Exercises — Chapter 36: Writing for Medicine and Healthcare

⚠️ Disclaimer: These exercises are for educational purposes only and do not constitute medical advice. The clinical content is illustrative; doses, thresholds, and treatment choices are placeholders for teaching the writing, not guidance for care.

Writing is learned by writing. Most of these ask you to produce or revise text, not pick a letter. Where a task is open-ended, a self-assessment rubric follows instead of an answer.

Part A — Analyze This ⭐

For each item, identify what works and what's broken. Name the specific principle.

A1. A clinical note reads: "O: Patient looks much better today, clearly recovering well. Temp 37.1°C, eating normally." Which phrase is in the wrong SOAP section, and why is that a safety problem rather than a style nitpick?

A2. A patient leaflet says: "Discontinue use and seek medical attention should you experience any untoward sequelae." List every word a typical patient would struggle with, and state what's missing that the patient most needs.

A3. A medication label says: "Take 3 tablets daily." The pharmacist insists it's perfectly clear. Construct two different, both-reasonable readings of "daily" and explain why one instruction permitting two readings is a defect.

A4. Two recommendations: (a) "X is strongly recommended (high-certainty evidence)." (b) "X is strongly recommended (low-certainty evidence)." A reader objects that (b) must be a typo—strength requires strong evidence. Is the reader right? Explain using the certainty/strength distinction.

A5. A discharge instruction ends: "Resume activity as tolerated." Identify the ambiguity and explain what unsafe (or merely confused) behavior it permits. Then name the one thing the phrase fails to give the patient.

A6. A SOAP note's Plan reads: "Continue current management. Will monitor and reassess as appropriate." Critique it against the standard set in 36.1. What would a covering clinician at 3 a.m. be unable to do?

A7. A home-use device IFU buries a warning at the end: "Note: do not use near water." The device is an electrical skin-treatment tool. Two problems—one from Chapter 22, one specific to medical devices. Name both.

A8. ⭐⭐ A consent form is described by the clinic as "thorough—it covers everything, signed by every patient." A patient who signed it later says they had no idea the procedure had the risk that occurred. Reconcile "thorough and signed" with "not informed." Which distinction from 36.7 is at play?

Part B — Revise This ⭐⭐

Rewrite each passage. Give the scenario, not the answer; you supply the improved text.

B1. (Structure these notes as SOAP.) A clinician's raw scrawl, all jumbled:

58-year-old, cough 3 days, now chest hurts when breathing in. Lungs: crackles at the left base. Temp 38.4, sats 94% on room air, HR 102. Looks like pneumonia, PE seems unlikely but can't fully rule out. Reports no leg swelling, no recent travel. Starting antibiotics, getting a chest X-ray, will recheck in 4 hours, told them to come back if breathing gets worse.

Reorganize this into clean S / O / A / P sections. Put every fact where it belongs; separate what was observed from what was concluded; make the Plan concrete (add a named escalation threshold). (Values are illustrative.)

B2. (Rewrite this discharge instruction in plain language.) A jargon-dense wound-care instruction:

Cleanse the laceration site daily with sterile saline. Apply topical antimicrobial ointment BID. Observe for erythema, purulent exudate, increasing induration, or pyrexia, and present for evaluation should any manifest. Suture removal at 10–14 days. Avoid submersion of the site.

Rewrite it for a patient at roughly a 6th–8th-grade level. Translate every clinical term in place. Organize it for a frightened reader who scans. Add the three answers a patient needs: what do I do, how do I know it's working, when do I call for help?

B3. Tame this medication instruction so it has exactly one reading:

For pain, take 1–2 tablets as needed. May repeat as required. Do not exceed the maximum daily dose.

Add a stated dose, a minimum interval between doses, a maximum number of doses, and a concrete 24-hour ceiling (use a placeholder number and label it as such). Note what unsafe behavior the original permitted.

B4. (Match hedging to certainty.) Rewrite this overclaiming sentence honestly:

Studies prove that early mobilization improves recovery, so all post-operative patients should be mobilized within 2 hours."

Name a plausible certainty level and recommendation strength, and—crucially—say why the recommendation is strong or conditional and what the reader should do (e.g., shared decision-making). Label the grades as illustrative.

B5. A patient-facing paragraph drowns the one safety-critical sentence:

This medicine works by inhibiting an enzyme involved in the inflammatory cascade, and has been used for many years across a range of conditions; it is generally well tolerated, though as with all medicines individual responses vary, and you should take it with a full glass of water and remain upright for 30 minutes, and do not take more than 1 dose in any 24-hour period.

Restructure so the safety-critical instructions (upright 30 minutes; never more than 1 dose / 24h) are unmissable. Cut what doesn't help the patient act.

B6. ⭐⭐⭐ A device quick-reference card for nurses reads: "Calibrate the device. Take the reading. Record the result." Rewrite it so a nurse who skips calibration is stopped by the writing—add the consequence, and put the warning where Chapter 22 says it goes.

Part C — Write This ⭐⭐–⭐⭐⭐

Produce the document described.

C1. Write a complete patient medication instruction for a fictional once-and-evening tablet "for blood pressure" (use placeholder doses, clearly labeled). Include: dose, frequency stated as concrete actions, route, timing relative to food, what to do about a missed dose, the common side effect (expected) versus the escalation trigger (call now), and a closing teach-back prompt. Keep it at a 6th–8th-grade level.

C2. ⭐⭐⭐ Take this single clinical fact and write it three ways—for a clinician, a patient, and a regulator:

A drug lowered a risk marker versus placebo in its main trial; it caused dizziness in a notable minority, usually mild; it should not be used in pregnancy.

For each version, write 2–4 sentences and label which audience it serves. The fact must stay constant; what changes is vocabulary, what you lead with, and what you can claim. (Use bracketed placeholders for any numbers.)

C3. Write a short "When to call us" box for a patient discharged after a minor procedure. It must list 4–6 concrete, plain-language warning signs (translate any clinical concept), and it must distinguish "call the clinic" from "go to the emergency department / call emergency services" with a clear rule for which is which.

C4. ⭐⭐⭐ Write the Plan section of a SOAP note for a fictional patient with a likely minor infection. Make it concrete enough that a covering clinician could act: tests, treatment, a named monitoring threshold, follow-up timing, and explicit return precautions. (Illustrative; placeholder values.)

C5. ⭐⭐ Write a short patient instruction for "what to do if you miss a dose" of a once-daily medicine. This is the instruction patients most often have to improvise, and the dangerous default they reach for is "double up." Give a concrete rule (take it when you remember unless it's nearly time for the next dose; never take two to catch up), in plain language, and tell them when to call if unsure. (Use a placeholder medicine; this is about the form of the instruction.)

Part D — Synthesis & Critical Thinking ⭐⭐⭐

D1. (Translate for three audiences — cross-chapter.) Chapter 2 had you write one finding four ways; Chapter 27 turned Dana's churn analysis into versions for different stakeholders. Take one technical finding from your own field (not medical) and write it three ways using this chapter's audience triad: a precise version for an expert peer, a plain version for a layperson who must act on it, and an evidence-traceable version for an auditor/regulator. What did keeping the fact constant force you to notice?

D2. (Find the flaw.) A hospital proudly reports that 100% of its discharge leaflets are "reviewed for patient education." On inspection, the leaflets average a 12th-grade reading level with untranslated jargon. Write a two-paragraph critique using the threshold concept and the "checking the box" failure from 36.7. What measurable thing would you change, and how would you verify the change worked?

D3. (Why does it work?) Explain to a skeptical clinician—who says "I always ask if patients understand, and they say yes"—why teach-back surfaces problems that "Do you understand?" hides. Use the curse of knowledge and the difference between recognition and retrieval (Chapter 2; the retrieval principle behind this book's quizzes).

D4. ⭐⭐⭐ A colleague argues that writing patient materials at a 6th-grade level "loses important nuance and treats adults like children." Write a rebuttal that (a) concedes the one true thing in their objection (you must never sacrifice accuracy or omit a safety caveat), and (b) distinguishes simplifying expression from simplifying truth, using the "plain language never simplifies truth" rule from 36.7.

Part M — Mixed Practice (Interleaved) ⭐⭐–⭐⭐⭐

These mix this chapter with earlier ones. Part of the work is choosing the right tool.

M1. You're handed a paragraph that is (1) over the patient's reading level, (2) structured bottom-up with the key warning at the end, and (3) written in the passive voice. Which chapter's fix do you apply first, and why does order matter? Then apply all three to: "It should be noted that contact with the affected area should be avoided, and that, in the event that swelling is observed, medical care should be sought."

M2. A clinician's email to a colleague needs to convey a SOAP-style update and request a specific action by a deadline. Combine Chapter 19 (emails: purpose first, one clear action) with this chapter (separate observation from interpretation). Write the email (6–10 sentences, illustrative).

M3. Choose the right genre: a team needs (a) a step-by-step home-use guide for a new device, (b) a one-line safety warning for the device's screen, and (c) a recommendation in a clinical guideline about when to use the device. Name the chapter/principle that governs each, then write one sentence of each.

M4. ⭐⭐⭐ Take the "before" discharge instruction from B2 and run it through both the Chapter 4 reverse-outline test (is the conclusion/most-urgent item buried?) and this chapter's ambiguity hunt. Report what each test catches that the other misses.

M5. A patient leaflet uses "hypertension" once and "high blood pressure" three times for the same thing. Chapter 7 said define on first use; this chapter said prefer the plain term. Reconcile: when should the clinical term appear at all in patient material, and how should it be handled when it must?

M6. ⭐⭐⭐ A SOAP note's Assessment overclaims — "Definitely a viral infection, no further workup needed" — the same way a Discussion section overclaims in a lab report (Chapter 13/14). Rewrite the Assessment to show appropriate uncertainty (likelihood, differential, what would change the plan), and explain how the overclaiming version could anchor the next clinician into missing something. Connect the move to the honest-hedging discipline of Chapter 7 and 36.5.

Part E — Extension ⭐⭐⭐⭐ (optional, Deep Dive)

E1. Find a real, publicly available patient medication leaflet or device IFU (e.g., one in your own medicine cabinet). Run the ambiguity hunt from 36.6 on its dosing section. Catalog every two-way phrase and every unstated quantity, and rewrite the dosing instructions to a single reading. (Analyze the writing only—do not change how you take any medicine.)

E2. Read three patient-education pages from a major public-health body and three from a random web search on the same condition. Compare their reading level, their handling of jargon, and whether each answers "when do I call for help?" Write a one-page synthesis (Chapter 15's skill) on what separates the good from the bad.

Self-Assessment Rubrics (for open-ended tasks)

SOAP rewrites (B1, C4): ✅ Every fact is in the correct section · ✅ Observation and interpretation are cleanly separated (nothing concluded sits in Objective) · ✅ Assessment shows reasoning/uncertainty, not just a label · ✅ Plan is concrete with a named escalation threshold a covering clinician could act on.

Plain-language rewrites (B2, B3, B5, C1, C3): ✅ Every clinical term translated or glossed in place · ✅ Short sentences, active voice, concrete actions · ✅ Answers all three: what do I do / how do I know it's working / when do I call for help · ✅ Safety-critical items (max dose, escalation triggers) are unmissable and single-reading · ✅ Reads at roughly 6th–8th-grade level (test it: would a bright 12-year-old follow it?).

Three-audience tasks (C2, D1): ✅ The fact is identical across all three · ✅ The clinician version uses precise terms; the patient version translates and adds an action; the regulator version ties claims to evidence with exact (placeholder) numbers and definitions · ✅ Each version leads with what that reader needs first.

Evidence-grading rewrites (B4, D-series): ✅ Certainty and recommendation strength are named separately · ✅ The hedging matches the stated certainty (no "proves," no "all patients" on modest evidence) · ✅ The why behind the strength is given, and the reader is told what to do (e.g., shared decision-making) · ✅ Grades labeled as illustrative.

Selected solutions and rubrics: appendices/answers-to-selected.md.