Three Absolutely Mandatory Rules for Communicating Important Information

It doesn’t matter what line of work you’re in. If you have something important to say, you have an ethical obligation to say it as clearly as you can. Here’s my three essential rules for achieving maximal clarity.

Preface: A little story. (Skip if you want.)

The physician Atul Gewande, in his book Being Mortal, recounts a story concerning his mother’s unexpected death. He was a young boy at the time, and when his barely middle-aged father got the call to come to the hospital right away, the pair anxiously made the drive together. When they arrived on the hospital floor there was a doctor waiting for them. The father told the doctor that he’d gotten a call, that he was there to see Mrs. Gewande. The doctor’s knowing reply was “Yes. I’m sorry, but she’s gone.”

At this, Mr. Gewande turned around and headed back to the car, annoyed that he’d missed his wife, who must have made her way back home by now.

Atul doesn’t tell us how far his father got before realizing that he’d misunderstood the doctor’s timid, utterly ambiguous explanation of the situation. It’s hard on the heart to imagine how crashing the weight of that realization must have been. But there’s no doubt that the botched communication made it worse and harder.

Intro

Ambiguity isn’t just a serious problem in medical scenarios. Any time important information is being conveyed, as the clarity of communication decreases, the risk of harm increases.

Recently I was asked to look over a document for a doctor friend of mine who is offering a new aesthetic service and wanted to create a brochure explaining the procedure and the steps of the (self-administered) aftercare to her patients.

She’s an excellent caregiver — I know; I’m her patient — and when I was reading the draft of her patient brochure it just reminded me how problematic it is that even the best medical schools send their physicians out to practice medicine, with almost no communications training — a pretty stupid situation given that the vast majority of the time physicians spend with patients is devoted to asking and answering questions.

So as I edited my friend’s document, I jotted down a list of notes, and afterward consolidated them into three major principles that apply to any communications context where serious, actionable information is being passed along — whether its a parent explaining safety rules to their kid, or a restaurant manager training new kitchen staff, or a manual explaining how to use a kitchen appliance.

No matter the circumstance, these three rules should be considered inviolable.

The Three Rules

Rule 1: Avoid ambiguity and unnecessarily complex language.

When we express a thought, we tend to assume that whatever we said was just as clear as the thought was in our head. But now as I’m proof reading this, it just took me seven tries to revise that sentence, and I’m still not entirely happy with it. Thankfully it’s not an explanation of how to safely handle a volatile chemical, or administer a medication to a child.

Here’s three pretty common examples:

• “Avoid drinking alcohol 1–2 days before treatment”. The ambiguity lies in the range here. If there’s any reason to think it could be dangerous to drink 2 days before the treatment, say “Don’t drink for 2 days before treatment”. If the worry is that some people can’t do this safely (some can’t), then the instructions should include a caveat: “Some patients’ lifestyles do not allow for easy compliance with this policy. If you are among them, check the box below and your doctor will advise you on the safest course of treatment.
• “Use sunscreen of SPF 30–50 every two to five hours”. SPF30 every five hours vs. SPF50 every two hours is a huge range. If it all offers the same protection, recomment the least finnicky option. If SPF50 is more protective (it is) and more often is more protective (it is), then the instruction should be SPF50 every two hours. Nobody reading the instructions is looking for how to use the product so they get a little melanoma protection, but not a lot.
• “Caution, contents are hot.” The ambiguity here is in the adjective hot. I like my showers hot. Molten lead is hot. The sun is hot. What point on that temperature spectrum does the word indicate when it’s on, say, a coffee cup?

These are, in fact, the words that caused the McDonald’s coffee case. A cup with those words printed on it tipped into a woman’s lap, soaked into her sweat pants, and burned her so badly that the shock caused her body weight to drop below 100lbs over a few days, and she had to spend over a year in the hospital undergoing corrective surgery and skin grafts to her genitals and thighs. She very nearly died.

McDonald’s at the time pressure cooked its coffee at a minimum temperature of 185F, which is hot enough to make your skin slough off like a wet sock after just 8 seconds. Which explains why the company had received tens of thousands of burn injury complaints before The Coffee Case — many of which they settled for at least half a million dollars.

Some will gripe, ”But it’s hot coffee. Of course it burned her! And the cup warned her!”.

The problem is not that it burned. She knew it would. The cup said so. What she didn’t know, and what the cup didn’t clearly communicate, was that it would burn her so badly that if she didn’t get it off her in five seconds she’d spend a year in the ICU.

No reasonable person would interpret “Caution contents hot” on a styrofoam cup to mean “If you spill this on you, you’ll likely permanently lose sensation, and then you might literally die”. That would have been fair, unambiguous warning. But then no one would buy McDonald’s coffee (which is now served as a much more reasonable 165F.

Rule 2: Aside from headers, don’t use emphatic formatting like bold, italic, underline, all caps, asterisks, etc. in text, unless it’s emphasizing a singularly important part of the document.

Why? Because emphatic styling doesn’t just say “this part is important”, it, by contrast, gives the impression that the non-styled portions of the document are comparatively less important. Overuse then sends the message that the reader can just skim the bold parts and get the important stuff.

So if your document says:

“Don’t take MAOIs while on this medication”

and then later on says

“Be sure you are well-hydrated when you come in for your treatment”

You’re telling the reader that the danger posed by being under-hydrated (which is pretty low in most cases) is greater than MAOI interactions (which can cause death or psychosis). This sort of mistake is not only seriously misleading; it creates serious legal vulnerabilities too.

Trust the reader to read the document. Drawing their attention to a particular bit of text is inevitably drawing their attention away from another part. If, however, there is one piece of information on the document that is of absolute, greatest importance, emphatic styling is justified. (In this case, it’s the MAOI interaction).

Rule 3: Never use the word “please”. Important information is conveyed through statements, not requests.

This issue shows up everywhere. Just pick up a user manual or read a warning label. They’re, bizarrely, full of requests in the form of “please” statements. But “please” is easy to interpret as a request or as something negotiable.

Yet, look at a half dozen manuals for toasters and I’m willing to be at least one will say “Please do not submerge while plugged in”, as if you’re just doing the company a favor.

A more serious and more common instance of this error is when an entire document full of absolutely essential information introduces itself by saying “Please carefully read this important information”. This is a tepid, mixed signal that says “We like it if you read this but we don’t want to sound pushy so could you just do it if you don’t mind too much?” and then later says “If the red and green light are blinking simultaneously your house is full of carbon monoxide and you’re all going to die if you don’t get out of there.”

Conclusion

So, if you have something important to tell someone, don’t say “Please do x.” Use imperatives. Say “Do x.” This doesn’t come off pushy or bossy or cold. If anything, the conversationally polite “please” phrasing actually increases a person’s uncertainty and anxiety. Clear, imnperative language tells the person that the information is essential for their wellbeing. And if you have the information essential for customers’, users’, or patients’ wellbeing, it’s your duty to convey it clearly.