Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

The Deadly Sins of Writing for Publication – Part III: The Sins of Verbosity and Poor Writing

As I detailed in part II of this series, authors used to publishing without putting in their best effort or bullying their way to publication over the advice of reviewers and editors can result in publications having lesser impact than they might have had with greater diligence. In this post, I address the sins of verbosity and poor writing. Both are endemic in writings by physicians.

 Although many medical schools claim to be looking for well-rounded students, most ultimately select matriculates who performed the best in undergraduate science and technology programs. In many cases, these programs are so demanding that students receive little exposure to liberal arts courses that would have provided opportunities to hone critical thinking, speaking, and writing skills. I view these skills as essential to developing careers focusing on politics, administration, and research. As a result, I frequently am confronted with manuscripts that are difficult to read. In extreme cases, the writing is so indecipherable, so wooden, or so wordy that even the best of editors can miss a valuable kernel of new knowledge and reject a manuscript that, if better written, might have been accepted for publication.

The Sin of Verbosity

For a fool speaks nonsense. - Isaiah 32:6

The point of any writing is to tell an important, instructive story as interestingly as possible. In doing so, accomplished authors employ a variety of styles. Indeed, one of the great pleasures of reading comes with appreciating the many different ways to successfully tell a good story. However, because space in medical journals is limited and because the attention span of most readers is limited, writing for publication in medical journals usually requires a greater economy of style than writing intended for many other types of publications. In this regard, there are two verities:
  • The manuscript should contain the number of words needed to fully express the content… No fewer, no more.
  • The attention span of most modern readers is brief; shorter articles are more likely to be read than longer articles.

The Sin of Poor Writing
You shall teach [these rules] to your children, talking of them when you sit in your house… And you shall write them on your door posts and on your gates.- Deuteronomy 11:20

It takes desire and practice to achieve the goal of economic writing essential to a publication reaching its full value. There is much more to learning how to accomplish this than I have space available, so I will proceed directly to what I consider most important:
  • Write short, direct, active sentences, using straightforward understandable language. 
  • Split long, complicated sentences into two — or sometimes three — shorter sentences.
  • When you have a choice of words that apply to what you wish to say, choose the simplest, most familiar word among them.
  • Avoid the passive voice.

Here is an extreme example of bad writing and how it could be improved:

Bad Writing: "Our machinations were intended to transmogrify simple sounding truths into concupiscent folderol for the sole sake of obfuscating meaningless tripe and thereby furthering the inevitability of our ascension to academic Valhalla."
Better Writing: "We manipulated the data for our own pleasure-seeking entertainment. We did so to reduce the possibility that readers would recognize the poor quality of our work. Our motive was to further our academic careers."

An especially wooden writing style overly relies on the passive voice. This style is endemic among authors who have been told by their elders that it is anathema in scientific publication to use the first-person pronouns, "I" or "we." As a result, their manuscripts are boring litanies, often no more interesting stylistically than an amateurish reading of the Kenosha, Wisconsin, phone book. While beginning active sentences with "I" or "we" may be a little better, an entire manuscript of this approach also is likely to prove tedious. Rather, a dedication to the active voice should breed more creative ways of getting across the message. Here is an example:

Passive Voice: "The images were blinded and randomized. The images were assessed by 8 readers for the presence of an abnormality. The data derived from the readings were entered into an Excel spreadsheet then analyzed for statistical significance."
Active Voice: "Eight radiologists interpreted the blinded and randomized images. I entered the resultant data into an Excel spreadsheet, which formed the basis for the study statistician's analysis."

Good writing for scientific publication requires education, training, and, above all else, practice. Many busy physicians may make the decision that good enough is, in fact, good enough. However, in my opinion, more successfully transmitting the knowledge you wish to impart when you decide to write for publication is worth the effort.

Find more publishing advice in parts I and II of this series.


  By Bruce J. Hillman, MD, FACR, JACR Editor-in-Chief, from the Departments of Radiology and Medical Imaging and Public Health Sciences, the University of Virginia, Charlottesville, Va.

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