Medical Writing Medical Writing A Guide for Clinicians, Educators, and Researchers Second Edition Robert B. Taylor, M.D. Robert B. Taylor, M.D. Department of Family Medicine Mail Code FM Oregon Health & Science University School of Medicine Portland, Oregon 97239-3098, USA taylorr@ohsu.edu ISBN 978-1-4419-8233-9 e-ISBN 978-1-4419-8234-6 DOI 10.1007/978-1-4419-8234-6 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2011931891 © Springer Science+Business Media, LLC 2005, 2011 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) For Francesca, Masha, Jack and Annie Preface This book is intended to make you a better medical writer. This is true whether you are a clinician in a busy practice, an educator teaching students in the health professions, or a researcher who conducts and reports randomized clinical trials. It is for the physician, physician assistant, or nurse practitioner who sees patients and who also wants to contribute to the medical literature. It is for the medical educator writing articles and book chapters to share new information and, incidentally, to attain promotion and tenure. And it is for the investigator whose career success depends, in large measure, on critical skills in developing research protocols, preparing grant applications and writing articles describing the eventual research findings. If you are new to medical writing or even if you have been the author of some articles or book chapters and seek to improve your abilities, this book can help you. Who am I that I can make this assertion and write this book, both fairly presumptuous acts? Here’s my reasoning. As a practicing physician and medical educator, writing has been my avocation. Over 14 years in private practice and 32 years in academic medicine, I have written using all the major models described in this book: review articles, case reports, editorials, letters to the editor, book reviews, book chapters, edited books, authored books, research protocols, applications for grant support, and reports of clinical research studies. Most items submitted for publication have been published. Not all. Perhaps my most noteworthy qualification is not that I have managed to produce a lengthy curriculum vitae. In my opinion, what is more important for you, the reader, is that I have made all the errors. That’s right, the mistakes. Over vii viii PREFACE the years, I have jumbled spelling, mixed metaphors, tangled syntax, gotten lost in my own outline, written on unimportant topics, submitted grant requests that seemed to befuddle reviewers, and offered articles to the wrong journals. But along the way, I have published 25 medical books and added several hundred papers and book chapters to the literature. This book is written to share what I have learned—what works and what doesn’t in medical writing. This book aims to help clinicians, educators and researchers translate their practice observations, pedagogical innovations, wise thoughts, and investigational data into written form and eventually into print. In striving to achieve this purpose, I have written the book with four objectives in mind. Upon completion of this book, the reader should: ■ understand more about the art of medical writing, including motivation, conceptualization, composition, and frustrations; ■ know how use the different models of medical writing, such as review articles, report of clinical research, and more; ■ recognize how to get a manuscript published; and ■ realize that writing can be fun. Compared to the first edition, which targeted the clinician as reader, this second edition of the book has an expanded scope, with added material to help the educator and the clinical investigator—especially the relatively new academician who has encountered the infamous “Publish or perish” imperative. I have added two important, and somewhat technical, new chapters: How to Write a Research Protocol and How to Write a Grant Proposal. Also, throughout the book, I have updated content and added new concepts and examples, including technical advice on creating tables and figures, and tips on electronic submission of manuscripts. In Chap. 12 there is a new section about the future of medical writing and publishing. The Glossary of Medical Writing Words and Phrases has been expanded to include some occasionally encountered items such as doi, PREFACE ix RBG color mode, and grey literature. In keeping with the scholarly tilt of this second edition, I have added a focused dictionary of Methodological and Statistical Terms Used in Research Studies. The book’s content is a blend of personal experience and research on the Web and in printed sources. Throughout all chapters, I have attempted to follow the time-honored principle of supporting theory with examples, some from actual published materials and some created to help illustrate the ideas presented. Most of the examples presented are “good examples;” a few are illustrations of what not to do. In Chap. 1, I challenge authors to consider three questions before beginning work on an article or book: So what? Who cares? Where will it be published? As the author, I believe that I should answer the three questions in regard to this book. The “So what?” question asks what is new and different, and I think that the answer lies in the fact that I address medical writing knowledge and skills from the viewpoint of the clinician and medical educator, not that of the journal editor or professor of English literature. The “Who cares?” issue concerns the potential reader; for this book, that is the reader who aspires to write for publication in the medical literature. This is, in fact, a surprisingly large number of persons—all competing for limited space in print. In regard to the “Where will it be published?” question, I am pleased that this book is published by Springer Publishers, the world’s leading publisher of scientific books and journals, with whom I have had an author–publisher relationship since 1976. As a clinician and/or perhaps a medical educator or clinical investigator, you have a tremendous source for writing ideas— the patients, students, or research subjects you see each day. Think about the possible significance of a cluster of uncommon problems you have observed recently, the unlikely manifestation of a common disease, a curricular innovation that others could implement, or the extraordinary courage displayed by one of your patients or study participants. Perhaps you have found a new way to use an old remedy, have your own thoughts about a recently published study, or even have a pile x PREFACE of data from a clinical investigation you recently completed. This book is about helping you recognize the reportable idea, organize your information, and write it up. Happy writing! Portland, Oregon Robert B. Taylor, M.D. Table of Contents Dedication Preface About This Book 1 Getting Started in Medical Writing v vii xiii 1 2 Basic Writing Skills 31 3 From Page One to the End 65 4 Technical Issues in Medical Writing 91 5 What’s Special About Medical Writing? 115 6 How to Write a Review Article 143 7 Case Reports, Editorials, Letters to the Editor, Book Reviews, and Other Publication Models 161 8 Writing Book Chapters and Books 189 9 How to Write a Research Protocol 219 10 How to Write a Grant Proposal 239 11 How to Write a Report of a Clinical Study 265 12 Getting Your Writing Published 287 Acknowledgments 329 Appendix 1 Glossary of Medical Writing Words and Phrases 331 Appendix 2 Proofreader’s Marks 339 xi xii TABLE OF CONTENTS Appendix 3 Commonly Used Medical Abbreviations 341 Appendix 4 Laboratory Reference Values for Adults 345 Appendix 5 Methodological and Statistical Terms Used in Research Studies 349 Index 359 About This Book True ease in writing comes from art, not chance, As those move easiest who have learn’d to dance. English Poet Alexander Pope (1688-1744) After reading this book, you will have a better understanding of the art of writing, both of writing in general and, specifically, of medical writing, with all its idiosyncrasies. This short introduction tells a little about the book’s organization and its own peculiarities, including word use, reference styles, and the examples and allusions you will encounter. In the end, our common goal is to find some true ease in writing, through consideration of both current theory and samples from the literature, and by looking at what constitutes excellent and not-so-good writing. The book progresses from the theoretical to the practical. It begins with basic writing topics and skills. Next comes a consideration of the various models for medical writing, from the review article to the report of a research study. The final chapter discusses how to get your work into print. The appendix has some handy tools that may help you along the way, including a glossary of medical writing terms, proofreaders’ marks, definitions of commonly used methodological and statistical terms used in research reports, and some tables of commonly used abbreviations and laboratory reference values that you may use in your own writing. In the early chapters on basic writing skills, I use the word article, even though later in the book the principles of authorship described will also apply to editorials, letters to the editor, research protocols, grant proposals and research xiii xiv ABOUT THIS BOOK reports. I am a medical logophile, and in using words, I will often go to the Greek or Latin roots; doing so helps me use words more precisely. Within chapters, you will also note some shorthand reference citations, presented in parentheses. These are used for articles and books used as examples to illustrate good and bad titles, organizational structure, and prose. Although I believe it unlikely that any reader would actually want to consult these writings, I have provided abbreviated citations, just in case. With the information provided, you could find most of the articles on the Web. At the end of each chapter are references to sources important to ideas described. These are presented in the style of the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals,” a very useful guide that will be discussed in later chapters. Using this reference style for the book models the way you will generally prepare citations for your medical articles. I have done my best to make this book a pleasure to read. This includes using short, strong words, and, at times, colorful images. I have included allusions to medical history, classical writing, mystery novels, opera, sports figures, comics, and a few very odd creatures. We will visit Hippocrates and Frau Roentgen, Shakespeare and Hemingway, Princess Turandot and Pogo, zombies and clones. As you read along you will also learn some medical information, such as whether or not the use of probiotics can reduce crying episodes in infant colic and the relationship between the exposure to aircraft noise and cardiovascular mortality. All the examples in the book help illustrate points about medical writing that I consider important. I hope that what follows will help you master the art of writing, to “move easiest” by learning—not really new dance steps—but some guidance on how to walk the path from idea to print. I wish that I could promise that, having read this book, your next writing effort will be so inspired and luminous that everything else in print will seem drab by comparison. In fact, this is unlikely to occur. But I do earnestly believe that, as stated in the Preface, using the principles and tips presented here will make you a better medical writer.