Starting to write as a clinician or researcher

Clinical work, teaching and research provide material for publication, but subject expertise alone does not supply writing skill. Beginning authors need to learn the writing and publication process, choose a manageable contribution, protect time for it and persist through revision and rejection.

What subject expertise does not supply

Clinical practice or a faculty appointment does not by itself make someone a capable writer; writing requires knowledge, practice, experience, resilience after rejection and determination. ¹ Beyond medical knowledge, authors need to assemble and use writing resources, start and finish projects, understand publication forms, prepare manuscripts and get work published. ¹ Professional documents also need consistent presentation, grammar and spelling, and authors should expect reviewers to change their work and sometimes reject their suggested wording. ²

Rejection can continue long after early success: a clinician who began publishing studies in the early 1970s still received rejections for clinical papers, editorials and book proposals after forty years of writing. ¹

Material from clinical, teaching and research work

Daily work can supply reportable ideas: a cluster of uncommon problems, an unusual presentation of a common disease, a curricular innovation, a patient’s or participant’s courage, a new use for an established treatment, a response to published research or data from a completed study. ³ Patient histories also supply narratives in which the clinician is both participant and observer, with experiences extending beyond a list of medical facts. ⁴

Before starting an article or book, authors should answer three questions. ^{3, 5}

1. So what—what is the contribution?
2. Who cares—who will read it?
3. Where will it be published?

^{3, 5}

For clinicians pursuing academic advancement or research funding, a continuing subject area can connect publications, research and professional recognition. ⁶ It should be personally energising, broad enough to sustain several contributions, supported by evolving research and, if possible, socially relevant. ⁶ Authors should remain within their clinical expertise and consider whether they want referrals or requests for expert testimony in that area. ⁶

Possible continuing subjects have included women’s health-service measures, patient health literacy, professional-liability costs and physician retention, care quality after forced changes of doctor, complementary approaches in conventional medicine, screening cost efficiency, racial or gender disparities, and particular clinical diagnoses. ⁶

Repeated writing can change a clinical practice: a family physician’s migraine publications brought more headache referrals than desired, while an internist’s articles on alcoholism led to a practice dominated by those referrals and requests for expert testimony. ⁶

Time, resources and personal preferences

Commonly reported reasons for not writing include the following. ⁷

1. Insufficient time.
2. Nothing to write about.
3. No writing colleague.
4. Insufficient secretarial support.
5. Not knowing how to research information.
6. No writing mentor.
7. No motivation.
8. No self-confidence.
9. Not knowing how to begin.
10. Dislike of writing.

⁷

Writing time needs protection from calls, interruptions and other work. ⁷ One clinician’s approach was to write before breakfast while the family slept; alternatives included weekend mornings, late nights, a closed office door or working in a library. ⁷ That author advocated using personal time when writing time was not funded, while acknowledging strong disagreement with that position; research grants could support academic research and writing time. ⁷

Clinical experience provides ideas and credibility, while word processing, email collaboration and online information can reduce dependence on secretarial help and local collaborators. ⁷ Early publications may also build confidence and motivation. ^{7, 8}

There is no single typical medical writer; authors should understand their preferences, strengths and priorities, since writing can be satisfying for some and stressful for others. ⁹ Drafting involves creativity as well as information, and often requires solitary time reading, searching and thinking without seeking conversation as a distraction. ¹⁰ Ideas should be captured when they arise, on paper, cards or a phone, so that a useful thought does not disappear before drafting resumes. ¹

A feasible first assignment

Original research can be a difficult first project because it requires data and faces strong competition for publication. ¹¹ Joining a research team as a junior member can provide experience of the full project, including its report, especially with a senior mentor. ¹¹ Without a team, mentor and data, the following publication forms offer possible starting points. ¹¹

Form	Opportunity and condition
Review article	An option for a beginning author; advertiser-supported clinical publications have offered a regular market for reviews.
Case report	A possible starting point if there is a substantive lesson and the target journal publishes case reports.
Editorial	A way to express an informed opinion, particularly where the author’s role gives relevant expertise.
Letter to the editor	A brief response to published work that offers new insight and connects with readers, including disagreement with the paper’s conclusions.
Book review	An author can volunteer for a journal’s reviewer list and accept an assigned book, rather than submit an unsolicited review; the reviewed book may be retained as payment.

¹¹

A modest first publication may help establish momentum and a continuing subject area without itself assuring tenure or a career. ¹¹ Book chapters are commonly invited from authors already publishing on the subject, and a chapter or full book is usually not the best first project. ¹¹

Three starting mistakes can be avoided. ¹²

1. Trying to work alone: seek a more experienced coauthor or someone who can read and comment.
2. Attempting too much: start with a manageable piece that teaches the writing and publication process, rather than a definitive treatise.
3. Drafting without preparation: refine the topic, plan the structure, research the material and assemble writing tools before extensive drafting.

¹²

Early publication can affirm progress and sustain effort through later rejection, while a succession of early failures can be discouraging. ⁸

Continuing the practice

Writing groups can offer critique, exercises and encouragement, with either a designated or rotating leader and shared responses to successes and rejections. ¹³ A Vancouver hospital group discussed fifty projects during three years, of which twelve were subsequently published in indexed journals; its seven most frequent participants increased their publication rate by more than 300% over that period. ¹³ Other formats have included a faculty group formed in 2009 that developed into a publishing community, and a residents’ creative-writing group meeting monthly over dinner. ¹³

Writing and editing fellowships can provide further development opportunities for clinicians. ¹⁴ AMWA’s courses, workshops and journal provide education and information for biomedical communicators. ¹⁵ Writing contests offer another opportunity, but their announcements and deadlines need to be checked before submission. ¹⁶

Writing continues between drafting sessions through observation, collection of ideas and images, and organisation of ideas and supporting facts. ¹⁷ Nine rules summarise a clinician-author’s approach to sustaining it. ¹⁷

1. Be smart enough, while recognising that intelligence alone is not enough.
2. Organise files, notes and full references before drafting.
3. Read widely, noticing both content and expression.
4. Write only when there is something worthwhile to contribute.
5. Protect dependable writing time without neglecting clinical care, teaching or research.
6. Build and maintain relationships with editors and writers, and with potential authors when planning a multi-author book.
7. Be bold about ambitious projects, including those somewhat beyond present abilities; projects attempted with limited time and resources sometimes succeed.
8. Persist through rejection, revision, resubmission or restarting.
9. Remember the enjoyment of writing; when it disappears, take a restorative break and return.

¹⁷