Harvey B Simon
The Write Stuff: How Good Writing Can Enhance Patient Care and Professional Growth
Massachusetts Institute of Technology|Massachusetts General Hospital|Harvard University
life short said hippocrates art long human lifespan lengthened substantially 2400 years since father medicine wrote gains dwarfed explosive discoveries revolutionized art science medicine faced need master much scientific data surprising medical educators clinicians pay scant attention verbal written communication skills writing never displace molecular biology deserve attention respect believe writing important patient care professional communication educating public personal growth satisfaction timehonored first step patient care history physical listening patient acquired skill first step necessary sufficient1alpert js simple rules effective communication clinical teaching practice environmentsam j med 2011 124 381382abstract full text full text pdf pubmed scopus 3 google scholar next step reflect patients story organize relevant information construct coherent narrative writing narrative history active process good narrative complete compact organizing important medical events personal impact coherent story dispassionate nonjudgmental still capturing something personality characteristics make patient unique coherent narrative bring patients back life return charts months years communicate findings consultants providers act writing help understand patients plan approach clinical problems dont great novelist agree flannery oconnor said never know think read wrote indeed writing learning wellwritten narrative always important patient care gained urgency patients seek access medical records2zulman dm nazi km turvey cl et alpatient interest sharing personal health record informationann intern med 2011 155 805810crossref pubmed scopus 119 google scholar sharing medical records bolster patientcentered care3barry mj edgmanlevitan shared decision makingthe pinnacle patientcentered caren engl j med 2012 366 780781crossref pubmed scopus 2172 google scholar building trust transparency allowing patients add personal perspectives call attention errors medical records also spark confusion fear anger4walker j levelle sg ngo l et alinviting patients read doctors notes patients doctors look aheadann intern med 2011 155 811819crossref pubmed scopus 162 google scholar good writing help minimize risks maximize benefits information sharing electronic medical records make information sharing easy efficient also introduce new barriers good communication5hartzband p groopman j recordavoiding pitfalls going electronicn engl j med 2008 358 16561658crossref pubmed scopus 141 google scholar new patients record begins blank page daunting forces clinician create original narrative though ability copy paste presents almost irresistible temptation cut corners importing another persons narrative understand time pressures lead many doctors copy paste existing narratives still urge resist shortcuts prevent digesting synthesizing patients story also may enshrine errors crept record pitfalls digital technology limited copyandpaste applications templates make easy comply mandates thirdparty payers introduce observations may credible read cardiac consultant finds mutual patients pupils equal round reactive light accommodation suspect waste time brainpower minor mendacity neither builds confidence import reams laboratory data clicks mouse many electronic records become burdened reports irrelevant distracting thinking laboratory results radiology reports colleagues clinical pathology radiology could enhance patient care presenting findings patientfriendly formats consult notes whether digital handwritten present particular challenges effective clinical communication1alpert js simple rules effective communication clinical teaching practice environmentsam j med 2011 124 381382abstract full text full text pdf pubmed scopus 3 google scholar doctors request consultations get varying degrees practical help specialty education reassurance good consultant provide 3 proportion needs desires requesting physician every case though consultant strive clarity brevity instead dazzling erudition one important things learned infectious disease fellow came attending told keep simple simon another infectious disease attending set benchmark would impossible duplicate todays highly regulated environment crusty senior internist asked us nonacademic consultation answer 3 questions patient tests order antibiotics give reply colleague wrote simply 1 virus 2 none 3 none days good writing promote good patient care acquired skill table 1 offers tips may helptable 1tips clinical communicationwrite pride write patients read charts sooner later willbe concise clear complete exhaustiveuse everyday language avoid acronyms abbreviations jargon unnecessary technical termsavoid stilted formulaic words phrases patients men women males females patient good poor historian historian better worseget personal patient name use mrs jones tells patient claimswhen appropriate incorporate direct quotes patientbe descriptive discreet note mr smith forceful aggressive forgetful demented patient displays seductive behavior capture simply noting chaperone present throughout examinationmake electronic records useful copy paste create narrative use templates honestly sparingly defeat digital diarrhea editing reports deleting obsolete irrelevant dataproofread edit particularly important dictations use voice recognition software errors sometimes amusing always distracting sometimes dangerousfocus essentials especially consult notes lettersuse relevant communication tips table 2 open table new tab good writing promote good care helping physicians understand patients organize clinical information communicate effectively providers believe writing also help patients allowing express feelings may enhance wellbeing belief based personal experience psychological distress randomized clinical trial focusing physical symptoms6smyth jm stone aa hurewitz kaell effects writing stressful experiences symptom reduction patients asthma rheumatoid arthritisjama 1999 281 13041309crossref pubmed scopus 623 google scholar first witnessed healing potential writing father died stepmother shattered brilliant articulate woman within matter weeks mom began deal loneliness loss writing letters dad knew full well letters would never read much less answered act expressing feelings writing helped enormously past 25 years ive recommended similar strategy many bereaved patients ive never tallied results substantial number people accept idea appear benefit anecdotal experience suggests writing letters keeping journals help people across wide educational socioeconomic spectrum 1999 trial conducted systematic evaluation emotionally expressive writing6smyth jm stone aa hurewitz kaell effects writing stressful experiences symptom reduction patients asthma rheumatoid arthritisjama 1999 281 13041309crossref pubmed scopus 623 google scholar study evaluated communitydwelling patients welldocumented asthma n61 rheumatoid arthritis n51 undergoing medical psychological evaluations volunteers randomly assigned spend 20 minutes 3 consecutive days writing either stressful experience lives experimental group n71 emotionally neutral topics control group n41 disease activity evaluated intervention 2 8 16 weeks afterwards interval participants rated health status patients asthma underwent spirometry patients rheumatoid arthritis evaluated rheumatologists know whether patient experimental control group compared patients wrote mundane topics wrote stress demonstrated statistically significant improvements asthma 2 4 16 weeks contrast emotionally expressive writing appeared reduce rheumatoid arthritis activity 16 weeks 471 experimental patients versus 242 control patients met criteria clinically relevant improvement p001 relatively small brief study nave hope expressive writing could ever replace betaagonists diseasemodifying antirheumatic drugs study needed writing may benefits similar forms emotional expression patients medical well psychological problems department chairs medical school deans may roll eyes denial academic imperative contain germ truth whether writing grant preparing manuscript good writing important success communication skills also crucial oral presentations us develop personal style voice us benefit simple guidelines apply settings diverse international meetings patient care conferences talks community groups writing publication elite scientific journals mass circulation magazines table 2 offers tips may helptable 2tips professional communicationwhen choice pick topic interests even subject assigned find aspect excites enthusiasm infectious boredomknow audience physicianscientists speak also communicate students patients community groups even children tailor tone language level detail readers listenersrespect audience never talk people however unsophisticated young try show smart youre likely seem stuffy best arrogant worsttell story every communication beginning middle end use beginning explain topic important interesting audience outline plan get started material complex lengthy remind audience youre taking go along conclude brief summary key points note areas deserve studyuse direct clear language conversational tone avoid jargon inflated language 10dollar words cleverlytitled paper documents pitfalls inflated language7oppenheimer dm consequences erudite vernacular utilized irrespective necessity problems using long words needlesslybehav sci 1985 77 199214google scholaruse active voice obtained samples patients samples obtained patientsvary sentence structure beginning writers always put subject first variety however hallmark engaging writersavoid redundancy useful even important emphasize key points restating appropriate places never wise repeat minor obvious information avoid repetition redundancy repeat eitherminimize echoes refer people advance medical knowledge scientists investigators workers researchers instead repeating single identifier clinicians called physicians doctors cliniciansthink manuscript look use subheads short paragraphs bulleted lists graphs illustrations appropriate concise possibleuse visual aids oral presentationsbut make clear legibleuse humor suits voice style appropriate tasteful gonococcus may worth chuckle meningococcus may notproofread use software check spelling grammar true errors may still crop sloppiness dagger heart credibilityacknowledge others thank mom every time boot hide achievements rock still weve learned mentors benefited collaborators whenever appropriate use humble instead selfaggrandizing ipractice oral presentation seek editing writing ask feedback whenever possible matter good better next time open table new tab finished fellowships knew clinical medicine would challenging thought major tasks would diagnosis therapy weeks practice though recognized third challenge informing motivating patients always crucial element good care important ever era shared decisionmaking8stiggelbout van der weijden de wit mpt et alshared decision making really putting patients centre healthcarebmj 2012 344 e256crossref pubmed scopus 650 google scholar whether call compliance adherence cooperation good clinical outcomes depend active participation patients often concert family members multiple interventions needed enhance adherence9steiner jf rethinking adherence ann intern med 2102157580585google scholar many patients benefit clear specific written information low health literacy presents barrier understanding medical instructions drug information one reason low literacy associated increased mortality10bostock steptoe association low functional health literacy mortality older adults longitudinal cohort studybmj 2012 344 e1602crossref pubmed scopus 390 google scholar individual practitioners cannot correct educational socioeconomic problems limit literacy tailor communications patients abilities11raynor dk health literacybmj 2012 344 e2188crossref pubmed scopus 11 google scholar doctors transformed gods guides growing number physicians strive provide medical guidance public large first embarked consumer health writing 1970s dearth physicianauthored material relatively easy reach readers digital age easier get platform much harder cut blizzard medical chatter connect community many webbased sources incomplete frightening misleading responsible consumer health information important ever trained read understand scientific literature physicians ideal position interpret data public media reports written journalists often rely press releases issued health care organizations medical journals incomplete press releases contribute inaccurate articles lay press12schwartz lm woloshin andrews stukel ta influence medical journal press releases quality associated newspaper coverage retrospective cohort studybmj 2012 344 d8164crossref pubmed scopus 109 google scholar turn spin press releases often traced back spin conclusions presented abstract section medical journal articles13yavchitz boutron bafeta et almisrepresentation randomized controlled trials press releases news coverage cohort studyplos med 2012 9 e1001308crossref pubmed scopus 189 google scholar physicians write scholarly publications sure abstracts articles contain balanced responsible conclusions doctors write public read digest medical literature carefully would writing peerreviewed journals scholarly texts table 3 lists common pitfalls avoidtable 3writing public common pitfallsnot identifying duration study composition size study populationinferring causality observational studiesreporting relative risks absolute risksreporting statistical significance without clinical significance insignificanceomitting side effects negative aspectsomitting context including previous researchomitting conflicts interest potential biases including open table new tab writing public writing peers accuracy necessary sufficient tips table 2 apply writing audiences successful consumer health writing requires additional techniques first task capture attention readers article thats engaging instructive still engaging article thats instructive engaging algebra table 4 offers tips consumer health writingtable 4tips consumer health writingtell story begin lead capture attention explain topic important relevant try rely xxx leading cause yyy construct clear narrative arc middle story end clincher try rely conclusion find voice authentic conversational directidentify readers tailor tone medical sophistication target audiencerespect readers dont talk inflate importanceuse shorthand care exercise actually prevent heart disease simply reduce risk cardiac eventsdont sensationalize oversimplify dont hype article proclaiming new hope hopeuse personal anecdotes objective dataeliminate weasel words essentially use adverbs sparingly veryfavor short paragraphs bulleted lists dont fear compound sentences semicolons friendsdont snarky chiropractors people readers toosprinkle quotes appropriate shakespeare yogi berra among many notable quotablesremember words power dr alpert claims dr alpert says refer doctors statement different connotationsallow break rules long intentional fragments clichs infractions serve purpose open table new tab every practitioner writes course providing clinical care many physicians write scholarly publications doctors engage consumer health writing smaller number physicians made writing major part careers table 5 lists notable examplestable 5select physicianwritersclinical scientific writing lewis thomas sir william osler hippocrateswriting medicine public jerome groopman atul gawande siddhartha mukherjee oliver sacks sherwin nulandliterary fiction drama abraham verghese ethan canin daniel mason walker percy somerset maugham anton chekovpopular fiction michael crichton michael palmer robin cook sir arthur conan doylepoetry william carlos williams john keats open table new tab inspiring list intimidating one writers achieve level success physicians generally face even greater challenges people choose writing primary careers embark major writing project understand literary fame fortune long shots best remember serious writing add stress busy professional life winston churchill one brilliant successful writers 20th century said writing book begins adventure amusement soon becomes mistress master finally monster still something say need say writing add important dimension life writing teaching teaching learning grateful dr robert leibowitz reviewing manuscript offering helpful suggestions