Medical Writing

Written Communication

Steps in Writing a Medical Paper

• Clarify the question– Know your purpose in writing- Why does it

need to be written?– Narrow the question. Be as specific as

possible.– Try to write the question or objective in a

single sentence.– Consider the audience. What will the

reader want to know?

Steps in Writing...

• Know requirements of publisher– Uniform Requirements for Manuscripts

submitted to Biomedical Journals (JAMA 1993)

– length, format, number of copies etc.

• Use best relevant literature– Use studies that address question

• Be: Up to Date, Accurate, Thorough

Steps in writing….

• Begin writing.– Use techniques to let reader know where you are

going. – Use the three main parts of a paper:

• Introduction/Background• Body of the paper. (Use headings/subheadings,

enumerate; state your conclusion or main idea in the 1st sentence of the paper, section or paragraph.)

• Conclusion: summarize you recommendations. Remember what your audience is looking for, support your conclusions by info presented in body of paper

Styles of Writing- Pure Technical Style

• Pure Technical style– Used by business or technical professionals

addressing other professionals in the same field– Most common style by RPh’s when writing for

publishing• Characteristics

– Technical language– Written in formal English– Written in 3rd person– No slang, No contractions

Styles of Writing- Middle Technical Style

• Middle Technical Style– Used by professionals addressing professionals in other

fields or mixed reader audience– Examples: a Dept QA report, P&T Comm. Report read by

others outside of pharmacy.

• Characteristics– Not quite so technical– Written in 3rd person– No slang– Very little use of contractions

Style of Writing- Popular Technical Style

• Popular Technical Style– Used by professionals addressing lay people– Examples: Writing for Reader’s Digest, a senior center

newsletter, a patient information sheet,etc.

• Characteristics– Common language– Written in 3rd person– No slang– No abbreviations, acronyms unless explained

Common Pitfalls in Medical Writing

• Use proper grammar and spelling.• Keep things simple and direct-- BE CONCISE• Avoid:

– abbreviations, acronyms– writing in the 1st person– slash construction (he/she, him/her)– contractions

• Avoid qualifier, hedge or waffle words:– Indicate, suggest, appear, may, might,

conjecture, theory

Write Plainly

• Use– About– Symptoms– Before– Method

• For– approximately– symptomatology– Prior to– Methodology

Avoid Jargon and Abbreviations

• Avoid: “tubed”, “scoped”, CNS, IV drip.

• Don’t create new jargon: Dilantinized, atropinized, beta-blocked.

• Write concisely– Avoid phrases ending in “of”.– Avoid phrases beginning with “It was..”or

“There were…”

Be Concise

• Delete unnecessary introductory phrases. – The word “that” is a suitcase word. It carries

along 5-6 excess words. “It is interesting to note that…” It should be remembered that…”

• Eliminate unnecessary words or phrases• The dose is in the range of use about• In order to use to• A period of ten days use ten days

Avoid redundancy, Be Precise• Avoid redundancy

– Green in color– Human volunteer– still remains– Because of the reason that

• Combine short sentences when possible• Be Precise. Brevity and conciseness do not

supercede clarity– “The patient was beta-blocked”. Instead use: “We

readministered beta adrenergic blocking agents..– “Calcium blocker”. Instead use: “Calcium channel

blocker”.

Actual Medical chart notes…….• “Patient has two teenage children, but no

other abnormalities.”• “On the 2nd day the knee was better, and then

on the 3rd day it disappeared.”• “Discharge status: Alive, but without my

permission.”• “The patient has no previous history of

suicides.”• “Patient has chest pain if she lies on her left

side for over a year.”• “The patient has been depressed since she

began seeing me in 1993.”• “Skin: somewhat pale but present.”• “She is numb from her toes down.”

Safe Drug Information Writing• Always put space between a number and its

units.• Don’t put periods after the abbreviations mg or

ml.• Correct Incorrect Incorrect• 10 mg 10mg 10mg.• Avoid using abbreviations (5FU, CPZ, PBZ, MTX)• Don’t write Q.D., it may look like QID.-- use QD-

“q day” or “daily” is best• Don’t use 6-mercaptopurine-- use

mercaptopurine to avoid 6-fold overdose• Do not use apothecary system or symbols

(dram, grain.)• Do not use ug for microgram. Use mcg.

Safe Drug Information Writing

• Never place a decimal and a zero after a whole number (2 mg is correct, and 2.0 mg is incorrect)-- can cause a 10 fold overdose!

• Always place a zero before a naked decimal (0.5 ml is correct, .5 ml is incorrect)

• Never abbreviate the word unit. The handwritten U or u, looks like a 0 (zero), and may cause a 10-fold overdose error.

• Be very careful using IU for international units. It can be mistaken for IV. Write out or use int. units

Safe Writing

• Don’t write “nitro” drip-- could mean nitroprusside or nitroglycerin drip

• Don’t use slash (/) marks-- write “per”

• Be careful with MSO4 and MgSO4

• A.U. and O.U., A.S., O.S., A.D., and O.D. can easily be misread

Dangerous Drug Abbreviations

• Drug Means Misinterpretation• CPZ Compazine Chlorpromazine• HCT Hydrocortisone Hydrochlorothiazide• MTX Methotrexate Mitoxantrone• TAC Triamcinolone tetracaine,adrenalin,cocaine

• TIW 3 times/week 3 times/day• Per osorally for left eye• DC discharge discontinue• AZT zidovudine Azathioprine• x3d for 3 days for 3 doses

ss sliding scale insulin “55” units of insulin

Prescription writing…..

• A woman in Arkansas brought her baby in to see the doctor, and he determined right away the baby had an ear ache.

• He wrote a prescription for ear drops. In the directions he wrote, “Put 2 drops in right ear every four hours” and he abbreviated “right” as an R with a circle around it.

True story continued….

• Several days passed, and the woman returned with her baby, complaining that the baby still had an earache, and his little behind was getting really greasy with all those drops of oil.

• The doctor looked at the bottle of ear drops and sure enough, the pharmacist had typed the following instructions on the label: “Put two drops in R ear every four hours.”

Doctor’s Handwriting….

• A newspaper article reports…

• “Doctors at a hospital in New York have gone on strike. Hospital officials say they will find out what the doctor’s demands are as soon as they can get a pharmacists over there to read the picket signs!”

Referencing

• Cite all direct quoting, direct sentences lifted from article; also cite phrases or ideas taken from another’s work even if you changed the phrasing or wording slightly.

• Cite all lab results, charts, graphs, statistics.

• Cite the reference you took your information from, if that information is also referenced to somewhere else.

Public Domain Information

• Public domain information is usable without asking permission from copyright author but it should still be referenced.

• Public domain information is:– Drug name, common dose, side effects,

interactions, toxicity symptoms, etc-- things that are in the package insert from the manufacturer--- use it but still cite reference for it.

Referencing• Medical writing uses Endnotes technique

• The first article referenced in your paper is reference #1 in your bibliography. The 2nd article referenced is #2 in your bibliography, etc.

• The number is in Arabic numerals (1,2,3) and superscripted at the end of the referenced part.

• Bibliography-- 1,2,3,etc. (numerical order not alphabetical)