Last time, we identified the Problem:
Readers of your report can’t find the Good Stuff. It’s buried under 8-12 pages of history they already know, test results of unclear significance, and a “story” about their child that might be confusing or alienating.
This week in WBR, we identify some potential Solutions:
1. Start with the End
One way to solve this problem is to start with the Good Stuff. What I mean by that is: You can start with the summary.
No, really, you can. You can completely change your report format and put the summary right at the start. You don’t have to put the summary at the end. There’s no law that says it needs to go there, other than the “we’ve always done it this way” fake law.
In fact, most people who communicate for a living do not endorse putting the most important info anywhere other than right at the beginning.
For example, journalists learn to write articles so all the important stuff is right in the first paragraph or two. They call this structure the Inverted Pyramid. The Inverted Pyramid looks like this:
Next time you read a newspaper article, look for the Inverted Pyramid. Notice how all the “need to know” bits are in the first paragraph or two. Watch how less important “nice to know” info is relegated to the later paragraphs.
After considering all my options, I chose this inverted solution. All my reports now start with the summary.
I was inspired to embrace this approach by a local large medical center. For unclear reasons, they send me medical records for any child who has seen me within the past 3 years. Even if it’s for some clearly unrelated medical procedure. They send me a lot of records. (Their postage bill must be huge.) One day while filing these records, I realized it only takes me a few minutes to decide if the records are relevant and to get the gist of the findings.
Because all their medical notes and evaluations start with the summary. Bam. Three to five minutes of reading and I know the problem, the test results, and the plan for treatment.
Do you hear that sound? That’s the sound of a huge “aha” bell clanging in my brain.
I was floored when it occurred to me that I could be writing my reports that way. I changed my report template within the week.
Now, whenever I read one of my old reports (usually for a re-evaluation), I’m annoyed that I have to spend time wading through pages of info I don’t need to find the info I do need. I’m frustrated and sad that I made the families who saw me do this too.
Now my reports looks like this:
I keep each section to 1-4 pages – usually 2 for the summary, 2 for recs, 2 for the history, 1 for behavior observations, and 4 for the tables and test results. To keep the page length down, anything that doesn’t fit into this page count or that is “nice to know” goes in an appendix at the end.
If you’re reading this you’ve probably already seen my samples, but if you haven’t and you want to, please just send me a quick email.
Possible drawbacks to this approach:
It’s different. Different is sometimes hard. If you write a lot of reports for a specific referral source and they are used to your old format, they might think this new approach is “weird.”
This format isn’t as efficient for supervisors.
The naïve reader may need some help orienting to this format. For example, you might have to explain that the history comes after the summary.
Because the format is unexpected, unexpected things can go wrong. For example: I had one family just give the school pages 1-4 and pages 10-14 of a report, leaving out the entire middle. This odd situation was compounded by the school not noticing they were missing pages 5-9. The school kept demanding to know why I did not include the child’s [complex] history, which mystified me since I’d spent 4 pages on it. This whole confusing mess probably could not have happened if the history/background had been on front page with my letterhead. The school would have noticed the missing pages more easily. The point is, when you change something, new things can go wrong for a while until you work all the kinks out of the system.
2. Show Readers Where the Good Stuff Is
Perhaps you love the format of your reports. You like your summary where it is. You have good reasons for putting the Good Stuff at the end, and you want to keep it there.
That’s fine – I’m not here to talk you out of anything. I just want to give you options.
One way to make your reports instantly more user-friendly without changing the format at all is to give readers a roadmap. A roadmap in the form of a Table of Contents.
A Table of Contents lets the reader know how a report “works.” The reader can see at a glance what sections the report includes. She can see how each section connects to the last. She can picture where the report is going.
If the reader wants, with a Table of Contents she can easily skip ahead to a specific section of interest. She can also quickly return to a section she wants to re-read.
If you use Microsoft Word, making a Table of Contents is super easy. You can put a customized, auto-generated Table of Contents into your report template in under 5 minutes. Then you’ll never have to think about it again, except to hit “Update” when you finish each report.
Here’s an unedited sample of the Table of Contents I just asked Microsoft Word to auto-generate for the report I’m working on:
Of course, you can format the font and appearance of your Table of Contents any way you like. You also don’t need to use upper case, or multiple colors. You also don’t need to have a multi-level Table of Contents (in fact it’s probably overkill). This is just a sample using the defaults to give you a general idea of what an auto-generated ToC can look like.
Here’s an article on how to make a Table of Contents, with instructions for any version of Word from 2002 on: https://shaunakelly.com/word/numbering/tableofcontents.html. (If you use anything program other than Word, you’ll have to google for yourself.)
Readers need a certain level of education and some familiarity with nonfiction books before they can really use a Table of Contents.
If your reports are really long, or you use many levels in your table, a Table of Contents might make your report look intimidating instead of user-friendly.
Psychologists use all sorts of phrases to mean “The Good Stuff.” Most of them are not obvious. For example, I call my Good Stuff the “Summary” or the “Summary and Impressions”, which is pretty conventional. While I’m sure it’s obvious to you what the “Summary” is, to a naïve reader, “Summary” probably sounds like a… well… summary of everything that's already been said in the report. A summary sounds like section that you don’t even need to read if you’ve read everything else. It’s probably not clear to a layperson that the summary is really the “Good Stuf.f” Other phrases psychologists commonly use (e.g., “Clinical Impressions”, “Diagnostic Considerations”) may be even more obscure. A map where all the destinations are marked with unreadable hieroglyphics is about as helpful as no map at all.
3. Make Time Fly 'Til You Get There
You can also use formatting to indirectly highlight where the Good Stuff is. This is another option that keeps the IMRaD order if you like it. The idea here is that you make the info before the summary as quick and easy to read as possible.
The ideal way to achieve this is for your summary to be visually and conceptually different from the rest of the report. These formatting and conceptual differences will convey to the reader that it’s OK to quickly skim the background info. When the reader gets to the Good Stuff, your formatting will help them intuitively know to slow down, read thoroughly, and digest fully.
One effective way I’ve seen this done was in a report from a psychologist in the Midwest. That psychologist used tables to convey all the background information. Here’s a rough re-creation* of what that looks like:
In contrast, the summary is in full paragraph style. This contrast clearly emphasizes that the background info is for skimming and the summary is for careful reading.
Another way to accomplish this is to use bullet points for some of the background. My own use of bullet points in a table format looks like:
In their article Communication is key: the utility of a revised neuropsychological report format, Dean Beebe and colleagues propose another option. Unfortunately their article is paywalled - I wish this info could be more easily shared.
If you can’t see it for yourself, their model uses very short, brief paragraphs to talk about each background section. This contrasts with the longer, fuller summary. Again, the formatting contrast allows the reader to intuitively sense where the Good Stuff is.
Here’s a rough re-creation* of what that kind of very brief background might look like:
This section is so brief it will be clear to most readers that this is not where the “Good Stuff” is. This is introductory info only.
Tables are hard to read. They almost always look ‘busy’ on a page (and oftentimes even look ‘ugly’). Tables are especially hard for people with weak visual skills.
Bulleted or tabled reports can look templated or ‘cookie-cutter.’
The information might seem too abrupt – the total opposite of ‘telling a story.’ This could alienate some parents who want or expect something more personalized or with more of a narrative flow.
Messing around with the formatting of tables is a good way to find yourself procrastinating for hours rather than actually writing.
4. Make More Work For Yourself
Maybe you’re not ready to change a single thing about your reports. That’s ok too! You can actually write better reports without changing your reports at all.
The secret to this magical-sounding option is the decidedly-not-magical trick of doing more work. This sounds crazy, I know, but it’s a fantastic way to “ease in” to changing your report format. What I’m talking about is writing a summary of your reports that you also give parents or referral sources.
This is a great strategy for 3 (maybe 4) reasons:
You get practice at shortening your reports.
You get to see what families or referral sources actually want. If they want it in a brief version of the report, it’s probably essential “need to know” info. If they don’t even notice that the brief version doesn’t include section X or Y, that section can be relegated to the “nice to know” pile. When you decide to change your full report format, you’ll know exactly what to keep and what can go (or at least be a lot shorter).
If you are struggling with getting reports done on time (no shame here, it happens to all of us), this is a good way to get families the essential info quickly while they wait for the full report.
(Sneaky marketing tactic if you get permission to send these to referral sources – pediatricians don’t have time to read a 20-page report. Send them a cover letter or short version and you’ll stand out.)
Here are a few ways to make more work for yourself, ranging from hardest to easiest option:
The long feedback summary:
For the past 10 years, I’ve provided families with a 2 page summary of the test results at the feedback. This summary is essentially my "full" summary and recommendations but in slightly abbreviated form. I use bullet points, but I also use full sentences.
Here’s what they look like:
These take me about an hour to put together before the feedback. It takes me maybe another half hour to turn these into the “full” summary for a report – usually I’m just fleshing out a few sections.
The better/shorter feedback summary: I got this idea from a psychologist who works in Texas (who got the idea from a supervisor who still practices in the upper Midwest). My Texas colleague writes 1-page feedback summaries using much shorter bullet points. (I would totally do this if I knew how, but “writing things in fewer words” is… ummm… one of my major growth areas.)
Here’s what that psychologist’s feedback summaries look like:
Another sample of a short one is this one from my archives, from back when I tried exceptionally hard to write less. You can see how this one is partially templated:
The cover letter:
A psychologist I know in Massachusetts writes a 1-2 paragraph cover letter that reviews the key elements of the report. This psychologist sends the cover letter when faxing or mailing reports to pediatricians or therapists.
The paragraphs follow the familiar IMRaD format, but with only 1-2 sentences per section. An example might look like:
The cover table:
Here’s a really easy option. A psychologist in Washington State uses a cover page that is a simple 4-box table. This psychologist writes the child’s strengths, weaknesses, needs, and recommendations into the 4 boxes, and then staples it to the front of the report.
It ends up looking something like this:
The templated form:
Another easy option would be making a templated form with boxes that you could check as appropriate. This requires some work on the front end to create the form, but then only a minute and a black marker before each feedback.
Here’s a sample of what that could look like:
Notice this one is very different in style from the previous examples. The point of this WBR series is not to suggest there is any one style of reports that is “better.” This is all about how to communicate the info you think is important in the most effective ways possible.
Some readers may think this is your entire report. Whether that’s a good thing or a bad thing likely depends on their expectations and your perspective.
All of these are more work. Who’s got time for that?
5. Put In An Abstract
Even scientific papers recognize that the IMRaD format is clunky and annoying. Enter the abstract. The abstract is quick way to get the main findings, placed – surprise! – right at the beginning.
Adding an abstract to your report is yet another easy way to improve your communication without changing the format of your reports. Essentially, it’s making more work for yourself like in the section above... but putting that work at the beginning of your reports instead of producing a second document.
The abstract can be as long or as short as you want. I provided several examples of longer approaches in the previous section – you could work many of these into something that serves as an abstract for a full report.
Here's a much shorter example. Dean Beebe’s group starts out each summary with a section called “Key Findings." I think it will fall under “fair use” to reproduce just that short section as an example:
- Average to above average cognitive skills (consistent with 20XX test results).
- Continued relative weakness in processing speed, but this was mild and inconsistent.
- Ongoing difficulties with attention and executive skills in real-world settings.
That’s less than 35 words!
You can combine any of the above suggestions into a hybrid that best suits your needs. For example, a psychologist in California wrote me an email recently saying “I’ve developed a unique format that includes a brief initial summary, hypothesis questions, and table of contents.”
In a "brief initial summary" this same psychologist shared with the PED NPSY listserv a while ago, my colleague was able to boil a full report, including extensive recs, down to 25 lines of text in 6 sections:
Disorders that were considered and ruled out
A psychologist in Georgia uses a beautiful format where the first page is the:
Table of Contents
Reason for Referral
Key Findings (about 4 bullets in full sentence form)
This format manages to convey the comprehensiveness of the report, while also getting you everything you need to know in one page. It also just looks really pretty, like the front cover of a brand new text book for a class you’re excited to take.
More work, more work, more wooooooooork.
Technically, these approaches make reports longer. Longer reports waste more paper, cost more to mail, and add more pages to the child’s often-already-extensive file. Longer reports can also intimidate readers, even if it is longer in the service of being easier to read.
6. Write Something Integrated
Maybe you’ve read to this point and you feel all my suggestions are just adding another thing to your already too-long to-do list. Here’s your option for if you want to get to the Good Stuff faster without having to write a report plus do more work.
Try writing something that integrates everything all into one narrative. This is the "Jacques Donders approach," as outlined in his classic Pediatric Neuropsychological Reports: Do They Really Have to Be So Long? (Unfortunately, this one is also paywalled.)
Donders provides a sample report, which is a scant 2 pages (though in small font and printed in double columns because it is in a journal article).
The "Impression and Recommendations" [sic] section of the report integrates test results, relevant behavior obs, summary statements, and recs into 4 paragraphs. (13 sentences… I’ll try not to mention the 30+ word average sentence length).
A sample sentence, which I'm again hoping falls under fair use to reproduce here, is:
When John starts to perseverate or lets his attention wander, then a brief, gentle tactile cue might help (I had reasonable success with touching his cheek and then redirecting him to the task at hand).
This single sentence conveys info about John’s struggles, behavior during testing, and a suggested rec all in one package.
The essence of this strategy is making ALL of your reports the Good Stuff. Readers don't have to skip anything to get to the Good Stuff because it's all useful.
Here’s a sample from my archives of me trying to write in this integrated style. You can see I’m combining test results, summary statements, and behavior obs in each paragraph:
Potential drawbacks to this approach:
OMG it takes me forever to write like this. I think some psychologists easily think this way and can just dictate this straight into a report – more power to you if that's you. I love reading reports like this. However, I find it really effortful to write this way.
Putting the test results in parentheses gives other psychologists and schools info they may need. It also lets the reader know what test you’re talking about. It drives me crazy when a psychologist says something about a test and I can’t figure out what test they are referring to, or what they mean when they say the score was “lower than expected.” However, these parentheses make sentences hard to read.
7. Start Even Closer to the End
I asked a random selection of parents what they would want to read first in a report. By random selection, I mean I asked people I know socially who are parents and who were willing to indulge my odd questions.
You know what most of them said they wanted to read first? Go ahead, guess.
Almost universally, they said things like "I would just want to know what to do." One was brave enough to tell me,
“I don’t think I would even understand what was ‘wrong’ when you explained it to me. But, I would do anything you told me to do if you said it would fix the problem.”
A veteran of several evaluations for her kids said, "I heard all that other stuff [in the report] when I met with the psychologist. When I got the report in the mail, all I wanted was that numbered list of what to do next."
Other parents told me they want to read the section that explains “exactly” how to use their child’s strengths to compensate for areas that are hard for them. Two parents told me they want to start with “what kind of learner” their child is and “how to make learning easier” for him.
No one said they wanted to start with the history.
When I asked a few teachers and a school psychologist over text what they would want to read first, they told me they wanted to read the “goals” for the student. I took that to mean recommendations. (Though are there any school psychs reading this who could expand on what this might mean?)
These professionals were also not interested in reading the history first.
So a consumer-oriented option would be to start with the recommendations. I've never actually seen a report start with the recs - the closest I’ve seen are when recommendations are included in a cover letter, abstract, or cover table (as in Sections 4 or 5 above). Does anyone here start with the recs? What does that look like? How is that working for you? What do you see as the potential drawbacks to this approach?
I'd also love to hear if you've seen or developed something I didn't think of here. Or maybe you want to share a sample of what you've come up with?
Note: This post is written at the 7th grade level. There are 301 sentences (14 words per sentence). 46 of the sentences are hard to read. 32 are very hard to read. There are 9 uses of the passive voice.