Before I became a medical editor, I worked at an English-teaching company. I edited training materials for learners of English as a second language.
Our clients were lawyers, managers, CEOs from European countries. So whenever I trained new writers, I reminded them their work will be read by people who were well informed and competent.
The learners’ only weakness was they weren’t too good at understanding English.
“So introduce complex topics,” I would tell them. “Analyze. Philosophize. And yes, use difficult words, and then help your learners understand them through context, definition, and discussion.”
One thing they should never, ever do was insult the learners by talking to them as if they were four years old.
Keeping these guidelines in mind, our team turned out plenty of excellent learner-friendly materials.
And then I became a medical writer, and I forgot the very same guidelines I had made myself.
Limited in Vocabulary, Not in Intelligence
I forgot that the readers of my consumer-targeted medical material were people of at least average intelligence, well informed and competent, whose only limitation as far as I was concerned was they weren’t too good at understanding “medicalese.”
So I fell into the trap of talking to my readers as if they were four years old.
The road to this trap is paved with good intentions: I wanted to simplify the material — but ended up making it patronizing.
But we learn from our mistakes. So now, here are 5 things I will never do again when I’m writing consumer-targeted medical content:
1. Spelling out common knowledge. “AIDS is a sexually transmitted disease.”
“Really?” the readers’ eyes roll. “You don’t say?!”
If a piece of information is likely to be known by most fifth graders, we shouldn’t spell it out for adults.
Patient-friendly materials are meant to teach new things. When we put common knowledge in there, we are telling our readers we think they are so ignorant, this old information might be new to them.
2. Putting definitions in parentheses. Simple words are great, but sometimes we need to use complex medical terms to maintain the accuracy of our communication.
Complex terms need to be defined. The adverse repercussions of misinterpretation are simply too great.
But there is a right way to present definitions. One thing I’ve learned is to never put definitions in parentheses.
Why? Let’s look at the difference parentheses make:
- This drug is associated with the development of myocarditis, an inflammation of the middle layer of the heart wall.
- This drug is associated with the development of myocarditis (an inflammation of the middle layer of the heart wall).
Without parentheses, the definition is unobtrusive, conversational, like something the author would have said regardless of who the reader was.
But look at what happens when we put definitions in parentheses.
Now it looks like an accommodation. It says to the reader, “Most people don’t need this help, but you might, so I’m bending over backward for you.”
Acronyms are a special case. We introduce them in parentheses because nobody ever says, “The World Health Organization, double u, aitch, oh,…” in ordinary conversation. They are unquestionably parenthetical, so it is correct to keep them in parentheses.
Personally, though, for consumer-targeted content, I prefer to make acronyms an appositive of their definitions: “The World Health Organization, or WHO,…”
To me, it sounds friendlier that way.
3. Adding a pronunciation guide. Here’s a sentence I’d once written: “This drug is associated with the development of myocarditis (mai-oh-car-DAI-tiss).”
Ugh. Did I really syllabicate a word for my adult readers, as if I were their teacher and they were in first grade?
Yes, I did. Some words are just so tempting: Mesothelioma. Thrombocytopenia. Lymphangioleiomyomatosis.
But what for? Will the readers’ comprehension of my material suffer if they don’t know whether “schistosomiasis” has an initial /sh/ or /sk/ sound?
And where do we draw the line?
“The patient reported experiencing borborygmi, or stomach growling, after consuming two spoons of Worcestershire sauce.”
Do we put in a pronunciation guide for “borborygmi”? How about for “Worcestershire”?
Considering how many English words are commonly mispronounced, we could end up with a dozen pronunciation guides in an article with just 300 words.
4. Forcing short sentences. Once upon a time, I wrote like this:
Head lice infestation leads to social disruption: It stigmatizes infested children. It causes parental anxiety. It forces parents to care for the child at home. This can lead to loss of income. It can also lead to absenteeism from school or day care.
I avoided 20-word sentences because I feared that lay readers might not easily comprehend them.
But long sentences have their use. They build up a crescendo that finally hits you with a force no series of staccato-like statements can muster.
If the best authors in the world believed that lay readers cannot appreciate long sentences, we would have been deprived of literary masterpieces such as this 107-word idyll from EB White’s Stuart Little:
In the loveliest town of all, where the houses were white and high and the elms trees were green and higher than the houses, where the front yards were wide and pleasant and the back yards were bushy and worth finding out about, where the streets sloped down to the stream and the stream flowed quietly under the bridge, where the lawns ended in orchards and the orchards ended in fields and the fields ended in pastures and the pastures climbed the hill and disappeared over the top toward the wonderful wide sky, in this loveliest of all towns Stuart stopped to get a drink of sarsaparilla.
How this sentence would have been ruined by a 20-word limit!
But is this applicable in medical writing?
Yes. Remember those choppy sentences about head lice you had earlier read in this section? Compare that version with its original 40-word form:
Infestations of head lice (Pediculus humanus capitis) lead to social disruption by stigmatizing infested children and causing parental anxiety, loss of income because of the need to care for the child at home, and absenteeism from school or day care.
See how ideas flowed more smoothly in the long version?
And did you find the longer sentence more difficult to comprehend?
I didn’t think so.
5. Omitting pertinent details. Here is a sentence I would have written just a few months ago: “A 2015 study conducted on 114 men and women associated the daily consumption of 13-mL coconut oil with a 2-cm waistline reduction after 3 months.”
Sounds like an excellent support for the health benefits of coconut oil, right? What could possibly be wrong with that sentence?
Look closer: What was the study population’s mean age? What kind of coconut oil did they consume? Did they make any other lifestyle changes?
I used to skip details like those because I thought lay readers would not be interested in the nitty-gritties of a study.
But leaving out details such as these not only insults the intelligence of the audience but also shortchanges the readers and lets them down.
In this case, unrevealed to the readers, the study population had a mean age of 62 years. Therefore, the results are not necessarily valid for a 30-something mom looking to regain her pre-pregnancy figure.
What kind of coconut oil did they consume? It was extra virgin, so readers who incorporate this 13 mL into their diet by using it to fry their fish are likely to be disappointed with the results.
What about other lifestyle changes? “Patients were seen in a monthly basis at the clinical nutrition department of a specialized hospital where they received intensive dietary treatment with periodic phone calls to assess compliance.”
Did we hear that right? Their diet was modified, monitored, and if they didn’t comply (an awful word that all medical writers should avoid, by the way), they were taken out of the study.
In short, this 2-cm reduction didn’t necessarily result just from the coconut oil intake. In fact, some of those who just stayed on the modified and monitored diet without consuming coconut oil at all lost 2 cm as well. (However, the average loss for this other group was 0.2 cm only.)
As medical writers, we know that the content we create is seldom read for relaxation and entertainment. People read our work to solve problems that can usually be a matter of life or death.
It is therefore important that we provide them with the most complete and accurate information we have.
And while doing so, let us treat them with respect and talk to them as competent adults, not as four-year-old kids.