Choosing the plain word over the impressive one
A long or impressive word chosen where a short, plain one says the same thing, and a word that adds nothing, are both repaired one word at a time: the word is replaced, cut, or tested against everyday speech.
Long words and their plain replacements
As a general rule, a short word is better than a long one, and a writer should resist the urge to use less familiar words. Sir Peter Medawar reckoned that people who write obscurely are either unskilled in writing or up to some mischief. A regular contributor to the BMJ held that the first and rarest quality is brevity, short words and short sentences, and asked why intelligent people, doctors among them, become imbued with verbosity the moment they put pen to paper.
A writer should not open a thesaurus and take the synonym with the most syllables, but should be precise with language. At a speech-crafting workshop, for example, a presenter defined enervate as to energise or excite; several participants knew that it means to destroy or weaken, but nobody could work out how to correct him tactfully, so the participants spent the workshop describing how a holiday or their children had enervated them. The trouble comes if one of them writes a follow-up note after a job interview and describes the interview as an enervating experience.
Orwell's rule never to use a long word where a short one will do can be adapted to phrases: plain writing replaces long words and phrases with short ones, which means deleting text and eliminating polysyllabic words: despite for notwithstanding, other for contralateral, do for perform or execute, treatments available for therapeutic armamentarium, and on for upon, where one writer has yet to find an instance in medical writing in which upon is better than on. Some polysyllabic words are also used incorrectly, as symptomatology, localisation, methodology and represents are where symptoms, site, methods and is are meant. Simpler words and phrases reward both the reader and the writer because they make the writing easier to read, and a two-syllable word such as render has no reason to stand where make will do.
Wordy phrases give way to single words in the same way: outside the normal range to abnormal, period of time to period, in a regular fashion to regularly, in consideration of or in view of the fact that to because, is indicative of to shows, were found to be to were, to come to an agreement to agree, except in a small number of cases or in all but a few cases to almost always, and is in need of to needs. Eliminating wordy phrases not only reduces the word count but also simplifies sentence structure and places less stress on the reader.
The choice among a verb's synonyms should follow the audience, and that often means the simple, common Anglo-Saxon verb over the long, fancy Latin one: she ate 2 apples rather than she consumed 2 apples. Because of the sight-word method of teaching reading, millions of Americans do not know how to sound out the long words they see in print, but they recognise many short, common Anglo-Saxon words without sounding them out, and even for readers who can sound words out, the short Anglo-Saxon words are easier to read: the client ran away from the group home rather than the client eloped from the residential mental health center. The National Institutes of Health urge medical communicators to use plain language and, when there is a choice, especially in writing for non-specialists, the common, everyday word. For this reason, writing for consumers can be a good discipline: it can help a writer learn to write simply and clearly, and writing for professionals may also become simpler and clearer as a result.
Words that add nothing
Orwell's rule to cut a word wherever it can be cut covers superfluous qualifiers, such as advance in advance planning, absolutely in absolutely essential and investigative in investigative research, and whole phrases: in conclusion or in summary it can be said that, the perennial statement that randomised clinical trials are required to confirm the results, and in order before an infinitive, which can always be deleted. Many superfluous qualifiers have become fixed phrases, in which the single word has been devalued so far that many people feel the qualifier is indispensable: completely resolved, time schedule, predict in advance, and even the pre- of predefined, preprogrammed and preplanned. Superfluous modifiers should be removed where possible, but an author who wants link qualified by together is not worth fighting, although the qualifier is not needed.
In the objective to explore Somalian new mothers' experiences with the Norwegian healthcare system and their experienced needs during the hospital stay and the postpartum period, healthcare system adds no information, experienced needs are just needs, and postpartum period is used confusingly, seeming to start after the mother came home from hospital, and needs no period. Where two words are synonyms in context, as function and act are in a sentence saying that skin, functioning as the body's exterior interface with the environment, acts as a physical barrier, there is no need to use both.
Many famous writers have claimed to hate adverbs: Mark Twain called them a plague, and Stephen King wrote that the road to hell is paved with them. Some adverbs, such as really and very, are typically used as meaningless intensifiers that can be deleted unless they are part of a technical term such as very-low-density lipoprotein cholesterol. Others express a meaning that some verbs already contain, so an expressive verb can often replace a verb and its adverb or adverbial phrase, glanced for looked briefly and sprinted for ran as fast as possible, for a livelier, tighter sentence.
Testing a word against everyday speech
Many troublesome words, the longer and less common words that medical writing tends to contain more than English fiction does, can be identified by asking of each whether, technical medical terms aside, it is one the writer would use in everyday speech. Not all such words are to be avoided, and many are good words when used properly.
Troublesome words are an indicator of poor style and often point to grammatical errors. An easy way to start improving a text is to look for them and replace them with shorter, more common synonyms. A term more precise than the common one is sometimes needed, but when an author was asked at a meeting why he had written were haemorrhaged rather than were bled, he answered that haemorrhaged seemed more scientific; bled is a perfectly good word, and haemorrhaged says no more about the process.
Counts of word prevalence have put numbers to the long-accepted impression that medical writers tend to use longer words, such as administered for given, less familiar ones, such as lethality for death, and less precise ones, such as address for ask, consider, answer and many other verbs. In those counts, a word's prevalence in medical writing was the number of PubMed titles or abstracts containing it in 1975 and 2010, corrected for the total number of English-language articles with abstracts, and was compared with its percentage of the Ngram corpus of English fiction in 1975 and 2008. From such quantitative analysis, lists can be drawn up of common troublesome words and of troublesome words whose prevalence is increasing particularly in medical English.
Troublesome words and their replacements
Novel means interestingly new or unusual, so it must be more than new, yet in medical articles it rarely means more and is often applied to things that are not even new: xenon, called a novel anaesthetic in a 2001 paper although its anaesthetic properties were described in the early 1950s; atelocollagen, called a novel treatment for perforated teeth in 2011, which might not have been used for perforated teeth before then but whose use in dental practice had been researched since the late 1980s; and video simulation, which was not even new when a 2012 paper called it novel. Improved technology had made xenon just about economical only recently, but that did not make it a novel anaesthetic. Between 1975 and 2010 the prevalence of novel in medical writing rose 18-fold, and it kept rising: 7.5% of titles or abstracts contained it in 2010 and 8.7% in 2015. Innovative, which means featuring new methods or original ideas, is another word to avoid, and its prevalence rose 12-fold between 1975 and 2010. Both words are better replaced by new, although most of the time even new is unnecessary: a title about novel trends in PET/CT technology loses nothing by losing novel. Novel is correct for a class of compound that is genuinely new, as the benzothiazinones for treating tuberculosis were when they were published.
Demonstrate should be reserved for an active illustration, such as a working model, an experiment in front of an audience or a computer simulation, and exhibit and display carry an unnecessary theatricality. Studies show; a correlation is shown; Crohn's disease has or shows marked clinical heterogeneity, or, alternatively, is clinically heterogeneous. Better still, the verb can go: studies have demonstrated a decline in prevalence of abdominal aortic aneurysm is sufficient with shown but better as abdominal aortic aneurysm is becoming less prevalent, and in it exhibits prebiotic properties, has is better than exhibits but better still is it is prebiotic. Phrases such as was shown to improve are common in medical writing, and in it exhibits prebiotic properties and was shown to improve mineral absorption the simple verb improves replaces it.
A study does not suggest anything, so a conclusion opening this study suggests can open the authors suggest or our results indicate, and one editor prefers the latter because it stresses that the conclusion builds directly on the results; indicate is the stronger word, but a can improve later in the sentence moderates it enough to keep the meaning. Influence is unspecific: the reader understands that it does not mean aggravate, so improve may as well be written.
Explore is a big word that is, in one editor's opinion, overused, and the editor often suggests clarify, describe or document instead. Surgeons really do explore, but medical scientists study or investigate, or, where that is what they did, measure. Revealed is an over-dramatic word, often used instead of showed, though it is apt for what surgical exploration reveals. Quantify and evaluate are imprecise: both imply forming an idea of an amount, number or value, whereas measure implies a standard for comparison, so an assay measures light chains and a study measures the effect of a solution on surface microhardness. Where no precision is required and the report is more general, evaluation or assessment is correct, as in the evaluation of a national programme or the clinical evaluation of new pharmaceuticals.
Option is a vogue word in colloquial English, but its prevalence has risen more in medical writing, 25-fold, than in English fiction, 3-fold, and by 2012 one paper in 50 contained option or options, more than two-thirds of the time in the phrase treatment or therapeutic option. A treatment option is a treatment, and effective pharmacological management options are effective drugs.
Perform carries connotations of performance and the arts, and did and done are the better words, but better still can be to remove the verb: matching performed at a group level becomes matched by group, executes double-stranded DNA cleavage becomes cleaves double-stranded DNA, executes its function means works, and the method executes on a laptop within seconds or minutes means the method takes seconds or minutes on a laptop.
Represents means to be entitled or appointed to act or speak for, and is correct of a group standing for five antenatal centres or of sensation represented in the sensory cortex. Otherwise represents is usually an indicator of poor style, often embedded in impenetrable abstracts, and mostly it means is. A percentage needs the sentence inverted rather than the word replaced: Gram-positive organisms represented 47% … of corneal isolates becomes of corneal isolates, 47% were Gram-positive.
Target has a real use, for a particular gene or a desired drug concentration, because a physical target has to be hit exactly and both overshooting and undershooting are bad. As a catch-all noun, verb and adjective it marks imprecise writing: our target is to target resources to the target population may mean either that the resources are to be made available to the right people or that money is to go to the right people, and the people receiving a questionnaire are its intended recipients rather than its target recipients. As a noun, target, like focus, is fashionable and liked particularly by politicians and administrators, presumably because it sounds more solid than the preferable aim or objective. Target should not be used as a verb: aimed is the better word for interventions targeted at hard-to-engage patients, and where no verb replaces it easily, as with targeting a questionnaire, direct is possible but target is a sign that the sentence is badly written.
Side effects are sought or looked for, not evaluated. Video simulation is a method or a technique, not a technology, and writing pathology where disease or condition is meant is the same error. Home telehealth is a practical, not a pragmatic, approach, and improve is better than enhance, which has the sense of intensifying, as in the use of isotopes in radiography. A panel of biomarkers is a number of them. Radiofrequency ablation causes gas bubbles rather than inducing them, in the way a therapist might induce someone to drink less or syntocinon induces labour. Major is overused and correct in major operation, major complication or, with care, major cause, but it should not be used instead of a more explicit adjective such as main, large or largest, important, serious, obvious or extensive. Heart failure is an important cause of hospital admission, not a major one.
Strategies to reduce resistance are ways to reduce it or methods of reducing it. A strategy is a plan designed to achieve a particular long-term aim, and unless that is the meaning, plan, way or scheme is better. The prevalence of strategy rose 22-fold between 1975 and 2010, and the word occurs in 5% of articles. It is often redundant: one in twenty strategies in PubMed is a treatment strategy, and therapeutic, coping, teaching and shoulder rehabilitation strategies are no different from treatment, coping, teaching and shoulder rehabilitation.
Quantity words collapse to plain ones: a paucity of and a dearth of are few, while a myriad, a litany or a plethora of are many or a lot of; a majority of is most and a minority of is few. To an equal extent is equally, a clinical treatment method is a treatment or a method of treating, and to improve early detection is neater as for earlier detection. Something that may happen is by definition potential and therefore in the future, so this gene may serve as a potential therapeutic target in glioma in the future reduces to this gene may be a therapeutic target in glioma, and target for treatment is, in one editor's view, better than therapeutic target.
Practising on published abstracts
A writer can practise on published abstracts: search PubMed for any two of the troublesome words together, such as option and represents; limit the search to English-language articles with abstracts and scan the abstracts retrieved; ignore those crammed with abbreviations, which make an abstract impossible to understand, and those clearly written by someone whose first language is not English; and rewrite the ones that remain. Many abstracts turn out to be very difficult to understand at first reading, and that should be a stimulus to make one's own articles easy to understand. The published sentence we aim to demonstrate the value of the alternative concept of social practices for quantitatively operationalising drinking culture, for example, means, as far as one editor can make out because the rest of the abstract is just as wordy, we aim to find another way by describing a usable scale of drinking habits, though the sentence is taken out of context.