Ask the right readers for the right critique
A draft gains from a reader other than its author, and getting that reading means choosing who reads it, telling them what to look for, deciding how much of it to pay for, and taking in the answer when it comes.
Choosing the reader
When a manuscript has been through at least three revisions and is almost ready for its final draft, it is time to pass it to a colleague for critical review, a process sometimes called informal refereeing. A critical reader who does the job shows the author at least some of the paper's weaknesses in time to correct them before submission, and finding the flaws then is much better than having the journal's peer reviewers discover them and trigger rejection by the journal the author most wanted.
The critical reader must understand the science involved and know the principles of good writing, and, more important, must not be intimidated or overly impressed by the author's writing skills. A reader who reports that the article is flawless has wasted everyone's time. There is always something that can be improved. The author needs someone tough, honest and not afraid to use the red pen liberally, a quality medical writers have called "benign brutality", on the understanding that the author will give a reciprocal reading when the critical reader writes an article.
The critical reader need not be a clinician in the author's specialty, and the manuscript may go to two types of reader. The local expert in the field points out the errors of commission and omission. The naïve reader is not an expert in the field and may be someone who knows a little about the field of medicine, but not too much, and can say whether the article is intelligible, has too little or too much detail, and leaves too many questions unanswered. A totally nonmedical person may also review the article, looking for clear English and logical development of the message. One family physician has served as critical reader for a gynecologic oncologist, an international medical graduate whose English lacked some of the subtleties precise written prose needs. For decades his own best critical reader has been his wife, a non-physician medical educator and successful author. Another writer recommends, as a skill-building task, applying a scientific perspective to one's own writing by testing its effectiveness with actual readers, in a sort of informal peer-review process. She often does this by giving a draft to her husband, a professional writer who is not an expert in scientific matters, asking him where the explanations or language were confusing, and using that feedback to make changes.
Working alone, a writer can find it difficult to know when their work is good enough and can fall into the trap of striving for perfection, which is rarely what the client is paying for. Sometimes a writer needs a sounding board to check whether their work is good enough, and a two-minute check-in is harder to schedule from home than with someone sitting alongside to ask.
A guide for junior researchers emphasises the value of writing retreats and writing groups, where writers can receive constructive criticism on their efforts. One writer who had left research lacked such a forum for feedback on early writing and could have used one.
What to ask the reader
The instructions to the critical reader are important. The request is neither for redaction, the word-by-word, sentence-by-sentence editing of the text, nor merely for general comments, since being told that the article is simply wonderful is no help at all. Instead, the critical reader can be given specific questions such as these:
- Can you state in one sentence what the article is trying to say?
- Is what the article says medically (or scientifically) sound?
- Are there any errors of fact?
- Should the structure be changed in some way?
- Is the prose clear?
- How can the article be improved?
Paying for a check
A writer who is not a native English speaker can ask a native English speaker to be their quality controller, as some French medical writers do by having an English person check everything they write to make sure the English is good. Someone can also be paid to do a quality control and check all of the numbers. But a writer who is not careful and pays too many people makes no profit. So one experienced writer's number-one advice is to work very carefully and not make mistakes from the beginning.
Receiving critique
There is no perfect document, and every medical writer has at some point been on the receiving end of feedback. The feedback is not always pleasant, and writers dread the mark of the red pen or, in the digital age, the tracked changes, the comment bubbles and the error messages. Feedback on written work comes from many places, high and low: peers, quality-control AI software, line managers, skip-level and C-suite executives, journal peer reviewers and regulators. Giving and receiving feedback is a soft skill that writers should keep practising and honing at every level, from an entry-level position to the upper echelons of management.
It is important for medical writers to develop resilience to criticism, because they often get feedback from a very broad range of stakeholders, and it is not always polite. Finding the advice or learning point in a comment means detaching from the way it is given. A writer should not take feedback personally or become emotionally attached to their documents. The more a document is revised and discussed with others in the team, the better it comes out.
One mentor thinks resilience to criticism is harder for remote workers, because their feedback is more likely to be written, which can make it seem more blunt. She advises remote workers that finding a way to separate their sense of worth from their work will help them take in feedback no matter how blunt it is. It also helps to have a work best friend who understands, to complain to when really annoying comments come along. She also advises reflecting on feedback and thinking about how it might apply to other projects or to one's writing in a broader sense.
One editor relies on four B's to keep perspective when receiving feedback:
- Bask. Enjoy every positive feedback and celebrate every win, no matter how small.
- Breathe. When feedback is not so good, breathe in and out, pause, take a walk to clear the cobwebs, and look up and find the silver lining.
- Bitter or better? Negative feedback can be a bitter pill to swallow, or it can be the medicine that makes the writer better, and which it is, is the writer's choice.
- Plan B. When something did not work this time, move on to the back-up plan.
A beginner's work is vetted and checked for errors by senior writers, and the first document is very likely to come back riddled with tracked changes and comment bubbles. That can be a truly humbling experience for someone fresh out of academia, even one with several years of scientific writing and multiple publications behind them. The sooner a writer learns to accept criticism positively and apply the feedback to their work, the quicker their learning curve and the faster they can progress to leading their own projects. Unlike an academic author, a medical writer is not the owner of the document and may not have the final say on how it is written. Medical writers are service providers, and although they may advise the client on the writing, how the document is written is ultimately up to the client. So a writer may have to accept major changes the client requests, even to work they think is written perfectly, and must then swallow their pride and accept feedback they do not fully agree with.