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ABC of Medical Writing: Language and Style in Scientific Communication

Amitabh Prakash*

^* Wolters Kluwer Health | Adis, Auckland, New Zealand.

Introduction

The ‘ABC’ of scientific communication stands for accuracy, brevity and clarity, that is, the data presented in every scientific manuscript should be accurate, concise and easy to read. While it is true that brilliant prose will not be able to salvage a fatally flawed research protocol, a poorly written manuscript can easily hinder the publication of perfectly good research. Therefore, it is essential for every researcher to be able to articulate their thoughts in a logical manner for their peers.

Before starting to write a scientific manuscript, it is helpful to consider the following questions:

• Why am I doing this? If you are unsure, it is highly unlikely that you will be able to convince the reader of the value of the research.
  
• What do I want to say? What is my message?
  
• Who do I want to say it to? Who is the audience?
  
• What is the best way to say it? (What format should I choose? Should it be a full research paper, a short communication or a research letter?)
  
• Where should I say it? Selection of the appropriate venue is of critical importance.

Professor Van Way has dealt with important aspects of good writing in the previous chapter and I will therefore focus this discussion on common pitfalls that I have encountered in the last decade as a medical writer and the editor of peer-reviewed journals. There are many books^1,2 and Internet resources^3–6 that offer detailed guidance for preparing scientific manuscripts and readers should consult those authoritative sources for a deeper understanding of the English language. The overview provided here is intended to serve as a quick checklist for scientists.

Style

Grammar

Sentence

A sentence must contain the minimum of a subject and a verb and also usually contains modifiers and words to complete the thought. Inserting too many thoughts into a sentence increases the word count and risks losing clarity, that is, at the end of a very long sentence, the reader will often lose track of the subject at the beginning. Although there is no recommended maximum number of words in a sentence, this author believes that 75 words is a safe upper limit.

Paragraph

Literally, a paragraph is defined as any string of text that follows a hard return and ends with a hard return. However, it is easier to understand the paragraph as a group of sentences (or, occasionally, a single sentence) that represents one thought or several related thoughts. Paragraphs are essential to break long streams of text and focus the attention of the reader. They should be long enough to ‘stand alone’ but short enough to hold the reader’s attention. If a single paragraph runs over the entire page (about 600–850 words in most peer-reviewed journals), it will almost certainly not be able to hold the reader’s attention. Researchers are encouraged to break the text into paragraphs to emphasise important points.

Parallel Construction

Parallel construction is often used to build a sentence or emphasise a point, and often relies on coordinating conjunctions, for example ‘either/or’, ‘neither/nor’, ‘not only/but also’ and ‘both/and’. It is important to remember that these pairs must appear together in the sentence and the words on one side of the coordinating conjunction must match corresponding words on the other side for clarity, for example they could go either to the lecture or to the laboratory.

Parallel construction also helps in presenting a series or making a comparison, for example Risk factors associated with transmission of hepatitis A include contact with infected individuals, homosexuality, intravenous drug use and travel abroad; military personnel, children attending day-care and persons in institutions are also at risk.

Subject–Verb Agreement

The subject and verb must always agree, but it is not uncommon to see a mismatch between the two. A singular subject must be accompanied by a singular verb and a plural subject with a plural verb. For example,

• The combination of these two drugs is effective in most cases.
  
• These two drugs are effective in most cases.

Punctuation

Comma, Semicolon and Colon

Commas, semicolons or colons are used to indicate a break or pause in thought, to set off material, or to introduce a new but connected thought. Commas are the least forceful of the three and are most commonly used to separate phrases, clauses or groups of words. Commas are also used to clarify the grammatical structure and the intended meaning.

The following are commonly encountered difficulties in the use of commas:

1. Insufficient use: Omission of a comma results in the reader having difficulty in understanding what has been written. For example, the following sentence needs a comma after ‘treatment’ to warn the reader that ‘subsequent attacks’ is the subject of a new clause: Intravenous foscarnet is superior to vidarabine in the management of immunosuppressed patients but relapse occurs rapidly after treatment and subsequent attacks in these patients may still be caused by resistant strains.

2. Superfluous use: A comma has been inserted where it is not required. Even if a sentence is long, it is inappropriate to insert a comma that interferes with the structure of the sentence. For example, the following sentence does not require the comma after ‘polymer’: So that daily injections can be avoided, a depot formulation in which 5 mg of the drug is dispersed in a biodegradable polymer, is administered monthly.

3. Misplaced parenthetical commas: These commas, which appear in pairs, must be placed on either side of the supplementary material. A quick test of whether parenthetical commas have been positioned correctly is to replace them with parentheses and read the sentence without the words in the parentheses. If the sentence still makes sense, the commas have been placed in the correct positions, for example broad-spectrum antimicrobial activity, especially against anaerobes, is an important factor in the selection of the appropriate agent.

4. Inadequate use: Commas have been used where stronger punctuation (semicolon or colon) is required. For example, the following sentence clearly requires a semicolon instead of the comma: This drug undergoes virtually no systemic absorption after oral administration, thus it is used primarily to treat infections of the gastrointestinal tract.

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