Writing Instructions Patients Remember: Readability, Timing, & Recall

Research · September 1, 2026

A review of the research on patient recall and health literacy, and practical guidance for writing pre-op and post-op instructions that patients can understand and act on.

Clinicians spend real effort writing pre-op and post-op instructions. The research on patient recall explains why so much of that effort is lost, and it points to practical changes that make written instructions work better. This review summarizes the findings most relevant to procedural care and how they shape the way we design instructions in Vervi.

How Much Patients Remember

The most cited summary of this literature is a review by Kessels in the *Journal of the Royal Society of Medicine*. It reports that 40 to 80 percent of medical information provided by practitioners is forgotten immediately, and that a large share of what patients do remember is recalled incorrectly.

The review identifies several factors that make recall worse:

More information. The more that is presented at once, the lower the proportion that is remembered.
Anxiety and stress. High anxiety at the time of the conversation reduces recall, which describes most pre-surgical and discharge conversations.
Spoken-only delivery. Information that is only spoken is remembered less well than information supported by written or visual material.

It also identifies factors that help: presenting the most important information first, being specific rather than general, grouping related instructions, and supplementing conversation with written and visual material patients can return to.

Universal Health Literacy Precautions

Recall is only part of the problem. Patients also need to understand and act on what they read. Federal health literacy guidance treats this as a universal precaution: structure information so that everyone can understand it, instead of trying to identify which patients need simpler material.

The AHRQ Health Literacy Universal Precautions Toolkit recommends simplifying communication and confirming understanding with every patient. The CDC Clear Communication Index provides a scored checklist for written material, covering a clear main message, plain language, specific behavioral recommendations, and visual support.

Writing Better Instructions

Taken together, the research suggests a short list of practices for pre-op and post-op instructions:

Lead with the actions that matter most. Put stop-eating times, medication changes, and warning signs at the top, not after background information.
One action per step. "Stop taking aspirin seven days before surgery" is easier to follow than a paragraph about blood thinners.
Be specific. Use exact times, amounts, and days ("Remove the outer bandage on day two") instead of general guidance ("Keep the area clean").
Use everyday words. Replace clinical terms with plain language, or define them the first time they appear.
Group and label. Short sections with clear headings ("Wound Care", "Pain Medicine", "When to Call Us") let patients find what they need.
Release information when it is relevant. A patient preparing for surgery does not need week-three activity guidance yet.
Make it easy to return to. Written material only helps if patients can find it again when the question comes up.

How This Shapes Vervi

Several Vervi features are direct responses to this research:

Sections and blocks encourage short, labeled, single-purpose content instead of long pages of text.
Optional AI enhancement can rewrite content in plainer language and improve layout. Providers review and accept each change.
Playbooks release each instruction at its point in the timeline, which limits how much a patient sees at once.
The patient portal keeps instructions available on any device, with adjustable text size and saved sections.
The grounded AI assistant lets patients ask a question in their own words and get the relevant line from their clinician's instructions, which supports the "confirm understanding" principle between visits.

Good instructions start with good clinical content. The research is a reminder that how that content is structured and delivered has a large effect on whether patients can use it.

Questions

How much medical information do patients forget?

A widely cited review by Kessels (2003) reports that 40 to 80 percent of medical information provided by practitioners is forgotten immediately, and that much of what is remembered is recalled incorrectly.

What makes written patient instructions easier to follow?

Plain everyday words, one action per step, the most important actions first, specific numbers and times, and short sections with clear headings. Health literacy guidance from AHRQ and the CDC recommends these practices for all patients, not only those with low literacy.

References

All Resources