It was almost easier to identify the things that work against good writing.

And so here is a short list of key reader turn-offs and solutions compiled from some masters of good writing:*

1. Too academic, wordy, or abstract

Your text has many repetitive statements, redundancies and obscure points.  Passive voice bogs down the flow and makes for a dry and remote presentation. References and notes are over-used.

Solution: use active voice, stay real and don’t over-qualify everything you write.

 2. Too technical or instructional.

Your colleagues may understand what you are saying, and you may think it shouldn’t take an Einstein to understand you, but the average reader needs your lexicon of terms translated into simple English.  The text feels remote and ignores the fact that there is a reader.

Solution: Incorporate examples to ground what you are saying.

  3. Not original, too vanilla.

It’s already been said better by others. Your text may have some excellent points but you need a new angle. Or the material is flat and needs some lights, camera, action!

Solution: Use a little drama to retain your reader’s interest. Also, less is not necessarily more. Good writing uses anecdotes, examples, and illustrations.

4. Not convincing, unclear or poorly developed.

The text is full of faulty logic or incomplete transitions and explanations.  Or there is subject and verb dysfunction. This leads to confusion about who is doing what to whom and undermines credibility in the veracity of the text.

Solution: if you don’t believe in what you’re writing, neither will your reader. Text needs compelling examples to back up concepts and keep reminding the reader of the main points you are making.

You can avoid these turn-offs by creating an outline. A great place to start is right here.

*3 masters of good writing

Arther Plotnik Elements of Editing

Bill Stott Write to the Point

William Zinsser On Writing Well

Anne Lamott Bird by Bird: some instructions on writing and life 

A recent conversation with a market research acquaintance, who uses ethnographic and other qualitative research methods to collect data about how people take care of their bodies, turned to the topic of writing and publishing. There’s a lot of writing and publishing in the academic world of market research, but less so among on-the-ground researchers.

I’d say this is also true for CME practitioners.

I wonder why is this so, because when people are doing interesting, thought-provoking work – and there are many in the world of CME and CE – I get excited about it and always ask, “Are you planning to write about your discovery/experience/insights?”

The answer is invariably “no”, because most people don’t think of themselves as writers. Or at least as writers of something longer than a blog, an email, or a grocery list – say like an article, a journal manuscript or even a book.

Sometimes, that’s because people don’t think they have anything to say (they think it’s been said before, or other people say it better) and sometimes it’s because they simply  don’t know where to start.

CME Communities of Practice

The practice of CME is changing. In order to create and sustain communities of practice, there is a need for CME practitioners to share their expertise in ways that can be collated, archived and retrieved over time. For those of you who want to write about your CME work for publication but don’t know where to start, here are some ideas.

• Think about who you want to reach – this is key to the story you will eventually tell and the way you will tell it.
• If you want to speak to an academic audience, do you envisage an audience in a particular discipline (e.g. medical or nurse education) or across disciplines (e.g. social scientists who conduct research on health and/or education)? The British Education Index publishes a free access database of electronic literature that focuses on educational research, policy and practice.
• Although many journals are targeted to practitioners in a particular discipline, there has been growth in cross-disciplinary journals that makes it easier to reach interested others (educators? healthcare practitioners?) without getting too caught up in specific disciplinary debates.
• You might decide you want to reach a more hands-on audience – people who are doing similar kinds of work you have been doing who might be interested in your substantive or methodological issues. In which case, a trade publication is usually a better bet. Global Education Group lists several on its website.
• And you don’t need to be an academic to write for an academic journal. While such journals focus on scholarly work, not all are peer-reviewed and many offer the chance to write a well researched (scholarly) review article. A good place to start searching for relevant titles is Science Gateway, which provides information on journals by discipline and impact factors.

Coming Up

In the next 2 blogs, I’ll share tips on how to narrow your topic and craft an outline to guide your content development and what to do if you submit an article or paper to a publication and it is rejected – or worse, you’re asked to revise and resubmit.

My publisher, Polity Press, asked me to revise the book for a second edition. It sells pretty well and it’s straightforward approach marks it as an accessible teaching resource in a field that can be obscure, arcane and overtly abstruse. All good. Except that I’m no longer working in an academic context.

Now, that’s not a bad thing. Although I no longer have my finger on the undergraduate sociology student pulse, I’m still curious about the role the human body plays in establishing and maintaining our relationships, about how our size, shape, smell and bodily conduct creates a certain vantage point through which we experience and sense the natural and social world, and about the work we do to constrain, contain and control our bodies and their various functions.

I was reminded of the importance of vantage point recently in a conversation with a researcher who’s been doing some work on intimate hygiene (a euphemism for the ways in which we keep our intimate bits and bobs clean and fresh). She drew my attention to an advertising campaign launched in New York in 2008 by a Japanese manufacturer of bidets – warmed toilet seats with bidet that sprays hot water from underneath and dries with air.

A billboard ad in Times Square in New York featured the images of 6 naked people seen from behind, with their buttocks covered with a wide white bar. The company, Toto, also launched a Web site titled Clean is Happy, featuring the image of naked buttocks with smiley faces. The Asia Media Archives comments that ‘the original billboard ad would have featured naked buttocks, but it decided to run the covered version after a local church complained.’

I guess there are no surprises there. Despite the availability of sexual imagery in Western culture, there’s still a rather puritanical streak running through Anglophone veins that makes it challenging to talk about or draw attention to the non-sexualized human body. The body stripped bare. The one that breaks down, breaches social etiquette (makes noises, leaks and smells) and that, in highly individualized cultures, may be experienced as distinct from others, rigidly bounded.

Perhaps the boundaries between bodies, the ones that make it difficult to reach out and touch others, reinforce the sense of disgust and embarrassment that accompanies our experience of being embodied, and makes it difficult for those who are Westernized, and highly individualized, to openly acknowledge the vicissitudes of embodiment.

Like bidets and buttocks.

Phones have become taken-for-granted as tools of communication (or, as Marshall McLuhan put it, irresistible intruders in time and place). But do we really think about how we can make them work for us, especially when it comes to building relationships?

As writers, who by default often prefer solitude to sociability, we might be wasting opportunities for generating business and maintaining relationships via the phone.

Why?

Because we fail to understand that clients and colleagues make judgments about credibility and trustworthiness based on what they hear in our voices.

Email

The ubiquity of email is one reason that writers can be phone-phobic. When we write emails to prospective and current clients, or to faculty and colleagues, we have time to think about what we want to say (though we may also make plenty of communication bloopers with email).

Unlike writing text, we can’t edit as we’re speaking on the phone. Yet voice tone, inflexion and speed can give away our feelings and the real-time demands of the phone mean that we have to think on our feet to meet caller needs.

This isn’t easy.

Voicemail

The collective experience of automated voice answering has also contributed to jaded feelings about using the phone. Voicemail invites us to communicate with a machine rather than a real person in real time and in doing so, engenders hostility and anxiety—precisely because it represents a kind of manipulative interaction. I like the way Gary Gumpert, Professor Emeritus of Communication Arts and Sciences at Queens College, City University of New York puts it, that voicemail, or the diabolical machine’s egalitarian premise is that anyone can be reduced to thirty seconds.

No one wants to be reduced to a 30 second interjection. Yet we often end up being brisk, emotionally disconnected and ‘business-like’ when talking on the phone.

Why so?

Bodily cues

When we talk on the phone, we’re missing a range of rich and complex facial and bodily cues that helps us along in face-to-face communication. Take gazing, for instance. Looking at the other person when we’re talking face-to-face helps to regulate turn taking and sense the mood of the person we’re talking with. But when we’re talking on the phone, it’s harder to know when it’s our turn to speak. And though we might pick up a caller’s mood, it can be more difficult to gauge our contribution to it.

In fact, we’re missing out on that whole sense of physical presence and experience, or what psychologists call cuelessness.

Cuelessness

Cuelessness—the absence of contextual information—makes us feel distant psychologically and may also have the effect of shutting down out bodies. We become physically tense and slump over the desk, which limits voice range and tone. Consequently, we can adopt an informational, deliberate style of speaking that is task oriented and depersonalized, that sounds more scripted than spontaneous.

So phone calls can become instrumental exchanges of information rather than conversation. But more than this, talking on the phone can, paradoxically, cause us to become inattentive to our callers. We simply miss much of what our callers are saying because we’re inattentive.

When we’re on the phone:

• Our minds wander (what’s for lunch?)
• We can become distracted (e.g. doodling)
• We focus on auxiliary activities (e.g. taking notes)

Warm and fuzzy

People love to hear a warm, friendly voice that sounds like it is smiling, so cultivating vocal warmth is crucial. But it’s not intuitive to convey warmth via voice when we’re missing facial and bodily cues.

Yet we can improve voice tone and sincerity, enhance our listening skills and in doing so, create stronger relationships with clients and colleagues. We can get better at sensing a caller’s mood

• developing speech styles that are affective rather than task-oriented
• modifying bodily posture to open up voice

To improve voice tone and sincerity, enhance our listening skills build stronger, more connected relationships via the phone, communications expert Bette Frick, PhD, The Text Doctor, advises the following:

• Always stand up when you’re using the phone to conduct an interview — a standing posture will open up and enlarge your voice
• Invest in a really great head-set – this keeps tension out of your neck and your hands free (you can be expressive even if there’s no one to see it, which will help to generate warmth)
• And remember that you’re talking to a person, with real needs and feelings.

The phone, after all, is a tool of connection.

How do you use the phone? I’m listening.

Audience is everything.

There is no such thing as audience.

These claims point to two important issues in writing: craft and attitude.

In terms of craft (attention to workmanship, technical detail and order), audience is everything. In terms of attitude, as William Zinsser notes in On Writing Well, there is no audience: relax and say what you want – or need – to say.

Well, OK. But in fact, many writers, perhaps especially medical writers, struggle with the idea of audience. Tom Lang, of Tom Lang Communications, argues that when writing doesn’t work, when a text is hard to read or poorly organized, it’s often because the writer isn’t writing reader-based prose. In other words, the writer isn’t writing with the audience in mind.

How can we write with a clearer idea of the audience in mind? How can we reliably determine the knowledge, opinions, needs, and wants of our target audiences?

We need to be able to imagine the audience, to create a picture of who our readers are, or likely to be, so that we can reach out from the text and connect with them.

We need to analyze the audience, to systematically ask questions that provide us with information that will help us craft our messages – be they grants, manuscripts or trade publications.

These questions are simple:

Who are you reaching out to?

What do they already know?

What do they not know?

What do they want to know?

What do they need to know?

And what, as Howard Becker puts it, does the audience need to know so that they will not misread or find what we say obscure or unintelligible?

In asking such questions, an obvious acronym can help:

• Analysis: Analysis means asking questions and acknowledging that writing, like most other activities, is a form of social practice – of making text – that requires us to engage, reflect and interact with others.
• Understanding: What does your audience already know about the subject? If you don’t know, find out, so you avoid repeating things that are obvious to your audience. If you can, ask sample members of your audience to read an early draft of your document.
• Demographics: Age, gender, ethnicity and education background influence how you present information. Knowing as much as you can about your audience demographics and cultural specifics will help you avoid writing in ways that have the potential to intimidate, patronize or alienate.
• Interest: Why are is your audience reading your document? Alas, probably because they have to. So make it as interesting as you can within the constraints of the document type, organizational style and reporting requirements. Technical reportage doesn’t have to be tedious to read. Really.
• Environment: Where will the document be read? Federal grants are read in a warehouse or hotel room over 2-3 days. It’s a pretty intense process that you, the writer, can make less intense by writing succinct prose in a digestible format that readers can easily scan.
• Needs: What does your audience need to know? Find out by asking questions – yes, reach out again to sample members of your audience and identify gaps in what your audience  knows.
• Customization: Are there specific things the audience might want to know that you can build into your document? Offer nuggets of information to surprise and please your audience. Use sidebars and pull-out quotes as emphatic take-aways.
• Expectations: What does the audience expect to learn from your document? In medical writing, audiences often need to learn information that will help them take some kind of action. So identify the actions you need your audience to take as a consequence of reading your document.

How are you writing to reach your audiences?

1. The intervention targeted a cluster of care practices rather than a single indicator of care
2. Government support – this was a Ministry of Health demonstration project (something to be said for publicly funded health care systems then – e.g. Scotland has several such flagship initiatives).
3. Identification of local champions to roll out the project
4. Focus on process-of-care measures rather than clinical outcomes
5. Telemedicine (to which ICUs are not new) to enable communication and engage ICU personnel among geographically dispersed sites
6. In-depth qualitative interviews to elicit information from participating staff on how the study was affecting local practice (process evaluation – an often neglected  component of improvement initiatives)

And at the start of a new year many of us feel that we need a change of direction in our work, or crave a new job. For writers, that could mean focusing on a different specialty, like medicine and healthcare. For scientists, or those with a clinical background, that could mean moving into medical communications.

But how to engineer such a change in direction?

Fortunately, there are many  useful resources, new and established, that can help you plan your change and plot your course into a new career as a medical writer.

Start with the American Medical Writers Association. On the home page, click on About Medical Communication for an overview of the kind of work encompassed in medical writing, the environments in which medical writers work and how to break into the field. For instance, you’ll find a collection of articles about exploring a career in medical communications that personalize some of the challenges and discuss the advantages of working as an employee for a medical communications or pharmaceutical company, or as a freelance artisan who makes a living through craftsmanship and knowledge (and is, incidentally, an emerging economic force, according to a report by Intuit).

Emma Hitt’s website provides links to articles – available for a small fee - that specifically target newcomers and career changers. You might also try From Academic to Medical Writer, which targets the Versatile PhD demographic and charts some paths specifically for those who want to move out of academia and into a non-academic setting, but still use their scientific knowledge in their work.

But my new BFF resource is an e-book by Nancy Monson and Linda Peckel called Just What the Doctor Ordered. Nancy and Linda, medical writers and sisters, wrote the book because people kept asking them how they got into medical writing. Although the book is very focused and practical, it also respects the degree of effort involved in shifting career direction and in learning the craft of medical communications.

In 120 or so detailed and well-organized pages, the authors describe clear routes into medical communications and offer practical advice on how to get the job done. Chapters are supplemented with observations from employers in different sectors about what they look for in medical writers, must-have resources and samples of different kinds of writing, and the book even provides a list of potential clients to get the novice started. All of these resources help to reduce the learning curve, which can rise steeply for the 2-5 years it takes to develop proficiency and expertise as a medical communicator.

As Nancy observes, when she began writing in the 1980s, there was little formal training available in medical communications. She learned on the job and became a sought after writer by ‘putting her feet to the fire’ and paying attention to detail – an essential skill for any medical communicator. While there are more opportunities for formal training now (including a Masters program in Biomedical Writing at the University of the Sciences in Philadelphia), what hasn’t changed is the need for medical writers, especially those thinking about a freelance career, to be self-motivated and willing to create their own apprenticeship.

The maps are available to help you plot your course – are you ready to change direction?

I’m fairly certain the authors of Demystifying Psychiatry would not agree with this assessment. Charles F. Zorumski and Eugene Rubin view psychiatry as a profoundly misunderstood discipline and lament the popular view—as Tom Cruise famously put it—that psychiatry is a “pseudoscience”. Eminent scholars both, at Washington University, St. Louis, Zorumski and Rubin are on a mission to explain to the lay reader the evolution of psychiatry into a biologically oriented specialty that, while firmly operating within the medical model, has increasingly integrated social and psychological treatments into its clinical paradigm.

Though the history of psychiatry is somewhat tortured by a string of treatments that have been co-opted for abusive purposes (e.g. lobotomy, or the use of anti-psychotic agents in the criminal justice system) and dodgy diagnostic categories (homosexuality was only removed from the Diagnostic and Statistical Manual of Mental Disorders, or the DSM, in 1973), the authors bypass such controversies and move straight to their principal focus: to lay out psychiatry as a valuable resource for a society with so much psychiatric disease. About a third of us suffers from mental illness at some point in our lives, and so, Zorumski and Rubin argue, it is important to know how such illness is going to be treated, by whom and what the likely outcomes are.

Demystifying Psychiatry is a clearly organized book in fifteen short chapters—with take home messages and illustrative case studies—that supports their mission. The early chapters detail psychiatric terms and offer a lexicon for patients and their caregivers. Chapter three tells us what psychiatric illness looks like and offers brief crib sheets of behavioral red flags, while chapter four describes what psychiatrists actually do, how they are trained and the multidisciplinary context they work in. In later chapters dealing with diagnosis and treatment, the authors do a thorough job of picking through the ambivalences of modern psychiatry (there are still no definitive tests to support diagnoses) and provide an overview of available pharmacologic and nonpharmacologic treatments, as well as developments in neuroscience and their implications for new therapies.

Yet the authors don’t shy completely away from controversies (such as the role of industry in driving pharmaceutical therapies and the enduring role of ECT) and are they unambiguous about the important part that families and patients—all of us—play in recognizing and managing psychiatric disease.

Although neither for the faint of heart—psychiatric disease can have a devastating effect on patients and families—nor for those interested in a more critical history of psychiatry, Demystifying Psychiatry nonetheless provides an invaluable and accessible overview of psychiatric care for the lay reader. In fact, it won first place in the American Medical Writers Association 2010 Book Awards (category: Public or Health Care Consumers).

The authors are realistic about how complex and challenging diagnosis and treatment of psychiatric disease can be, but optimistic about psychiatry’s capacity to offer good outcomes for patients through validated treatments and integrated, multidisciplinary care. Perhaps, then, psychiatry is not as slippery as it once seemed.

*Scottish term for catching trout by hand (i.e. slippery and near impossible).

Late-breaking clinical trial data is, well..late-breaking, which means that as the writer, you can’t second-guess content. And if you don’t know what the trial data are going to focus on, it’s going to be difficult to identify clinical gaps.

But there is a work around.

Say you’re working on a needs assessment to develop a grant for a CME activity in oncology. Let’s say the activity will focus on targeted therapy in colorectal cancer and be based on emerging data from late-breaking clinical trials presented at an annual meeting, though you don’t know which trials. And if you don’t know which trials, you can’t possibly know what the late-breaking presentations are likely to focus on.

But there are some things you do know and from which you can extrapolate.

You know the therapeutic area (oncology). You know the disease setting (mCRC). And you know that your client wants to develop a grant to fund an education activity about emerging data on targeted therapy.

1. Start by identifying which clinical trials are ongoing in this area (search www.clinicaltrials.gov). Use this information to get a sense of the key researchers and the hot research topics.

2. If you have access to expert faculty, ask them what the hottest research topics are in the field you are focusing on and who is expected to present trial data in the next 3-6 months (or whatever your time frame is). This information will help you narrow down the relevant practice gaps.

3. Search meetings and conferences that oncologists attend to see who has been presenting trial results on targeted therapy in mCRC and what their particular focus is. You may be able to spot trends in who has been regularly presenting and what their focus is.

4. Use this information to research gaps in clinical practice broadly around the areas in which clinical trials are ongoing. For instance, if your research reveals that KRAS mutation testing is a hot topic, you might focus on looking for practice gaps around adherence to testing guidelines.