Communication & Medicine, Vol 14, No 1 (2017)

Language complexity differs between doctors and patients during contraceptive counseling: A mixed-method study

James P. Meza, Anthony Provenzano, Lawrence R. Fischetti, Elise LaRoche
Issued Date: 12 Aug 2017


The purpose of this study was to assess differences in language complexity for physician and patient speech and describe differences in speech content and literacy for medical office visits related to contraception. In a cross-sectional, mixed-methods study, we invited clinic faculty, residents, and consecutive patients to participate in simulated clinical encounters. Two investigators independently transcribed the recordings of these encounters. We calculated Flesch-Kincaid Reading Level (FKRL) and Flesch Reading Ease (FRE) scores as proxy measures for language complexity related to physician and patient speech. We also performed content analysis of the office visit transcriptions. Thirty-one of 33 physicians and 51 of 61 patients participated in the study, yielding response rates of 94% and 84%, respectively. Student Independent t-tests revealed differences in language complexity for providers and patients. On average, physicians spoke at an Eighth-Grade (13 to 14 years old) reading level, while patients spoke at a Fourth-Grade (nine to ten years old) level. Physicians gave primary importance to physiologic mechanisms. Patients focused on efficacy and side effects. We interpret the findings from the theoretical perspective of language and culture as inseparable components of communication. Both language and culture communicate, but at different levels of analysis. We explore both dimensions of communication with the same data set. Although this paper is theoretically exploratory, we believe it broadens inquiry of language use in medicine for subsequent investigation.

Download Media

PDF (Price: £17.50 )

DOI: 10.1558/cam.29523


Baker, D. W., Parker, R. M., Williams, M. V., Pitkin, K., Parikh, N. S., Coates, W. and Imara, M. (1996) The health care experience of patients with low literacy. Archives of Family Medicine 5 (6): 329–334.

Barfield, T. (ed.) (1977) The Dictionary of Anthropology. Malden, MA: Blackwell.

Bass, P. F. 3rd, Wilson, J. F., Griffith, C. H. and Barnett, D. R. (2002) Residents’ ability to identify patients with poor literacy skills. Academic Medicine 77 (10): 1039–1041.

Berkman, N. D., DeWalt, D. A., Pignone, M. P., Sheridan, S. L., Lohr, K. N., Lux, L., Sutton, S. F., Swinson, T. and Bonito, A. J. (2004) Literacy and Health Outcomes. Evidence Report Technology Assessment 87. Rockville, MD: Agency for Healthcare Research and Quality, Prepared by RTI International – University of North Carolina Evidence-based Practice Center. Retrieved from

Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J. and Crotty, K. (2011) Low health literacy and health outcomes: An updated systematic review. Annals of Internal Medicine 155 (2): 97–107.

Brenneis, D. and Macaulay, R. K. S. (eds) (1998) The Matrix of Language: Contemporary Linguistic Anthropology. Oxford: Westview Press.

Finer, L. B. and Zolna, M. R. (2011) Unintended pregnancy in the United States: Incidence and disparities, 2006. Contraception 84 (5): 478–485.

Flesch, R. (1948) A new readability yardstick. Journal of Applied Psychology 32 (3): 221–233.

Gazmararian, J. A., Parker, R. M. and Baker, D. W. (1999) Reading skills and family planning knowledge and practices in a low-income managed-care population. Obstetrics and Gynecology 93 (2): 239–244.

Howard, D. H., Sentell, T. and Gazmararian, J. A. (2006) Impact of health literacy on socioeconomic and racial differences in health in an elderly population. Journal of General Internal Medicine 21 (8): 857–861.

Katz, M. G., Jacobson, T. A., Veledar, E. and Kripalani, S. (2007) Patient literacy and question-asking behavior during the medical encounter: A mixed-methods analysis. Journal of General Internal Medicine 22 (6): 782–786.

Kelly, P. A. and Haidet, P. (2007) Physician overestimation of patient literacy: A potential source of health care disparities. Patient Education and Counseling 66 (1): 119–122.

Kincaid, J., Fishburne, R., Rogers, R. and Chisholm, B. (1975) Derivation of New Readability Formulas (Automated Readability Index, Fog Count, and Flesch Reading Ease Formula) for Navy Enlisted Personnel. Research Branch Report 8-75. Memphis, TN: Chief of Naval Technical Training Naval Air Station. Retrieved from

Kirsch, I., Jungeblut, A., Jenkins, L. and Kolstad, A. (1993) Adult Literacy in America: A First Look at the Results of the National Adult Literacy Survey. Washington, DC: National Center for Educational Statistics.

Kost, K. and Henshaw, S. (2012) U.S. Teenage Pregnancies, Births and Abortions, 2008: National Trends by Race and Ethnicity. Retrieved from

Kripalani, S., Jacobson, K. L., Brown, S., Manning, K., Rask, K. J. and Jacobson, T. A. (2006) Development and implementation of a health literacy training program for medical residents. Medical Education Online 11 (13): 1–8.

Kutner, M., Greenberg, E., Jin, Y. and Paulsen, C. (2006) The Health Literacy of America’s Adults: Results from the 2003 National Assessment of Adult Literacy. Washington, DC: United States Department of Education-the National Center for Education Statistics. Retrieved from

Lewontin, R. C. (1991). Biology as Ideology: The Doctrine of DNA. New York: HarperCollins.

McKay, A. and Barrett, M. (2010) Trends in teen pregnancy rates from 1996–2006: A comparison of Canada, Sweden, USA, and England/Wales. Canadian Journal of Human Sexuality 19 (1-2): 43–52.

Peterson, L. S., Oakley, D., Potter, L. S. and Darroch, J. E. (1998) Women’s efforts to prevent pregnancy: Consistency of oral contraceptive use. Family Planning Perspectives 30 (1): 19–23.

Radecki, S. E. and Beckman, L. J. (1994) Contraceptive risk-taking in a medically-underserved, low-income population. Women and Health 21 (1): 1–15.

Ratzan, S. C. and Parker, R. M. (2000) Introduction. In C. Selden, M. Zorn, S. Ratzan and R. Parker (eds) National Library of Medicine Current Bibliographies in Medicine: Health Literacy, 6. Bethesda, MD: National Institutes of Health, US Department of Health and Human Services.

Rivera, R., Reed, J. S. and Menius, D. (1992) Evaluating the readability of informed consent forms used in contraceptive clinical trials. International Jornal of Gynaecology and Obstetrics 38 (3): 227–230.

Rogers, E. S., Wallace, L. S. and Weiss, B. D. (2006) Misperceptions of medical understanding in low-literacy patients: Implications for cancer prevention. Cancer Control 13 (3): 225–229.

Schieffelin, B. B., Woolard, K. A. and Kroskrity, P. V. (eds) (1998) Language Ideologies: Practice and Theory. Oxford: Oxford University Press.

Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., Palacios, J., Sullivan, G. P. and Bindman, A. B. (2002) Association of health literacy with diabetes outcomes. Journal of the American Medical Association 288 (4): 475–482.

Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C. and Bindman, A. B. (2003) Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine 163 (1): 83–90.

Turner, V. W. (1969) The Ritual Process: Structure and Anti-structure. Chicago: Aldine.

Weiss, B. D. (2003) Health Literacy: A Manual for Clinicians. Chicago: American Medical Association Foundation.

White, S. (2008) Assessing the Nation’s Health Literacy: Key Concepts and Findings of the National Assessment of Adult Literacy (NAAL). Chicago: American Medical Association Foundation.

Williams, M. V., Davis, T., Parker, R. M. and Weiss, B. D. (2002) The role of health literacy in patient-physician communication. Family Medicine 34 (5): 383–389.

Williams, M. V., Parker, R. M., Baker, D. W., Parikh, N. S., Pitkin, K., Coates, W. C. and Nurss, J. R. (1995) Inadequate functional health literacy among patients at two public hospitals. Journal of the American Medical Association 274 (21): 1677–1682.

Williams-Deane, M. and Potter, L. S. (1992) Current oral contraceptive use instructions: An analysis of patient package inserts. Family Planning Perspectives 24 (3): 111–115.


  • There are currently no refbacks.

Equinox Publishing Ltd - 415 The Workstation 15 Paternoster Row, Sheffield, S1 2BX United Kingdom
Telephone: +44 (0)114 221-0285 - Email:

Privacy Policy