This article explores rhetorical implications of extending the audience of written physician notes in hospital settings to include patients and/or family members (the OpenNotes program). Interviews of participating hospital patients and family members (n = 16) underscored the need for more complex understandings of audience beyond “universal” and “particular” explanations. Interviews were organized around the aspects of comprehension, affect/emotion, and likes/dislikes about receiving notes. Results from these interviews indicated that participants understood the notes overall but had questions about abbreviations and technical terms. Many participants felt reassured about the care they were receiving, and many liked having the notes as a reference and springboard for further discussion with health care staff. A more detailed content analysis of the interview data yielded themes of document use, readability, involvement, and physician care. Findings from this study reveal an expansion of audience in this case to include both universal and particular audiences. Also, findings point to the possibility of audience involvement among patients and family members through activities such as asking questions about the physician notes. This study has implications for other forms of written communication that may extend readership in novel ways.

Medical personnel in hospital intensive care units routinely rely on protocols to deliver some types of patient care. These protocol documents are developed by hospital physicians and staff to ensure that standards of care are followed. Thus, the protocol document becomes a de facto standing order, standing in for the physician's judgment in routine situations. This article reports findings from Phase I of an ongoing study exploring how insulin protocols are designed and used in intensive care units to transfer medical research findings into patient care “best practices.” We developed a taxonomy of document design elements and analyzed 29 insulin protocols to determine their use of these elements. We found that 93% of the protocols used tables to communicate procedures for measuring glucose levels and administering insulin. We further found that the protocols did not adhere well to principles for designing instructions and hypothesized that this finding reflected different purposes for instructions (training) and protocols (standardizing practice).