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Little quantitative research has explored which clinician skills and behaviors facilitate communication. Mutual understanding is especially challenging when patients have limited health literacy (HL). Two strategies hypothesized to improve communication include matching the complexity of language to patients’ HL (“universal tailoring”); or always using simple language (“universal precautions”). Through computational linguistic analysis of 237,126 email exchanges between dyads of 1094 physicians and 4331 English-speaking patients, we assessed matching (concordance/discordance) between physicians’ linguistic complexity and patients’ HL, and classified physicians’ communication strategies. Among low HL patients, discordance was associated with poor understanding ( P = 0.046). Physicians’ “universal tailoring” strategy was associated with better understanding for all patients ( P = 0.01), while “universal precautions” was not. There was an interaction between concordance and communication strategy ( P = 0.021): The combination of dyadic concordance and “universal tailoring” eliminated HL-related disparities. Physicians’ ability to adapt communication to match their patients’ HL promotes shared understanding and equity. The ‘Precision Medicine’ construct should be expanded to include the domain of ‘Precision Communication.’