Cultural competence and first-language rhetoric
Supporting an author who writes in English as an additional language means working across a culture as well as a language. What a retraction costs an author, why a paragraph that a native reader finds digressive may be good writing in the author's first language, and how a client from another culture phrases a request all shape both the working relationship and the editing of the text.
What cultural competence is worth to authors and clients
Personal relationships, guanxi, are a fundamental element of Chinese culture, and for Chinese authors internationally co-authored publications can enhance them. The loss of face, mianzi, that results from having an article retracted is devastating for Chinese authors, and writers who can protect authors from losing mianzi are highly valued. A well-chosen professional medical writer can help Chinese authors in a positive cycle that enhances their mianzi and guanxi. If authors and sponsors choose the wrong writer, such as one who is inexperienced, unethical or culturally insensitive, the cycle may be broken, and authors could lose mianzi, for example through a publication retracted for misconduct, and guanxi, through damaged relations with international researchers.
Issues of authorship, author payments, financial disclosure, audit trails, secondary publications, encoring, journal choices and sponsor involvement are not unique to China, but they can lead to disastrous outcomes in China and beyond if they are not handled in an expert and culturally sensitive manner. Writers who have appropriate experience and cultural sensitivity will find work on publications from China challenging but rewarding.
Writers who share a client's cultural and linguistic background are able to communicate more effectively with the client in their native language and to build stronger relationships with that client. For one native English writer who works with medical writers from Poland, this is an enormous asset: the Polish writers can communicate much more effectively and efficiently with Polish clients, and without that client interaction her job would become extremely difficult. Cultural sensitivities likewise come into play when interacting with Asian cultures, and by working closely with her Asian colleagues, who are more attuned to them, she can avoid unintentionally offending the client through cultural differences.
How the first language shapes writing
Language reflects a way of thinking and is shaped by the culture a person comes from and was brought up in. Language also influences the way people think, see and describe the world. Writing is a learned skill, and education systems around the world emphasise different approaches to effective communication. Learning the vocabulary and grammatical rules is one thing; switching one's mentality and expressing one's thoughts properly in a language that is by definition foreign is another. Improving one's writing is always a challenge, but for medical writers whose first language is not English it is often much more difficult. Complex concepts are difficult to express in one's mother tongue, let alone in an acquired language.
Preferred patterns of writing have been said to be genre-dependent, and this is particularly true of medical writing: much of its text follows a defined structure, and within that structure writers are allowed some creativity, which is where their culture comes into play. Thirty years of research has suggested a range of reasons for cultural differences in writing, and it has been generally agreed that the biggest influence comes from the four dimensions across which cultures are said to differ: individualism versus collectivism, power distance, uncertainty avoidance, and masculinity versus femininity. Contrastive rhetoric studies how a writer's first language interferes with writing in a second, through the writer's choice of rhetorical strategies and content. In 1966 Kaplan described native English speakers as having a linear thought pattern, speakers of Semitic languages such as Arabic and Hebrew as having a parallel style, speakers of Asian languages as having an indirect style, and speakers of Romance and Slavic languages as having a digressive style. His ideas have been developed further since, but the study highlighted that culture does influence writing. One editor from a Slavic language background sees in Kaplan's characterisation the reason she needs so many parentheses when she writes in English. These cultural differences do not hold for every piece of writing or every genre.
In English, the flow of an article, meaning the ease with which the author develops an idea and connects it to the next, shapes whether readers perceive it to be a good or a bad piece of writing. So if native-level English is the goal, improving the unity and coherence within and between paragraphs can significantly improve the flow of the final product. This linear style of writing, in which the logic between ideas is defined and explicit, is taught from an early age in the Anglosphere, and topical cohesion, or repetition of the topic subject, and the sequential development of an idea are thought to be markers of good English. Good writing in other languages does not always share these markers. Spanish speakers, for example, tend to write more elaborately than native English speakers, which results in some digression from the main argument and so less coherence, an editor's anecdotal observation that published work supports. This digressive style may be due to the far greater flexibility in word order that Spanish is said to have compared with English, which allows more creativity in composition.
The Italian education system encourages verbosity and creativity in style in all forms of text, in stark contrast to the Anglo-Saxon education system, in which succinct, logical essays are a must. In the experience of one native English writer who has lived in Italy for more than twenty years, Italians are on the whole gregarious, passionate, joyful and enthusiastic orators who can begin a story from any point in time and jump back and forth among events. An Italian surgeon's manuscript, rejected by a peer-review journal, did not follow a logical flow, was spoiled by numerous superlatives, was inconsistent in its facts and was unstructured, and she struggled to make out its key messages and the surgical technique until she asked him to tell her in Italian what he wanted to say. What he explained face to face was far from what he had written. His team had been the first in the world to treat ruptured abdominal aortic aneurysms with an endovascular approach, and once reworked to respect the structural guidelines of English scientific language, the manuscript is still celebrated as a core reference for an approach now commonly adopted. In the rewriting, however, the cultural nuances, some colour and a lot of passion were inevitably dulled in favour of clarity. The Danish linguist Otto Jespersen suggested that English is a "methodological, energetic, business-like and sober language, that does not care much for finery or elegance, but does care for logical consistency". The writer who has lived in Italy describes her role as assisting clients in a change of perception and thought processes to an English-based model, asking non-native speakers to see the world through a different lens.
Reading writing shaped by another culture
Understanding the differences between native and non-native English speakers matters for addressing non-native speakers' needs, and one editor suggests it also matters for native English-speaking writers and editors and for editors whose first language differs from the writer's. A reader's expectations have been shown to affect what is perceived to be straightforward writing, and a reader's own cultural expectations can lead to an unfair evaluation of a text simply because it differs from the style typical of the reader's native language. English speakers are apparently not the only readers who fail to appreciate cultural conventions: in a study published in the mid-1990s, Chinese speakers who evaluated an English text written by a native speaker found it "insufferably redundant, cyclical, excessively detailed, forced and unnecessary".
A general awareness and understanding of cultural differences in rhetorical structure is important for an editor because it provides a framework within which to work, allowing the editor to interpret the author's intended meaning and then to help the author build the story for the intended audience. One editor whose early work was largely correcting the English of researchers whose native language was Chinese did not then fully appreciate the almost poetic way in which many of them wrote, or recognise that it was typical of good writing in Chinese culture. Now more aware, she still needs clarification from time to time, but rather than assuming the author's message is unclear, she understands that it is simply not clear to her, which is not to say it is unclear to others. For a writer or editor, native or non-native, being aware of one's own perspectives on writing structure can be extremely helpful in improving one's own work, and when revising a text this self-awareness may make potential points of confusion easier to identify.
Bringing writing to native-level English
For a writer or editor, striving for native-level written English is important to ensure clarity of message, particularly when the register needs to be formal or academic. Non-native English speakers, however, often use literary tools that a native speaker would not, and their non-traditional phrasings and word pairings often add richness to a piece of writing, so editors should appreciate and embrace them, as long as they do not impede or confuse the intended message.
Where the intent is to present a piece of writing as though a native English speaker had written it, one editor recommends the following strategies, which she has found particularly helpful:
- Read the work aloud, recording it, or talk the ideas through with colleagues or an editor. Many of the non-native English speakers she works with are more confident in spoken than in written English, and one of the most effective strategies she has found is to go through the planning process aloud. Getting the ideas in the right order is the first step, and the register can be changed from spoken English to a more formal written style later. Even for writers who think their written English is better than their spoken English, she has found that this process helps them identify the main points of their work more easily.
- Build the bones of the paper before writing, as a linear structure to work with. Note the topic of each paragraph, the data or arguments that prove or disprove the hypothesis or idea, the conclusions to be drawn, and how each paragraph will move to the next, then add the content to that skeleton.
- Once the piece is reasonably fleshed out, stop and revise for unity, coherence and balance, ignoring sentence-level problems for now. Ask whether each paragraph covers just one topic, whether its ideas are coherent, whether the whole piece is balanced, and whether the ideas are organised according to their importance.
- Make a final edit for grammar, spelling, formatting and referencing.
What clients from other cultures expect from a writer
In 2013 the pharmaceutical industry was changing rapidly, particularly in Asia, where researchers and pharmaceutical companies had to produce more and more documents in English, which spurred demand for translation and medical writing services. Customers who prepared these documents shopped internationally for translators, writers and editors who could meet their needs, and they expected the final product in clear, readable and appropriate medical and pharmaceutical English.
In a questionnaire of Japanese clients reported in 2013, 60% of respondents worked in the pharmaceutical industry, 17% in newspapers or publishing companies, 13% in research institutes and 10% in publicity or advertising agencies, and 67% had worked with native English-speaking medical writers living in Japan or overseas. The tasks these clients most often outsourced were editing and proofreading, translating into English, and preparing journal articles for submission. Respondents described good native English-speaking freelances or contractors and inadequate ones as follows:
- good contractors are speedy, reasonably priced, and able to work without errors and omissions; sufficiently skilled in Japanese to improve the wording rather than simply correct the grammar; and willing and able to read relevant reference materials in advance and to suggest useful phrases from them
- inadequate contractors produce low-quality work, delivered late or with many errors in numbers and content; communicate poorly, not making requested changes or responding to questions; deliver inconsistent documents, appearing to use multiple translators or returning deliverables with inconsistent terminology and corrections; and produce work that peer reviewers criticise as requiring proper editing
Fully 79% of respondents wanted translators and writers to produce high-quality writing that is easy for non-native English speakers to understand. Clients also most often wanted translators and writers to use simple English, to communicate requirements briefly and clearly, and to work harder to understand client requests. One experienced Japanese-to-English translator of pharmaceutical documents advises that translators and writers should strategically repeat words and phrases to ensure the customer clearly understands, and should remember that non-native English-speaking clients take longer to understand English messages. Asked about the greatest concern of non-native English-speaking customers, the questionnaire's presenter answered that customers value good communication with translators and writers, and that simple, straightforward English was, in 2013, increasingly appreciated in the global marketplace.
Drawing on extensive experience with Eastern European customers, one speaker holds that cross-cultural communication in written English can be difficult because English is less exact than some languages, and misunderstandings can arise if translators or writers fail to clarify a project's scope and requirements, for example by asking whether the end user wants the document rewritten and, if so, to what extent. The translator of Japanese pharmaceutical documents stresses the importance of verifying the customer's requirements by asking "What do you want, and when do you want it?" In her words, in Asia indirectness is an art form, and when a client says "Please take care of it" it can be difficult to know exactly what is needed, so the writer should restate, clarify, confirm and be more blunt. The speaker with Eastern European customers agrees, noting that it is also important to check whether the translator or writer has the flexibility to edit and make changes, especially if the customer might be unavailable for contact. She adds that using plain English is a good start for communicating with customers.