Clear medical writing

Eschew ambiguity

Which sentence is easier to understand:  (A)  "The turn-of-the-century developing world now often confronts more of a problem with fat than it does with famine . . . . " or (B) By the year 2000, obesity was a larger global problem than famine . . . ."? 

Sentence A, a quote from a leading journal, left me wondering whether (1) the century at issue was  1900 or 2000 and (2) was this an issue for the developing countries or the whole world.   

I was also confused by the phrase "now often more of a  problem with fat than with famine."  I was left wondering whether the more went with the "now often more" as in the common use of "more often" or did "more" belong with the word "than" which was eight words away. 

I prefer version B for clarity.  Do you?         

Be internally consistent

I recently needed to look up the likelihood that a new inguinal hernia might strangulate.  A textbook chapter on inguinal hernias contained two statistics that left me more confused than when I started. In one paragraph, the article noted that the "cumulative probability of strangulation is 2.8 percent [sic] at three months" and 5 paragraphs later they noted that "significant hernia complications are rare . . .and overall there were 0.0018 hernia-related adverse events per patient year." 

So what is the answer?  2.8% over 3 months or 0.0018 over a year? 

Energize your verbs

These two sentences are from an editorial about the importance of preventive cardiology.   

"A dedicated focus on modifiable risks that apply to all individuals is of paramount importance.  Along with cigarette use, obesity and a sedentary lifestyle are chief among these modifiable risks." 

I would like to energize this important message, which I agree with 107%.   

In the first sentence, I believe that the verb "must focus" is more powerful that the phrase "of paramount importance.   So my more sentence then reads "All individuals must focus on modifiable risk factors."      

I had to read the second sentence twice to understand its meaning.  I prefer putting all three life style risk factors together and giving the sentence a call to action.  Remembering that we can not use the same word twice in a paragraph, I have to find an alternative for "modifiable."  I end with "The three personal health choices that cause premature disease are cigarette smoking, obesity, and a sedentary lifestyle." 

Together they become:

"All individuals must focus on modifiable risk factors.  The main culprits that cause premature disease are cigarette smoking, obesity, and a sedentary lifestyle."   

Not perfect, but a little harder hitting.  And, to win the preventive medicine battle, we have to hit hard. 

Do not leave your reader hanging

Here is the first sentence in the conclusion of a major article:  "Our review and meta-analysis has revealed that opioids are commonly prescribed for but may only be efficacious for short-term treatment for chronic back pain (<16 weeks)." 

I ask you, "commonly prescribed for" what?   Yes, the article is about opioids for back pain, but are they commonly prescribed for short- or long-term use?   

I think it clearer and cleaner if the conclusion had started "Our study showed that while opioids are commonly prescribed for long-term treatment of back pain, they are only efficacious for short-term treatment of back pain." 

Finish your thoughts to help your reader understand your message.

Write more clearly to help your reader. 

Dr. Bob Gleeson

 

Use acronyms sparingly

Acronyms save space, make the reader pause to translate, and limit your reading audience.

Unless you are a pediatric cardiologist, the following sentence, which appeared in a chapter on ventricular septal defects in a guidebook written for medical para-professionals is gibberish:  "A VSD may be in some instances complicated by a TFO or TGA." 

The acronyms saved space, but they also caused me, as a reader, to pause to translate them into understandable phrases, and they clearly limited the number of readers who would even try to translate.   

By the way, after I Googled the acronmyns I learned that a TFO is a Tetralogy of Fallot and a TGA is a Transpositon of the Great Vessels. 

Since the chapter is about Ventricular Septal Defects, the use of the acronym VSD through-out the entire chapter is acceptable.    However, the acronyms TFO and TGA are used only in this one paragraph; they confuse the reader; and, they indicate that the author was was writing for the wrong audience. 

The sentence would clearer if it read: "A VSD is also a component of other congential cardiac defects including both Tetrology of Fallot and Transposition of the Great Vessels."   

Do not use an acronym unless the meaning is clear to more than just a narrow audience and do not make anything into an acronym unless it is an important focus of the article. 

Be kind to your reader. 

Dr. G. 

Use words with meaning

An abstract included the sentence "studies confirmed that [drug x] was noninferior to treatment with other protocols." 

Everything hinges on the single word "noninferior," a word that is not listed my unabridged dictionary.  Does it mean equal to? or superior to? or bad-but-not-as-bad-as?  I do not have a clue.

Did the author think that he was giving a clear message.  Or did the author use that word intentionally  to obfuscate (confuse) the reader?  And what kind of an editor let that one slip through? 

In either event, I did not read the article. 

Every word in every sentence in every paragraph in every article should have a purpose.  And, as an author, your purpose is to help the reader understand your message. 

Be kind to your reader. 

Dr. G.   

Write sequentially

In scientific writing, words should appear in chronological order. 

The following sentence appeared in a manual:  "Histological exam and biopsy should be done on all polyps over 5 mm found at colonoscopy." 

We all know what that sentence says, but you, the reader, have to take an extra second to be certain you are correct because the steps in the sentence are not in the same order as the steps of the procedure.  The procedure is first do the colonoscopy, then find a polyp, then biopsy, and then histology. 

Rewriting the sentence in that order, we get: "During colonoscopy, polyps larger than 5 mm should be biopsied and sent for histological examination."  That sentence is passive, emphasizing the polyp.  You can write an even stronger sentence by stating this procedure as an instruction: "When doing a colonoscopy, you should biopsy all polyps over 5 mm and send the tissue for histological examination."   Or "All colon polyps over 5 mm must be biospied and the tissue sent for histological examination."   

In any event, if you write sequentially, your reader will more easily know what you mean.

Be kind to your reader.  Dr. Bob

A start: get rid of unnecessary words

"It has been reported that the writing of medical articles and texts is often poorly executed resulting in poor comprehension by the reader."   

Uggh.

What is the subject and where is the verb?  Strong sentences require a clear subject, usually at the beginning of the sentence, and a strong verb.  Of the two, the strong verb is the more important. 

Let's get rid of the first six words--they are useless and provide no information.   "Writing of medical articles and texts" is the subject, but it is excessively verbose. 

What does "is often poorly executed" mean to you?  It makes me think of a rope or a gun.  Bonus points if you caught the two uses of "poor" in the same sentence--another no-no.   

The sentence really means "Medical writing that is not well done reduces the reader's comprehension."   

Or, we could do even better and write in the positive: "Good medical writing increases the reader's understanding."