People and words

Taste in rule’s clothing

The British Academy of Medical Royal Colleges has told hospital doctors to write to patients in plain English and avoid the use of Latin, acronyms and technical terms.

There’s nothing wrong with asking doctors to be clear, but the Academy’s guidance also says doctors should avoid the passive voice. Now, that’s wrong. Here’s why.


English grammar has rules.

For example, adjectives should come in distinct arrangements. The Cambridge Dictionary states: “When more than one adjective comes before a noun, the adjectives are normally in a particular order.” For example, the ‘little white lamb’, not ‘white little lamb’ because an adjective denoting size comes before colour.

If you don’t want to emphasise any one of the adjectives, the usual sequence of adjectives is:

  1. opinion, for example magnificent
  2. size, for example tall
  3. physical quality, for example lean
  4. shape, for example muscular
  5. age, for example young
  6. colour, for example grey
  7. origin, for example Canadian
  8. material, for example tough
  9. type, for example lively
  10. purpose, for example predatory

That makes ‘a magnificent, tall, lean, muscular, young, grey, Canadian, tough, lively and predatory wolf’.


There are also misconceptions about grammar rules. For example, the idea that ‘fewer’ must always be used with count nouns, as in ‘fewer than five sheep’. But almost everyone uses ‘less’ with singular count nouns, for example ‘one less wolf’. And many people say ‘less than five lambs’. It’s not grammatically wrong, but some people don’t like it. It’s a matter of taste or preference, not a rule.

The reasoning that for clarity purposes the passive voice should be avoided is also a misconception based on taste or preference. The passive cannot be ruled out. One of the reasons for using it occurs when you don’t want or are unable to describe who’s undertaking the action.

So, my advice to the Academy is to change their guidelines – the suggestion to avoid the passive voice can be removed painlessly.