Revise a draft in ordered passes
A draft can be revised in separate passes, and a recommended order takes the whole document's structure, logic and fit for its audience first, then the details, then the expression. Revision starts from distance from the draft and a reading of the whole, checks a set of aspects that decide whether the draft works, and takes out what the core message does not need. A writer's own revision is best done before the draft reaches anyone else, and an editor working on someone else's text reads and checks it in much the same way.
Why writers edit their own work
Editing and proofreading benefit the writing of even the most skilful medical communicators, but professional editors and proofreaders are not always available. Even where they are, doing some editing and proofreading first is advisable. A polished piece demonstrates competence and decreases the time others must invest, and the less editing others do, the less likely they are to introduce errors or distort the meaning.
Revising one's own work differs from editing someone else's: an editor who feels major changes are in order cannot be sure the changes will express what the author wanted to say and may distort the meaning, whereas in revision the writer is in control at all times and free to make every change they want.
Editing and proofreading one's own work can help it meet high standards, and so can increase acceptance of what is written and minimise the editing and proofreading others must do. Most important, careful editing and proofreading can help the writer communicate with the audience and so achieve the goals of the writing.
Distance from the draft
Editing one's own work has much in common with other editing, but distance is lacking. The writer may already know what they were trying to say, so problems with clarity may be hard to detect, and may be emotionally invested in the writing and so lack objectivity. So the first step in editing one's own work may be gaining distance.
Unless deadlines require otherwise, writing should be set aside for a while before it is edited, which can help the writer approach it afresh, so that its problems, and their solutions, may become more apparent. Writing that has been viewed on a computer should be printed out, because the change of medium may help the writer see it from a new perspective. A printout can also help in viewing the document as a whole and in spotting problems such as many paragraphs starting the same way. Changing the look of the text can help the writer view it with new eyes, for example by printing it on paper of a different colour or by changing the typeface or the margins. Printing with large margins can also make it easier to write comments and edits. Reading the writing aloud may also give a fresh perspective, in which omitted or repeated words and awkward phrasing may be easier to notice.
A physician who writes a magazine column found that reading her stories aloud before turning them in, as an editor had suggested, made a huge difference: out loud, long wandering sentences leave the speaker gasping, and clunky metaphors declare themselves as soon as they are spoken. After years of the practice, she does not really know what she has written until she hears it.
A writer who must edit their own blog post can ask someone else to read it with a fresh pair of eyes. Where that is completely impossible, the writer should wait at least 24 hours before editing the post, since coming back the next day sometimes brings another perspective.
Documents should not be sent for review until the writer is really happy with them. A writer working alone should print the finished document, go and sit somewhere else, such as in the garden or outside, and read it as if someone else had written it, asking whether a person who is not an expert in the field would understand it. Einstein's saying, that writing a six-year-old cannot understand should be written again, is perhaps a little exaggerated, since it is hard to imagine a six-year-old understanding a clinical study report, but it holds some truth: the writing has to be understandable to anyone else.
Reading the whole first
Once the writing is done, the editor's role is to check whether the content is tailored to the target audience and to recognise any errors or missing information, which is much more than eliminating spelling and grammatical errors. Beyond correcting typographical and grammatical errors, a medical editor has to ensure the clarity and flow of an article, keeping in mind its intended function and its readership.
An editor should first read the article entirely without making any corrections, even on noticing an obvious error, and then step back and consider whether the article has a clear structure and meaning overall. Keeping the audience in mind, the editor should also step back and look at the big picture. After editing, the editor should go back to the introduction and check whether the article has enough information to support the statements made there, whether it is complete, whether there are any holes or unanswered questions, and whether its overall structure makes sense and meets the guidelines.
Passes and their order
Unlike a first draft, revision can be done in discontinuous bits of time: revising a manuscript is tuning rather than creating, and the writer can stop and start without causing damage.
In editing others' work, some editors work first on large-scale aspects such as organisation and then on small-scale aspects such as wording, while others do largely the reverse or alternate between the two. Some edit from beginning to end, and others start elsewhere, for example with the reference list or the tables and figures. Some edit in several passes, focusing on different aspects each time, and others integrate the aspects more. Different approaches can likewise work for one's own writing, so the writer can choose whatever suits them or the piece, but thorough editing usually means reviewing the writing several times, at least once from beginning to end.
Macroediting comes first, even for editors who are passionate about microediting: text needs to make sense and be relevant to the reader before anyone concentrates on details such as formatting, consistent spelling and the use of hyphens, and there is no point working on the finer points of text that may well be moved or removed before it is finalised. The editor's first priority is to make the text clear and enticing, so that the reader wants to read on.
There are probably as many ways of revising as there are writers, but an article should go through at least three preliminary drafts before the final version, and the writer may choose to follow this pattern for them:
- First revision. Look at the paper as a whole and try not to be too focused on small spelling and grammatical slips: verify that the structure is sound and that what is said is appropriate for the intended audience and the target journal. Fixing the level of a heading or two is fine, but the emphasis must be on reviewing the organisation, logic and validity of what has been written, whether it all hangs together and whether it says what the writer wanted to say.
- Second revision. Verify. Look for errors in spelling, grammar and syntax, and check carefully for factual errors. Run the spelling and grammar checker, but do not rely on it to catch every spelling error, especially in small, common words such as one and on. Move any sentence or paragraph that is in the wrong place, insert any heading that is needed, and eliminate superfluous phrases and wordy constructions.
- Third revision. First, preferably, put the paper away for a week or two: this cooling-off period disconnects the writer from the writing, and on rereading the paper the writer will often wonder how they could ever have written a given sentence. Then polish, with the emphasis on clarity and style: simplify words, seek the best way to express each thought, eliminate unnecessary verbiage, and look for the danger signs of inappropriate stance, favoured but inappropriate phrases, and cuteness.
The aspects of a draft to check
However the editing is approached, certain aspects of a draft deserve attention, and they are sometimes intertwined: compliance with instructions, suitability for the audience, content, structure, organisation, mechanics, clarity and conciseness. Most medical writing must follow instructions, so the instructions should be reviewed before editing, kept to hand during it and checked against a final time before submission, and a checklist the journal or other recipient provides should be used.
Suitability for the audience is judged by asking whether a journal article is for generalists or specialists, whether a proposal will be reviewed by scientists or by a community board, what the prospective readers of a brochure know and care about, and what the readers' native languages are, and then by considering whether aspects of the text, or any of its content, should be revised to suit them. It is vital to pay attention to specialised terminology and to check that adequate explanation is given where necessary. Evaluating content is crucial, against both the audience and the goals of the writing: whether it includes all the content needed to achieve the goals, whether any superfluous content should be deleted, whether implicit assumptions should be made explicit, whether the logic is sound, and whether all the content is accurate, which can mean checking the writing against the original data or source material.
Structure is checked against the standard format for the genre, such as IMRAD for a journal article or the inverted pyramid for a news release, and a piece that departs from it is checked for whether it does so for a valid reason. Within the format, the checks are whether good choices have been made: whether subheadings, where allowed, are used effectively, sections and paragraphs are of suitable length, any lists should be numbered or bulleted, any material would be better presented in tables or figures, every table and figure is worth including and those kept are well designed, and italics or other typographic devices would help anywhere, without being overused. Where instructions and convention determine the overall structure, the organisation the writer controls is still checked: whether content within sections is logically structured, overviews precede details where warranted, so orienting readers, paragraphs generally begin with strong topic sentences, and list items appear in a logical order.
Mechanics are checked both for consistency with the instructions and for compliance with overall standards: whether a required style, such as American Medical Association style, has been followed in all regards; whether grammar, spelling, punctuation and usage are correct throughout; whether verb tenses are appropriate and the antecedents of all pronouns clear; whether all abbreviations and acronyms are defined and worth including; whether list items have parallel structure; whether sentences are of appropriate length and structure; whether there are effective transitions from sentence to sentence; and whether any references are in proper format. Clarity is checked by asking whether all the language is unambiguous, whether every sentence says what the writer means, whether anything is still hazy because the writer remains unsure what to convey, whether the wording is exact throughout, and whether anything is likely to be misread or misinterpreted. In medical writing, wording should be so clear as essentially to preclude misunderstanding. Drafts tend to be wordy, and editing them for conciseness can increase readability and save space.
Numbers are considered as well as words: whether they are accurate, whether they are in the required style, such as arabic numerals or spelled out, whether units of measure are present where needed, and whether the choice and presentation of units suit the audience and comply with any stated requirements. The last check is whether anything about the draft makes the writer uneasy: whether anything seems inconsistent, might be dehumanising, disrespectful or even libellous, leaves a copyright or permissions issue unresolved, or merits further checking, and where anything does, the steps needed to resolve the qualms are taken.
Cutting
Much of revising one's own work is taking things out: the editing function is chiefly one of 'putting out', especially in revision. A first draft may be chock full of material typed without stopping to ponder the best words and ideal sentence structure, and that material needs to be debrided during revision. By the principle of Occam's razor, anything superfluous to the core message should be shaved off and only what is needed said, whether the surplus is words, paragraphs or even sections.
Whole paragraphs and sections sometimes have to be removed or moved. Removal is usually prompted by one of two events. The first is realising that a paragraph is inappropriate, irrelevant to the core message, or perhaps illogical, silly or contradictory to something elsewhere in the paper, and then it has to go. The second is a journal editor requiring a 20-page paper to be cut to 10 pages: half the words are unlikely to go by fine-tuning sentences one by one, and one or more parts of the article will probably have to be jettisoned.