Written vs Spoken English

Should I write the same way I speak?

No.

Written and spoken English are different dialects of the English language. Yes, both are still English, but what works well for one is not necessarily work well for the other.

This applies to writing in general, and also applies to writing a medical chart.

Some examples of the differences between spoken and written English are in the lists below.

Spoken	Written
Tone	No equivalent
Timing	Uses punctuation instead
Rhythm	Uses punctuation instead
Inflection	No equivalent
Volume	No equivalent

Imagine reading a move script in your mind vs hearing it read out loud by good actors. It’s a world of difference. Spoken language is rich with other cues beyond the words themselves.

Good writing is not necessarily good speaking and vice versa. Good writing is typically more brief, terse, and direct. When reading good writing out loud, a listener may not catch every idea in a sentence in written English simply because of the brevity. The extra words themselves can give your listener an extra moment to process what you’re saying. When a reader is looking at the words on paper, these extra words are not necessary. In fact, the extra words get in the way.

Let’s look at these examples:

Spoken

I did read the CT scan of the chest. It showed no pulmonary embolism, but did show a left lower lobe pneumonia.

Written

CT read showed left lower lobe pneumonia. No PE.

The written version is shorter, and more compact. Writing allows the use of abbreviations and acronyms to make it more compact. When spoken out loud, the shorter sentence gives the listener less time to process the information.

Writing is refined thinking. The writer has to consider what words to use, and how to place the words in an efficient, coherent way. More mental processing goes into writing than goes into speaking. Speaking is natural. Writing is not. Writing gives you more opportunity to refine the end product than speaking, because you have to think more when you write

A good example of this is a dictated chart. When you do not take the conscious step of extra editing, your dictated chart will tend to ramble. It can look like a stream of consciousness. This is bad written communication. It’s much more difficult to read and understand.

You are also more likely to say accidentally something that you don’t intend to say.

Spoken (I dictated this to myself without editing)

The patient is a 25 year old female with a medical history of asthma. She came into the ER with accessory muscle use, shortness of breath, wheezing and said that this was consistent with asthma attacks she had in the past. She denied recent steroid use, and previous ICU admission. However, she said that she had a admission for asthma about 6 months ago. Her last steroid use was about 2 months ago, that she received from her primary doctor. Preceding symptoms include uri symptoms such as runny nose, sneezing, and dry cough. Overall, she had the asthma symptoms for about 2 days that are gradually worsening and the preceding uri syptoms for about 2 days as well.

Written

25 year old female asthmatic. She came into the ER with 2 days of symptoms consistent with asthma attack, including accessory muscle use, shortness of breath, and wheezing. No recent steroid use, or previous ICU admission. Most recent admission for asthma about was 6 months ago. Most recent steroid use about 2 months ago. Preceding symptoms include 2 days of runny nose, sneezing, and dry cough.

The written version is more compact, direct, better organized, easier read, and overall better communication. The directly transcribed spoken version comes across as a rambling, scattered stream of consciousness. The directly transcribed, spoken is worse communication by far.

If you’re going to use dictation, be sure that you put some thought into the words you are dictating. You should take the extra step and edit your words (either mentally or on the computer screen). You are translating from one dialect into another. Take the extra mental steps for that translation before you speak so that your charts aren’t rambling. Use the words in your mind and craft them in a way that is efficient.

If you are working with a scribe, make sure that the scribe knows that they should not transcribe word for word unless you are going to heavily edit the chart later. The scribe has to translate from spoken English to written English.

Either way remember to take the perspective of the reader. What will be easier for them to understand? Take these concepts into account and your dictations will get better.

To learn more about effective medical charting, check out my Handbook of Medical Charting