Many people tell us the same story: a thick brown envelope lands on the mat, they open it, see long words and numbers – and their chest tightens. Some read every line three times and still feel none the wiser. Others tuck the letter in a drawer, hoping a professional will explain it “properly” one day.

Hospital letters and test results are written for other clinicians first, not for patients. That does not mean you are not meant to see them; it simply means the language is designed for speed between professionals, not for comfort. This guide offers a quiet, structured way to turn those letters from a source of anxiety into a tool you can use.

A New Rule: You Are Not Marked on This

Before we touch a single number, it helps to set one mental rule: you are not being examined. The letter is not a test of how clever you are. It is a record of what has happened, written in shorthand between staff. When you read it, imagine you are eavesdropping on two professionals planning your care – and you are allowed to ask them to translate.

With that in mind, we can move step-by-step through the page, using three questions:

• “What are they saying?” (facts)
• “What are they planning?” (actions)
• “What do I need to clarify?” (questions)

Step 1 – Set Up Your Reading Space

It might sound small, but where and how you read the letter changes how much you can take in. Instead of opening it in the doorway when you are already tired:

• Choose a time of day when your mind is usually clearest – for many people that is late morning or early afternoon.
• Sit at a table with a pen, a highlighter and a second blank sheet of paper.
• If you wear glasses or hearing aids, put them on. Have a drink to hand.
• Decide how long you will spend. For example: “I will spend 10–15 minutes today just marking the main bits and writing one or two questions.”

This small “reading ritual” tells your nervous system: this is not an emergency; this is admin. Your body will relax enough for your thinking brain to do its job.

Step 2 – Find the Skeleton of the Letter

Most clinic letters follow a rough structure, even if the headings are not written clearly. Look for:

• Who it is from and who it is to (consultant, clinic, GP, you).
• Date of the letter and date you were seen.
• Reason for referral or follow-up (“Thank you for referring…”, “We reviewed Mr/Mrs… for…”).
• History / symptoms (“She reports…”, “He describes…”).
• Examination and tests (“On examination…”, “Investigations show…”).
• Impression / diagnosis (“In summary…”, “Our impression is…”).
• Plan (“We have advised…”, “We will arrange…”, “The GP is kindly asked to…”).

Take your pen and, without worrying about the details yet, lightly underline: the date, the impression/diagnosis sentence and each “we have advised / will arrange” sentence. These are the bones of the letter.

Step 3 – Circle the “Plain English” Anchors

Next, hunt for any words or phrases you already understand. These are your anchors. Common examples:

• Condition names you recognise (“heart failure”, “COPD”, “arthritis”, “angina”, “atrial fibrillation”).
• Everyday descriptions (“swelling”, “dizziness”, “breathless on exertion”, “poor appetite”).
• Test names you have heard before (“echo”, “ECG”, “CT scan”, “MRI”, “HbA1c”, “cholesterol”).

Circle them. This reminds you that you already understand more than your brain might be telling you. When anxiety is high, the mind tends to shout “I don’t understand any of this!” when in fact you understand several key pieces.

Step 4 – Tame the Numbers

Test results are often written as “lab code – number – units – reference range”. For example:

• “Hb 120 g/L (130–180)”
• “eGFR 48 mL/min/1.73m² (normal > 60)”
• “HbA1c 56 mmol/mol”

Rather than trying to interpret each number alone, use a simple three-step approach:

4a) Mark which test the doctor actually comments on

Doctors and nurses rarely comment on every number. Look for phrases like:

• “Blood tests are reassuring.”
• “Kidney function is stable compared to previous results.”
• “There is mild anaemia but no immediate action required.”
• “HbA1c remains above target; we have increased…”

Put a small star ★ in the margin next to any number they comment on. Those are the ones that matter most for this letter.

4b) Note trend words: “stable”, “improved”, “worse”

The single most important piece of “rare” information in test results is often not the number itself, but the direction of travel. Circle words like:

• “stable” / “unchanged”
• “improved” / “better”
• “worsened” / “deteriorated” / “progressed”

On your spare sheet, you can write:

• “Kidneys – stable”
• “Blood count – slightly low but no action now”
• “Diabetes – still high; changed tablets”

This turns twenty numbers into three understandable ideas you can discuss.

4c) Use one question for any number you don’t know: “Is this good enough for me?”

Instead of trying to learn every “normal range”, write one question for your GP or nurse:

• “You mention my eGFR is 48 – is that good enough for my age and conditions, or do we need to change anything?”
• “You say my HbA1c is above target – what is a sensible target for me personally?”

This respects that “normal” is different for a 35-year-old marathon runner and a 78-year-old with several long-term conditions. You are asking for a personalised explanation, not a textbook value.

Step 5 – Decode the Plan into Plain Language

The “Plan” section is where decisions live. It often includes phrases such as:

• “We will increase…”
• “We will arrange…”
• “The GP is kindly asked to…”
• “The patient has been advised to…”

Number each action in the margin (1, 2, 3…). On your blank sheet, rewrite each as a plain sentence starting with “I”:

• “I will start taking… (name, dose, time of day).”
• “I will be called for a scan / test within about… (timeframe if stated).”
• “My GP will be asked to review… (blood pressure medicines, pain relief, diabetes treatment).”

If a plan line says, “We would be grateful if the GP could…”, it means another action has been added to your GP’s list. That is not your fault. You can bring the letter (and your rewrite) to your GP and say: “The hospital has asked you to do these things – could we go through them together?”

Step 6 – Separate What Is Urgent from What Can Wait

Some letters include “red flag” advice, such as:

• “If she develops chest pain, worsening shortness of breath or collapses, please seek urgent medical attention / call 999.”
• “If new neurological symptoms occur, this should be treated as an emergency.”

Put a bright mark (for example a red pen or a big star) next to these. On your plain sheet, create a box called “If this happens, I will…” and copy those instructions in. Keep that box somewhere obvious – on the fridge, by the phone, or inside your one-page health summary.

Then, underline any actions with slower timeframes (“repeat blood test in 3 months”, “routine follow-up next year”). These can go on a calendar or reminder list rather than buzzing around your head.

What If the Letter Feels Wrong or Doesn’t Sound Like You?

Sometimes letters contain errors (wrong medication, wrong dose, wrong side) or descriptions that do not feel true to your experience. Instead of silently worrying, you can:

• Circle the part that feels wrong and write in the margin: “This does not match my experience.”
• On your question sheet, note: “The letter says X; in reality I find Y. Can we correct or clarify this?”
• Bring it to your next appointment and calmly point it out. You are allowed to ask for your record to reflect your actual situation.

Over time, your letters can become a more accurate story of your health, not just a list of problems.

Keeping Letters Together with Your Health Summary

Individual letters make most sense when they sit alongside a wider picture. You might:

• Keep a folder or wallet for important letters, grouped by condition (heart, lungs, joints, mood) or by year.
• Use our guide Creating a One-Page Summary of Your Health Conditions to hold your key diagnoses, medicines and “usual numbers”.
• Attach a sticky note to the front of the folder with your top 3 questions to ask at the next review.
• Combine this with gentle movement ideas like Chair Exercises You Can Do While the Kettle Boils so your “paperwork time” is balanced with small bursts of physical care.

If you ever feel unsure which part matters most in a pile of letters, you can also visit our PHAT Health Pathways and choose a topic like “Understanding Tests” to work on slowly.