Medical writing as a communication skill
By John Gartland, MD
Physicians as a group are widely regarded as poor writers and communicators, and the negative consequences of ineffectual writing by physicians has been a concern for medical educators and physician communicators for some time (1). I believe our problem with medical writing has its roots in our premedical education period. Writing was taught to most of us as one of the humanities, the literary form that emphasizes the writers need for self-expression. If there is anything that writing in medicine or science does not need, it is a writers need for self-expression. Confusion about the best writing form to use in medicine and science has been exacerbated by college and postgraduate writing courses entitled "Scientific Writing", when, of course, there is nothing at all scientific about writing. Writing is a graphic form of expression that, while requiring familiarity with its techniques, remains a sensitive and personal skill.
A likely solution to our confusion about the most appropriate writing form to use in medicine and science was described in Langs landmark 1987 article entitled "Technical Writing is Not One of the Humanities". Lang focuses attention on the need for medical and science writers to adopt a new and distinctive writing form called technical writing (2). A different writing form for medicine and science is needed so that communication in these areas can become more effective. Lang correctly notes that technical writing satisfies the readers need for information, not the writers need for self-expression. Technical writing is the writing form that focuses on the readers point of view and responds to the readers need for information. The intrinsic value of technical writing lies not in what it is, but rather on what message or information it conveys to readers. As is true for any learned skill, attention to writing craft is what turns a collection of words into technical writing that seems natural and dynamic to readers and, by so doing, more effectively stimulates medical and scientific exchange. Physicians who understand the requirements of the language, who are able to express themselves in logically derived sentences and paragraphs, and who appreciate the roles grammar, syntax, usage and tone play in writing will be better prepared to transfer clear and understandable information to readers by learning more about the theory and practice of technical writing.
The principal focus of technical writing is on the content of the material being presented to readers, not on the writer. The purpose of technical writing, then, is to communicate information to a reader in the clearest terms possible by combining good medicine and good science with good writing. When a piece of technical writing works, it means it was written so clearly that the reader fully understood the message or facts being presented. Literary writing, by contrast, is oriented toward writing style and personal expression, and emphasizes expression over communication. For example, if asked to describe the appearance of the sky, a literary writer could write " a solid azure blanket floats lazily overhead". A technical writer, by contrast, would write "the sky is blue and cloudless", a description that can neither be misunderstood nor misinterpreted. Medical and science writers who do not take the time and trouble to learn the preferred way of expressing themselves in their writing run the risk of having the information or facts they are trying to impart to readers misunderstood or misinterpreted by their readers which can be a fatal flaw for medical or science writers. Proper word choice is of crucial importance in technical writing. Words are the precision tools needed to build complete understanding and effective communication in medical and scientific writing. The clarity of the technical writing will determine the effect or impact of the message presented by the writer. Much of the craft of technical writing comes in choosing words that, in the context of the text, will mean to the reader exactly what the medical or science writer intended them to mean. Good technical writers avoid jargon and try hard to find the appropriate word for the particular piece of information they wish to convey to a reader. Lack of clarity in technical writing is a matter of degree that most frequently comes from a careless choice of words. For example, the words fewer and lesser frequently are used as synonyms when, in fact, they are not synonyms. Fewer pertains to numbers while lesser pertains to quantities, If used as synonyms, the writing loses a degree of precision. No word is, by itself, good or bad, or right or wrong. Whether a particular word is accurate or not in the context in which it is used, or is put to good use in the writing effort, can be judged only in the context of the writing situation as a whole. There is no danger in being too precise in technical writing. The danger for technical writers lies in being imprecise.
Medical and science writers need to develop what can be called a sense of audience which means becoming skilled in transferring information to readers in a form that is easily grasped and understood by them. Having a sense of audience for technical writers means being able to direct their written information to the readers who comprise their audience, and by rejecting the temptation to write mainly for ego gratification. Another fatal flaw for technical writers is to fall in love with their own words. The simple rule that underlies good medical and science writing is "write for the reader".
Medical and science writers also should be considerate of their readers which, among other things, means not using an excess of jargon words and not using fancy or unfamiliar words in an attempt to impress readers. Consideration also means knowing the intended readership and tailoring the writing to the level of their understanding. The heart and soul of good technical writing is the use of plain, clear language with the needs of readers kept constantly in mind. Medical and science writers also need to develop what can be called writing discrimination. This means developing a sense of content about their collected material. This means developing a sense about what information, tables, graphs and illustrations to include and, equally important, what to exclude. Good technical writers are ruthless in cutting their own material to the basic essentials needed to present and support their written messages. Medical and science writers would do well to remember that Watson and Crick first described the double helical structure of DNA in an article that occupies only 1 and 1/3 pages in a 1953 issue of Nature. Many inexperienced medical and science writers show their lack of writing discrimination by filling their manuscripts with every piece of information uncovered in their research, and by illustrating the text with a seemingly endless supply of tables, graphs and illustrations.
Technical writing allows the medical or science writer to focus attention on issues involved with communicating medical or scientific information to readers, rather than having to focus attention on language issues. The sole purpose served by technical writing is to deliver information to a reader in a clear and unambiguous fashion by using words and sentences that, in the content of the text, cannot be misunderstood or misinterpreted by the reader. Good medical or science writing, then, is a combination of good data, good vocabulary, good sentence structure, good organization of the material and is written in plain, clear language with the needs of readers constantly in mind. Good technical writing is delivered to readers in neat, clear packages of words and sentences that neither ramble nor are verbose. Good sentence structure, to some degree, also has a relationship to the use of the active and passive voice in constructing the text. Much of the published writing in medicine and science tends to be full of the passive voice which makes for dull reading. Some of the characteristics of good technical writing that make it the best writing form for delivering medical and scientific information to readers include its lucidity, its correctness, its conciseness, and its completeness. It can be anticipated that widespread adoption of the rules and practices of good technical writing will improve both the quality of the writing in medicine and science, and its teaching at the college and university level.
John J. Gartland, MD, is a Past-President of the AAOS.