Published in the Journal of the American Medical Women's Association. 2004; 59(3):157-159.
Published in the Professional Development section
You probably do more writing as a physician/researcher than you thought you would ever do when you took that pesky freshman composition class. As you now know, the process of writing requires great attention to detail whether you are writing an interoffice memo or a research article. It is true that the beginning of a good journal article is good science with rigorous methods, but the science will not be conveyed to the research community or the general public without clear writing. In fact, slightly more than a quarter of manuscripts submitted to peer-reviewed journals are rejected for poor writing or improper format.1 In How to Write & Publish a Scientific Paper,2 Robert Day states that when connections are not properly made in the discussion section, the articles are often rejected even when the data are sound. Thus, potentially life–saving information does not make it into the hands of the research scientists, physicians, and patients who would benefit most.
Written documentation represents us when we cannot represent ourselves. We send memos via e-mail to colleagues around the world and grant applications to places miles away from where we work and reside. Furthermore, we simply do not have the time to meet face to face with all of the people we depend on to conduct our work. Indeed, writing is an essential facet of professional life.
The entire writing process is too complex for me to discuss here. (In fact, there is no one writing process, but that is a topic for another day.) So in this article, I will mention some mistakes to avoid, the virtues of cohesion, and the time commitment necessary to write well.
Things to Avoid
Noun Strings
As the category suggests, noun strings are, well, strings of nouns. They are a series of nouns succeeding each other, with all nouns except the last one functioning as adjectives. Cancer patient is an example in which cancer is an adjective, not a noun. In such instances, the American Medical Association Manual of Style3 suggests patient with cancer as a replacement. The AMA manual gives another, more egregious, example: elderly over-the-counter drug users to be replaced with elderly users of over-the-counter drugs. As the previous example demonstrates, noun strings can be confusing, and the reader may have trouble determining what modifies what. Are the elderly using drugs right in the check-out line, over the counter? Of course, we can figure this out quite easily, but some noun strings may be difficult for the reader to decipher. Sometimes, noun strings cannot be avoided, however. In this vein, the AMA comments: "noun strings may be more acceptable, for the sake of brevity, if the terms have been previously defined without noun strings in the text." According to the AMA, some examples of acceptable noun strings are community hospital program, nicotine replacement program, and placebo pain medication. Consult the AMA manual for more examples.
Nominalizations
What might surprise you is that the best professional writing is simple writing, yet we often choose words that we think will make us sound more academic. So we write administration instead of administer and preparation instead of prepare, intention instead of intend. These seemingly erudite vocabulary choices are called nominalizations, and, in most situations, you should avoid them. Robert Day 2 gives the following examples:
"Examination of the patients was carried out" should be changed to the more direct "I examined the patient" ; "separation of the compounds was accomplished" can be changed to "the compounds were separated" ; "transformation of the equations was achieved" can be changed to "the equations were transformed." (p211)
You may have noticed that the nominalizations were changed to verbs for more succinct writing.
Wordiness
"Vigorous writing is concise. A sentence should contain no unnecessary words, a paragraph no unnecessary sentences, for the same reason that a drawing should have no unnecessary lines and a machine no unnecessary parts."4
The reality of publication is that space costs. Although cost is a great motivator for efficiency, it need not be the only one that influences the writing process. Being economical with your words (both literally and figuratively) helps the reader, whose time is just as precious and scarce as yours. I am not suggesting that you omit words that are germane to your discussion. Quite the contrary, I am saying that you should use only those words that are germane to your discussion. Joseph Williams5 offers this list of "meaningless" words: kind of, actually, particular, really, certain, various, virtually, individual, basically, generally, given, practically.
Strunk and White4 offer the following list of needless words or expressions and their suggested replacements:
Wordy
Replacement
The question as to whether
Whether (the question whether)
There is no doubt but that
No doubt (doubtless)
Used for fuel purposes
Used for fuel
He is a man who
He
This is the subject that
This subject
Be on the lookout for words that you can cut from your writing before you submit your text.
Cohesion: The Glue That Binds
When a piece of writing flows well from idea to idea, it is said to be cohesive. The ideas stick together, thus my glue analogy. As Joseph Williams comments in his classic Style: Ten Lessons in Clarity and Grace,5 connecting ideas is essential to the communicative effort:
"Readers may understand individual sentences, but if they cannot see how that series of sentences "hangs together," then no matter how clear individual sentences are readers will not feel that they add up to a cumulatively coherent passage." (p101)
Repeating key words is one way to achieve cohesion. For instance, if you have established the characters in your article as Patient I, Patient II, etc, you should refer to them as such throughout, but there is some flexibility here. Diana Hacker, in The Writer’s Reference,6 suggests, "To prevent repetitions from becoming dull, you can use variations of the key word (hike, hiker, hiking), pronouns referring to the word (gamblers . . . they), and synonyms (run, spring, race, dash)." In my example, you may first identify the character as Patient I, but alternately refer to the patient as the first patient.
Synonyms can also add variety and cohesion to your writing. I have found www.dictionary.reference.com to be a great resource for synonyms. It has a thesaurus feature in addition to its dictionary. Also, word processors come with a built–in thesaurus. When using either of these options, make sure that the synonym you choose fits appropriately within the context of what you are communicating.
One of the most widely used mechanisms of cohesion is the transitional word or phrase. The value of transitions is that they not only connect ideas, but also show relationships between ideas.
Here are some transition words and the relationships they convey:
to show addition: and, also, besides, further, furthermore, in addition, moreover, next, too, first, second; to give examples: for example, for instance, to illustrate, in fact, specifically; to compare: also, in the same manner, similarly, likewise; to contrast: but, however, on the other hand, in contrast, nevertheless, still, even though, on the contrary, yet, although; to summarize or conclude: in other words, in short, in summary, in conclusion, to sum up, that is, therefore; to show time: after, as, before, next, during, later, finally, meanwhile, then, when, while, immediately; to show place or direction: above, below, beyond, farther on, nearby, opposite, close, to the left; to indicate logical relationship: if so, therefore, consequently, thus, as a result, for this reason, since.
Internet Sources
For quick references on good writing skills, you can look to a couple of Web sites that give general writing advice and, in some cases, clarification on grammar: Purdue University’s Online Writing Lab http://owl.english.purdue/edu/ and Capital Community College’s Guide to Grammar and Writing http://webster.commnet.edu/grammar.
I have found these references to be very helpful when I can’t remember a particular rule or when others ask me about how to make their writing better. Both have examples that clearly explain parts of the writing process. The Capital Community College site even has quizzes so that you can test yourself on what you have learned. The site also has a search feature that you can use to see what others have asked about various writing issues and the answers to their questions.
Take the Time to Write
I have discussed only a few components of writing. To address even these few requires time. The good news is that the information discussed in this article applies more to revising than to writing the initial draft. Do not feel encumbered by style issues while you are just trying to express your basic ideas. Warren Browner, author of Publishing and Presenting Clinical Research,7states: "Don’t fuss over the first draft of a manuscript. Just write, without worrying about style, brevity, or clarity."
Keep in mind that revising is part of good writing. The best writers revise, but the number of drafts needed to get to a final draft is different for every writer and depends on the writer's skill and familiarity with the topic.
In his forward to The Elements of Style, Roger Angell writes, "Writing is hard, even for authors who do it all the time." Yet the labor is worth it when you see that the scrawl from your notepad has morphed into elegantly designed columns with an accompanying table or two, and your name is in the masthead confirming that the work was, indeed, worth it.
References
Bordage G., Matsuo N, Beaumont E, Anderson B. Considerations for Preparing a Scientific Paper in English: Increasing Your Chances of Being Reviewed and Accepted. Osaka: Medical Review Co, Ltd; 1997.
Day RA. How to Write and Publish a Scientific Paper. 5th ed. Phoenix, Ariz: Oryx Press; 1998.
American Medical Association Manual of Style: A Guide for Authors and Editors. Philadelphia, Pa: Lippincott Williams & Wilkins; 1998.
Strunk W Jr, White EB. The Elements of Style. 4Th ed. Boston, Mass: Allyn and Bacon; 2000.
Williams JM. Style: Ten Lessons in Clarity and Grace. 6th ed. New York, NY: Longman; 1999.
Hacker D. A Writer’s Reference. 5th ed. Boston, Mass: Bedford/St. Martin’s; 2003.
Browner W. Publishing and Presenting Clinical Research. Baltimore, Md: Williams & Wilkins, 1999.
About the Author
Shannon Wilkins – PhD in Professional Writing (medical communication emphasis)
Before focusing her energies on a freelance editing career, Shannon was a staff editor at Mayo Clinic, which has the largest in-house editorial service at a medical institution. In this role, she edited whatever manuscript came down the pike, whether it was about cardiology or dermatology. Such demands required her to be nimble in her approach to editing and to have a firm grasp of the medical resources necessary to assist authors in creating credible, cohesive documents.
In her dissertation, she analyzed the arguments regarding the federal funding of embryonic stem cell research. Besides providing an understanding of the nexus between public discourse and science, the PhD degree nurtured in Shannon a strong sense of what belongs in a scientific document and what does not. Added to this scholarly knowledge is the practical experience of being the copyeditor of the Journal of Pediatric Pharmacology and Therapeutics for 5 years. During the past 8 years, Shannon has balanced her time between editing scientific documents and teaching college composition courses. She currently teaches a college course in technical communication.
As Shannon follows the rhythm of an author’s language, she picks up the language of ESL writers that might need further clarity or the odd detail that seems out of place and needs to be researched. Her first clients were biomedical engineers whom she assisted in preparing their manuscripts for successful publication. Since her entry into the field of editing, she has edited manuscripts on pharmacology, dermatology, cardiology, echocardiography, endocrinology, transplantation, hand surgery, asthma, various cancers, and other topics. Shannon has edited manuscripts that have been published in several highly respected journals:
Biomedical Microdevices Echocardiography Endocrine Practice IEEE Transactions on Biomedical Engineering Journal of Pediatric Pharmacology and Therapeutics Journal of the AmericanAcademy of Dermatology Journal of the AmericanCollege of Cardiology: Cardiovascular Imaging Mayo Clinic Proceedings Neurocritical Care Techniques in Hand & Upper Extremity Surgery
Shannon considers all of the documents that she edits to be life documents—documents that are pivotal in the development of one’s life. Medical manuscripts are not just write-ups of research; they are documents that affect the career advancement of the writers and, often, the very lives of those in need of medical care. Various impediments may complicate journal acceptance of a manuscript, but the quality of expression should not be one of them.
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