Why won't health professionals write concise, accessible English? Tim Albert laments a culture of verbosity and pretension

It had been a hard day in the training room and now it was time to look at what we meant by a good writing style. I moved to the usual mantra, inspired by such luminaries as Somerset Maugham, George Orwell, Kingsley Amis and Keith Waterhouse:

Keep sentences short.

Prefer the active to the passive and the positive to the negative.

Use short, familiar words rather than the long and less familiar.

There was a shocked silence. Then the course participants began to protest. 'We couldn't possibly write like this, ' they said. 'Not in the health service. People wouldn't think well of us at all.'

And that, effectively, remained their position. Another group had enjoyed the day, been exposed to all kinds of tips for easing the writing process, and visibly gained in confidence. They had also been completely unmoved by pleas to turn their rococo prose into something rather more simple.

It was not an isolated incident. Despite all the publicity given to plain English campaigns over the past 30 years and the occasional well-trumpeted award of a crystal mark, plain English has not caught on. Most of the writing turned out by health professionals remains self-serving, pompous, difficult to understand and a waste of time and money. This is not because they cannot write plain English, but because they believe it would be inappropriate to do so.

For example, a health professional, relaxing with a colleague in the canteen, may say: 'We usually see people on time, but if there is an emergency they may have to wait.' Ask them to write this down, and they immediately wrap themselves up in a posh overcoat:

'Every effort is made by staff to adhere to the appointment schedules, but delays may occur due to the occurrence of unanticipated emergency situations.'

Why? The culture of the NHS provides the first key.

Despite varied attempts to make changes, it remains at root a sprawling bureaucracy, more influenced by professionals, pressure groups and political leaders than its customers.

Communication is based on the old Pravda model: the people will be told what the committees deem fitting for them to be told.

This explains the demoralising process, familiar to anyone who has advised health organisations on publicity, of seeing a readable first draft turned into the most terrible gobbledygook as it goes through the organisation. Legal advisers will insert caveats, administrators will replace short words with long ones, and status-conscious PAs will ensure that any reference to their Department will be in Capital Letters.

Another factor to consider is the hold that doctors have had traditionally on 'medical writing'. These are people, remember, who for the most part left the study of the humanities at the age of 16. They have since been brought up to believe that material that is easy to understand is somehow demeaning - hence their dismissal of publications like Pulse and GP as 'comics', even though they read and learn from them. Instead they value, though they don't necessarily read, the pompous prose of medical journals, which often breaks the rules of good writing outlined at the start of this article.

Sadly, other professional groups have followed suit.

Hence the proliferation of journals by nurses and other health professionals, devoted to recycling their MSc projects as hard-to-read peer-reviewed articles. At the same time those who could help - well-trained professional communicators - have been demonised and marginalised.

Curiously, writing seems to be one of the last areas in the NHS to be subject to rational scrutiny. As a surprised human resources professional remarked on a recent course, writing tasks are among the few activities not subject to rigorous goal-setting, resource control, monitoring and evaluation.

Perhaps it is because writing remains one of the last, great grey areas, where there are no agreed rules or criteria, where Young Turks can be controlled by setting them ill-defined tasks, and where tribal elders can employ ritual humiliation. Over the top? Perhaps, but certainly writing is one of the last areas to be affected by any concept of being evidence-based.

That said, there are some wonderful clear writers in the health professions, and you may occasionally glimpse them through their e-mails. These are the few pieces of writing that are clear, concise, entertaining and effective.

Enjoy them while you can. I suspect it is only a matter of time before they, too, become caught up in the prevailing culture - that writing is not of any value unless it is difficult to understand.