Better Physician Writing and Speaking Skills

Improving Communication, Grant Writing and Chances for Publication

John Gartland, Mithilesh Lal

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315342429
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This book covers the theory and practice of writing and speaking in professional settings for practitioners, educators and researchers in healthcare. A thought-provoking work, written by John J. Gartland, MD, Medical Editor at Thomas Jefferson University in Philadelphia and past president of the American Academy of Orthopaedic Surgeons, it will stimulate readers and change their perspectives on all forms of communication with their patients and colleagues. Uniquely, it also shows how to prepare an interesting, well-organized and well-written grant proposal to maximize the chances of obtaining funding. An essential resource for physicians and residents in all specialties, medical students, and educators and researchers, particularly those applying for research grants or wanting to publish articles. "Developing acceptable writing and speaking skills should be major goals for all physicians to attain because the very nature of the medical profession is such that few physicians can escape the need to speak and write in their professional careers. I share with you concepts and strategies about medical writing, medical speaking, and patient communication skills that have worked well for me over a long medical career. My hope is that these suggested communication and writing strategies will work as well for you as they have for me." - John Gartland, in the foreword.

Chapter 1

Physician Writing and Speaking Skills

Today, perhaps more than ever before, physicians need to improve their image in the eyes of the public. Some professional observers of the present medical care scene believe that today’s physicians seem more interested in the number of patients they can shuttle through their offices than they are in the number of patient cures they can provide. Today’s physicians are not regarded as good communicators by most patients. But it was not always that way.

During the nineteenth century the writer, Robert Louis Stevenson, described physicians as the flower of civilization, and it is instructive to speculate why physicians of that century may have deserved such an accolade. During Stevenson’s time medical science was minimal, medical technology was primitive, and diseases were rampant and frequently fatal. Yet, despite these almost overwhelming obstacles, physicians cared for patients with the limited resources available to them at the time. Their most potent weapon proved to be their ability to inspire their patients’ trust and confidence. This element of charismatic authority, which was wielded in a positive manner by physicians of those days, encouraged patients to help and heal themselves. For this, more than for their rather primitive medical skills, these physicians were regarded as humanitarians and, as such, were accorded Stevenson’s floral tribute. However, from the time when Stevenson bestowed this praise on physicians to the present time, his floral tribute seems to have wilted.

Society now tends to believe that today’s medical practitioners have, to a varying degree, lost sight of this idealism and professionalism, and have become to some extent a profession whose primary goal seems to be professional self-interest and financial return rather than the welfare of their patients. A lack of a warm, caring attitude of physicians toward their patients, coupled with their perceived overemphasis on the technological aspects of medical care, are the reasons most frequently given by society to justify their present assessment of physicians in general. Society now believes that physicians are well enough educated to address the health problems of patients and the treatment of specific disease states, but it also suspects that many present-day physicians are unable to deal with the patient as a person. Present-day society tends to believe that today’s physicians are poorly educated for providing the kind of emotional support that a patient often desperately needs when faced with a poor medical outcome.

In defense of physicians, however, it must be admitted that the current environment of medical practice in this country is unsettled because of interactions between the different objectives being pursued by the federal government in order to contain medical costs. Despite having the highest per capita expenditure in the world for health and medical care, the United States has neither the equity in access to health services nor the highest level of health compared with other developed countries. This has led to frequent disagreements between the medical profession, society and the government about how to contain the rising costs of providing health care in this country.¹ Attempting to gain control over the continuing escalation of health care costs has become a major focus of this country’s national health policy, as the available financial resources do have finite limits. These limits relate to the large federal deficit that is currently causing concern among the citizens of this country, which to a certain extent limits the amount of money available for improving the country’s present health care system.

Society has become increasingly concerned that it is not getting the best quality of medical care for the dollars it spends, compared with other developed countries, as mentioned earlier. Nor has it been lost on health policy decision makers that health service researchers have questioned the depth of the scientific base on which clinical decisions presently rest in this country. Variations in physician practice styles that are difficult to explain, relating to uncertainty in medical decision making and geographic locations of medical practice, have been identified. The scarcity of valid outcome studies needed to confirm the benefits of many of the treatments and surgical procedures currently used by physicians and surgeons has also been pointed out.

Medical care has gradually become a type of mutual participatory activity in which health care decisions are believed to be a responsibility that is properly shared between physicians and patients. This view makes it even more important that physicians begin to function as patient advocates and begin to practice more as teachers of patients and less as authority figures. To be able to teach patients adequately, physicians must be able to communicate with them effectively in order to elicit their cooperation in the management of their medical problems. Unfortunately, some physicians in practice tend to believe that they are too important, or too busy, to spend much time communicating with their patients. Those physicians who continue to cling to an outmoded “doctor knows best” style of medical care should not be surprised to discover, if they take the trouble to enquire, that their practices contain a large number of dissatisfied patients.

It is not possible to give excellent medical care to patients in a quick, easy or offhand fashion, or by delegating this physician responsibility to some other professional person. Patients want and need to discuss their medical problems and concerns with their physician of choice, and they have every right to expect that this will happen. Communication nightmares for patients can be avoided by teaching all of the medical office personnel involved, including physicians, the reasons for accepting their roles as patient advocates and patient teachers, and by structuring the clinical encounter and its environment in such a way that the primary goal is not convenience for the physician, but improved outcomes of patient care from the viewpoint of patients. The overriding goal of good physician-patient communication should be to improve the outcomes of patient care from the patient’s viewpoint.

There may be insensitive communication between physicians and patients for a variety of reasons, and the fault may lie with either party. Patients can be querulous, demanding, hostile, suspicious, exceedingly sensitive and highly dependent. However, a large measure of patient dissatisfaction and resentment arising from clinical encounters with physicians is due to physicians responding to these patient attitudes in a careless, thoughtless or insensitive fashion. Patting a patient’s hand and saying “trust me” hardly constitutes good patient communication. Regardless of origin, insensitivity on the part of physicians can be a major deterrent to the development of effective communication with patients. Those physicians who treat patients with respect and who have recognized the need to master the techniques of good communication skills are more likely to gather full and accurate information from patients, to dispense clear and persuasive information to them and their families, and to elicit the cooperation of patients and their families with the details of suggested patient management.

Most physicians are articulate, but many nevertheless find it difficult to communicate effectively with patients. Some find it difficult to choose the appropriate level of communication for carrying out effective communication interchanges with patients because they have never learned that a less specialized level of language can be just as correct, precise and appropriate, and also can actually facilitate communication with patients and others. However, attempts by some physicians to communicate with patients and others often confuse rather than simplify the communication exchange, and the reason for this is frequently the physician’s use of medical jargon, which patients very rarely fully understand. Medical jargon is a physician’s conversational short cut based on the arcane terminology of the medical profession, which is rarely comprehensible to listening patients. The word “jargon” has been identified as coming from Middle English, and its original meaning was “the twittering of birds.”² Skilled physician communicators do not need to use medical jargon, obscure medical terms or excessive medical abbreviations in their communications, because they know that their use severely limits understanding and wide dissemination of the information that is being conveyed to patients and to others.

Today’s physicians, in general, are blessed with and are trained in many technical skills. Unfortunately, effective communication skills and the ability to write clearly often seem to be missing from their list of abilities. Despite the personal nature of their professional calling and a better than average educational background, physicians as a group are frequently charged with serious deficiencies in their communication and writing skills. They have been accused of filling their written material with confused thought and ambiguity, ungrammatical and pretentious written constructions, and medical jargon, and a frequent tendency to pontificate when speaking and writing. Other cited shortcomings of physician communication include a tendency to write to impress rather than to inform patients, readers or listeners, and an overuse of technical terms to the exclusion of simpler words which would help to improve the understanding of readers or listeners. Inexperienced physician writers are frequently guilty of writing sentences with subject-verb discrepancies, misplaced modifiers, and unclear or missing antecedents for pronouns.

The communication tasks that may require writing skills which physicians carry out most frequently in their professional careers, in addition to dictating office or hospital medical records, include letters to referring and other physicians, patient medical histories and physical examinations, progress notes, discharge summaries, peer-reviewed medical articles and grant proposals. Physicians who wish to learn how to write well would be best advised to keep their written words and sentences short and to the point. For example, select the word “use” over “utilize”, as in the sentence “Local volunteers were used to build the playground.” Long and convoluted sentences are difficult for readers to follow and are more likely to bore them than to educate them. A particular aim of good medical writing is to tell a story, to provide a word picture, to persuade a reader, or to inform a reader about a particular piece of medical information that is being presented by the physician writer.

The basic purpose of physician writing is to communicate information of importance to patients, medical colleagues and other readers, and its intrinsic value lies in the message that it conveys, the questions that it raises, and the thinking behind the decisions that it announces. In medical writing for whatever purpose, the message conveyed by the writing must always be dominant. Medical writing must satisfy the reader’s need for information, not the physician writer’s need for self-expression. Good physician writers understand that effective writing skills afford them a unique opportunity for learning and teaching, and for persuading others. They possess a sense of audience which directs them to write from a reader’s point of view, and which enables them to keep the reader’s needs for information uppermost in their mind. In the long view, better physician communication skills and enhanced patient compliance with treatment recommendations depend, in great part, on the realization by physicians that producing competent and clear prose is part of the solution. Physician writers must learn to use the correct word for each writing situation, and would do well to remember Mark Twain’s words when he reminded us that “the difference between the right word and the almost right word is the difference between ‘lightning’ and ‘lightning bug.’”

Consider this sentence from a program abstract which appeared in the printed program for a meeting of a national orthopaedic organization: “To this date, however, there have been no published studies correlating gross intra-articular anatomy and the compartments of the ankle that can be instrumented under arthroscopic visualization.” The fact that there is no such verb as “instrumented” in the English language did not deter this physician author from coining a neologism. Writing and speaking are powerful and persuasive forms of medical communication, and physicians should be strongly encouraged to continually broaden and improve their skills in the techniques of both forms of communication so that they do not make such foolish mistakes in their writing efforts. It is also important for physicians to understand that each form of medical communication has different characteristics, because the written word is more formal than the spoken word. There is a need, therefore, for physicians to not only be aware of the structural and stylistic differences between spoken and written language, but also to understand and appreciate how each form of medical communication can be used most effectively. Physicians also need to think carefully about what they write in patients’ charts, in consultation reports, and in medical reports of all kinds so as to get the recorded facts in the correct order in the writing effort. Careful thinking beforehand about what is to be written allows the actual writing to emerge as a more or less mechanical act.

Physician writers, because of their inherent responsibility to readers to convey clear, concise and accurate information, can best fulfill this responsibility by using precise rather than vague terms, and concrete rather than abstract words to achieve clarity of expression and meaning. Clarity of writing usually follows clarity of thought, so physician writers must first think carefully about what they want to write, and then write it as simply and clearly as possible. In medical writing, as in medical practice, being “almost right” can be dangerous and could lead to inappropriate patient outcomes. Ensuring absolute accuracy when writing is an essential element of good medical care. Good physician writing reflects the physician’s ability to think logically, and physicians who learn good writing skills combine clear thinking with common language so that none of their readers will have any difficulty understanding the meaning of what has been written.

Language is the essential and perhaps the only medium by which information and ideas are transferred from one human mind to another. The first requirement of effective language is that it must be understood. The second requirement is that the information or ideas that are being transferred by the language from one person to another should not be distorted in the transfer process by factors such as faulty grammar, imprecise terms, poor word choice, disorganized sentence structure, or a writing style that is difficult to follow. The precise and accurate transfer of information by whatever means is selected is a goal that all physicians should embrace and constantly strive to achieve.

Good communication skills should be a required responsibility for physicians as professionals. Physicians need to have a clear and direct writing style, in addition to understanding exactly what they want to say, in order to be able to write clearly. In order to understand why a physician might write badly, it is necessary to look at a sentence and understand how it should work, how the ideas should be distributed through all of its different parts, and then be able to decide how to write it better. Physician writers also need to use language that is clearly understandable to readers. Impenetrable prose will impress only those physicians, patients and other readers who confuse difficulty with substance. Basically, the functions of medical writing are to tell a story, to provide a word picture, to persuade readers and to inform readers. It then becomes the obligation and responsibility of the physician writer to write clearly, without ambiguity, and with as much elegance and style as possible.

Many physicians never learned how to write clearly and effectively during their education. The very act of writing and rewriting helps physicians to clarify their ideas, to understand better what they want to say, to find the best way to organize their thoughts and their material, and to speak to the real interests and needs of their readers. The odds are poor that physicians who never learned to enjoy reading, and who have not read voraciously all their lives, will become good medical writers.³ Physicians who wish to write must first understand what they want to say in order to be able to write it clearly and concisely. Once physicians begin to understand their own ideas better, they will start to write more clearly and will begin to understand the need both in medical writing and in medical correspondence for a clear and direct writing style. Good writing in medicine requires economy, not wordiness. It also requires physician writers to know the meanings of all the words that they choose to use, and in addition to use only words that their readers will also understand. The clear communication of ideas and concepts is the natural climax of an intellectual pursuit such as writing in medicine.

Physicians who have committed themselves to the medical profession must also be committed to providing good data to patients and others through effective communication skills. The appropriate means of communicating important information in medicine continues to be the written word. Written medical articles that are deemed worthy of being published are visible signals that the work is important and deserves to be shared with others in a report that is well written and well received. This responsibility also implies that the physician writer understands their obligations to know all of the words that they have chosen to use, and also to choose words that readers will also understand. Physicians who wish to write well also need to familiarize themselves with accepted writing techniques - for example, not beginning a new sentence with the same noun that ended the previous sentence.

Good communication skills should be a required responsibility for physicians as professionals. Physician writing styles have no set rules except for those rules set by the requirements of grammar and by a basic understanding of the English language, which offers many alternatives to physician writers. What is required for good medical writing, however, is that physicians become familiar with these alternatives. Physicians who write must consider it their responsibility to know all the words that they decide to use, and also to choose words that their readers will know. Medical writing is not a game of one-upmanship, but rather it is a game of sharing of ideas with medical readers.

Medical writing that is unclear to readers and which does not transmit a useful message to them has very little value. Physicians who wish to write in medicine must always bear in mind when beginning to write that much of the general public does not believe doctors are good communicators. Despite the personal nature of medical care and the lengthy education required, the public often perceives physicians as having serious deficiencies in their communication, writing and interpersonal skills. It is, and will remain, the responsibility of physicians to prove the public wrong because writing, speaking and communicating are skills required of all physicians. The principal purpose of this book is to assist physicians in improving their skills in these required activities of professional communication.

Chapter 2

Good Physician Writing is a Communication Skill

The chief reason why physicians write in their professional careers is to communicate information of value to patients, colleagues and other readers, and its intrinsic value lies in the message that the writing conveys, the questions it raises, and the thinking behind the decisions that it announces. However, writing is more of an art than a science, and benefits as much from intuition as from logic. In medical writing for whatever purpose, the message conveyed by the writing must always be dominant. As mentioned in the previous chapter, medical writing must satisfy the reader’s need for information, not the physician writer’s need for self-expression. Consider the following sentence written by a physician in a patient’s hospital medical record: “Admitted with symptoms of congestive heart failure, she requested a private room so she could be alone and undisturbed, and her family was contacted about details of her past medical history.” This poor physician writer obviously had no con...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Preface
• About the Author
• 1 Physician Writing and Speaking Skills
• 2 Good Physician Writing is a Communication Skill
• 3 Technical Writing
• 4 Preparing to Write
• 5 Writing for Publication
• 6 Conferences and Talks
• 7 Grant Writing
• 8 Improved Physician Communication Skills
• 9 Improved Physician Interpersonal Skills
• 10 Physicians’ Voices
• Appendix
• Bibliography
• Index