The readability level of patient information material contrasts with the observed patients’ abilities to read. One third to one half of English speaking patients have difficulty reading material at the 10th-grade level.6 23 The estimates are greater among older patients at urban public hospitals (81%)7 and among Spanish-speaking patients (54% to 83%).6 7 Another compounding problem is that a patient’s educational level does not automatically guarantee proficiency at that same level. Patients’ observed reading abilities are usually 3 to 5 grade levels below what they report as grade completed. For example, among patients receiving warfarin at an anticoagulation management unit, 53% could not read material written at the 9th-grade level, while 83% of them reported having completed the 9th grade or beyond.24 Tailoring readability of patient information to reported grade completed may result in inappropriate material.