knowledge, Chapter 2). It became visible the instant Marisol reconstructed the message instead of being asked "Do you understand?"—to which she'd have said "yes" on her way out the door.

What this case teaches

1. Accurate is not the same as usable. The original instruction was clinically correct and practically useless. Correctness is necessary; for a patient, comprehension is the function.
2. Translate jargon in place, don't drop precision. Every term became a plain word (pus, swollen, fever) without losing what it meant. Plain language simplifies expression, never truth (36.7).
3. Answer the three questions. What do I do, how do I know it's working, when do I call for help. The original answered the first only partially and the third in a language the patient couldn't read.
4. Teach-back is the test, not "Do you understand?" Reconstruction surfaced a gap a yes/no question would have buried—and the gap was a safety item.

The fact content of the two versions is identical. The difference is that the second one can be acted on by the person it's for. That difference, in medicine, is the difference that matters.