First of all, I want to thank all who responded to my questions. The  
consensus appears to be the same as the one we are questioning.

In our attempts to make our clinical instruction materials more  
accessible to our clients and patients, we are trying to find a clear  
way of assessing (not testing) literacy levels. This is not only to  
help us with clarifying our materials, but to indicate to the  
clinician that this person needs some extra effort in ensuring  
understanding of the material. Too often, in present-day strictures  
of contact time, the clinician is tempted to send materials home with  
the patient - "Here - read these." This, in an area where over one- 
third of our clientele have less than functional literacy levels.

Reversing medicalese in a large medical system is akin to asking an  
oil tanker to reverse course immediately. It takes time and much  
effort. We have already accomplished much by establishing standards  
of clear language to be applied to new materials. We are also  
gradually revising materials devised years ago.

So the question remains. Is there a tool anyone has used on a one- 
time basis to establish an alert to be placed on a medical record -  
NOT to test the patient, but to remind the clinician to take extra  
care in instruction? The opinion on TOFHLA is clear and one that we  
agree with. How about the label assessment - has anyone used this?

Laurie Anson