Scientific and Medical Writing
October 12, 2008
Persuasive and Effective Writing
Scientific writing shares with all expository writing the need to be clear, concise, and intellectually creative, not to mention persuasive. A legal analogy (drawn from my days as a practicing attorney), helps make the point. You are writing a brief, or presenting a case to a jury – quite literally – in the form of a panel of reviewers and editors. You will present facts (the data), and describe how the facts fit (or fail to fit) into the existing precedent. You will argue persuasively, in an evidence-based manner, why your analysis should carry the day and be accepted as part of the canon of accepted wisdom – at least until someone comes along and upends you! Dividing the work of writing into tasks (or aliquots, for you pharmacists and biochemists) is a key feature of being efficient. As importantly, writing in chunks helps prevent wheel-spinning, which virtually always extinguishes the creative process. With this in mind, I’ll be suggesting that you adopt an algorithm that follows a step-wise process, with suggested blocks of time allocated for the various tasks. You don’t need an uninterrupted 6-hour stretch in an isolation tank to get started.
A quick note before getting to the heart of the matter:
Write with a grammar and usage guide (there are many online guides, see, e.g., The American Heritage Book of English Usage, The Chicago Manual of Style Online, University of Chicago Writing Program ), and a scientific style guide (such as the American Medical Association’s AMA Manual of Style, 10th Edition,The Council of Science Editor’s Scientific Style and Format), so that you are always prepared for those niggling issues such as “compared with” vs. “compared to” (here’s a freebie: with is for comparing like items, e.g., the U.S. Capitol with the British Houses of Parliament; to is for comparing or contrasting dissimilar items, as, “Shall I compare thee to a summer’s day?”), as well as for weightier matters such as international presentation of measurement, and accepted abbreviations. Also, have your Endnote library or other compilation file of the references you will likely need to have at hand as you are setting up the introduction and background.
Begin before the beginning.
Scribble or type a list of topics, themes, ideas, or conclusions, relating to your research, in any order. Don’t fret about making it perfect – this is the written equivalent of the “brainstorming” sessions sometimes used to break the ice at meetings. Using the scribble technique allows you to harvest all of your ideas, and then winnow them – some will go to the discard pile, some will be saved for another day (and another paper), but you won’t distract yourself by following ideas (too far) that are not relevant to this particular paper. Do this for about 15-30 minutes, and then relax — reward yourself with a latte or a quick peek at a Tivo’d Daily Show.
Build a scaffold.
Using the “Instructions for Authors” contained on the Web site of every scientific journal, open a new document and set up the section headings of the paper. Voilà — you are now no longer looking at a blank screen. Pull out or bookmark your style manual and grammar guide. You are almost ready to start. Treat yourself to a snack or another latte.
Put on the sorting hat.
With both the scribbled list and the section headings in front of you, begin to fill in the scaffold – penning a meaningful topic sentence for each section and subsection. Note: meaningful means an original idea that sets up an issue that will be discussed in the remainder of the section, subsection, or paragraph.
Fill in the space under the topic sentence with elements from your scribble list – perfect prose is not necessary – of findings, results, and conclusions, noting areas that require further thought or discussion.
A note: the hardest thing to do at this point in the process is to “murder your darlings,” the admonition famously delivered by Sir Arthur Quiller-Couch (1863–1944), and co-opted by fiction editors ever since to reprimand writers who have introduced too many characters or plot devices. As you are probably coming to realize, writing is a continuous cycle of refining the ideas that belong in this paper, and putting the others into a file called “good ideas for another day” (literally, that is what I suggest that you call it), and even consigning some to the scrap heap of investigative history. Virtually every author cuts too little at this stage, and virtually none cuts too much. Err on the side of mercilessness.
Work until you are repeating yourself, then go for a run or a ride. (Another latte and you will put yourself at risk for Atrial Fibrillation).
The Introduction: A promise to the reader.
The introduction is not simply a writing exercise or preliminary matter. The intro guides your PRESENT thinking about the paper – it may evolve; there is always the possibility that you’ll change course entirely, but likely not, as by the time you sit down to write you will have discussed your findings and their meaning with your co-authors, your statistician, your mother- really, whomever is willing to listen.
Content. The introduction is your promise to the reader. The key to convincing a journal that your manuscript is publication-worthy is a cogent articulation of the unique contribution your findings make to the literature. Describe the raison d’etre of the study — recall the deficit in the knowledge base, or interesting question that compelled you to conduct this study in the first place. Do not reinvent the wheel. If the study is drawn from a funded grant or response to an RFP, return to it and reproduce the reasons the funder of the study was sold on the novel research idea you presented. Review recently published papers in the journal that you are aiming for that pertain to your area of investigation. Note carefully which aspects of the scientific underpinnings of your study are essential to include. It will likely not be the entire history of the human genome project, but rather the most recent work on the use of BRCA1 and BRCA2 to screen for cancers beyond breast and cervical, and incorporate only those elements that are essential to set the scientific scene, citing published work in support. Close the intro with a “road map” to help telegraph to the reader what he or she will find in the paper, and (if you are feeling particularly gutsy) the contribution you believe you have made to our collective understanding of this key topic.
Style. Write the way that you speak, but not conversationally. That is, do not use more words to write something than you would to simply say it. Avoid connectors, descriptors, or transitions that you would not feel comfortable saying aloud or presenting orally (e.g., hence, thusly, etc). Read your introduction aloud to yourself to see if it rings true and sounds sensible. Then call it a day.
Write the easy parts first.
The methodology and results sections are relatively easy to knock off quickly. Carefully track the steps that you undertook to recruit subjects, and what you did with them, or, if one exists, the research protocol. If you repeat or reproduce a part of the protocol as stated in your original proposal, do not paraphrase or change verbiage.
This is also a good time to start noting which data are candidates for a table, and any concepts that are best depicted graphically in a figure. These are all good tasks for a slot of 30-60 minutes while commuting, or during academic senate meetings.
Results: The scribbled list re-rears its head.
Content. Spend some more time thinking about the most interesting and logical way to present your results. Was there an expected or unexpected finding? What grabbed you about your results? If you are presenting something new, build the case in a logical order – e.g., is this study the result of a long line of similar research that is “confirmatory, but…”? Does it present a new theory to explain an old phenomenon? Is it rebutting a long-held belief in the field? Does it have implications for research or social policy? Will it be a useful “tear-out” with pragmatic clinical application?
Style. Using the topic sentences you’ve already drafted into the scaffolding, write stand-alone paragraphs following the “I.A.C.” algorithm: Issue (the topic sentence), Analysis (the clinical, biochemical, social, economic, explanation of the issue or finding), and finally, the Concluding sentence (summing up the analysis of the paragraph), which should serve as a transition to the next paragraph. Get busy murdering those darlings. You will have many findings and results to choose from – choose judiciously.
If you find that you are stuck, particularly if you cannot create an I.A.C. paragraph for a finding or result, there’s a good chance that you have not been judicious enough. Go back to the topic sentence, and make sure that it is worthy of a paragraph. Some ideas that seem viable when they are drafted, turn out to be insufficiently meaty to stand alone as you move through the process. Another possibility is that this particular finding is not relevant to this paper – open your file of “good ideas for another day” and put the idea away. Ideas like this are not wasted, they are merely waiting to be re-purposed.
Another observation: while journals virtually always ask you to list results and discussion in separate sections, as you are working you will likely elide them a bit, i.e., it is sometimes difficult to simply articulate a result or finding without saying something explanatory about it, and the extra detail you find yourself adding helps to frame and organize the findings that belong together. At these times, I suggest you let your analytic mojo have its way, and later use the cut and paste function to pull out the “explanatory” discussion and place it into the “Discussion” section. You will not have wasted any time, and your creative process will not be needlessly interrupted.
Discussion: Actually speak to the reader.
The discussion is your opportunity to argue your case with the facts that you’ve set forth formulaically in the results sections. Repetition in the discussion does not make your thesis more persuasive. Here is where you persuade the editors and reviewers how and why your findings have meaning, fit together to create a story or explanation that has not been revealed before (and that is clinically relevant), or are the start of a re-thinking of formerly received wisdom. Check each paragraph against the next to be certain that you are connecting the dots for the readers, not bludgeoning them.
Limitations: Head off possible criticism with careful, but not defensive, explanation.
Anticipate critique of your methodology or study design and present the reasoning behind your choices. Your design and study criteria were well thought out in the beginning – now is not the time to have a crisis of confidence.
Conclusion: Provide a send-off, not a repetition.
The conclusion is your opportunity to take the bully pulpit, and set a course. This is the section in which to chart a research agenda, get others interested in your field, or create some controversy that flows from your findings. Articulate the thing you most want the editors and reviewers, and ultimately, the readers, to do with this new knowledge. What’s the take-home message?
Some practical advice.
Return to the rules for authors and re-check formatting requirements, word length, formatting of references, suggested number of references, directions about graphics — the works. Make sure you have complied with all of the structural requirements.
Print a hard copy of the manuscript, and proof it for substance by reading it aloud once. You will be amazed at what you will find to self-edit. Then, and only then, spell check. Wait a day, re-read a printed version of the manuscript. Then, and only then, with a sigh of relief, hit the send key to your co-authors, or other friendly readers.