[Silence]

[Doctor, Are You Speaking in Tongues?]

[Lois E. DeBakey, Ph.D., Professor of Scientific Communication, Baylor College of Medicine, Houston, Texas]

[Copyright Lois DeBakey, 1981. This video is copyrighted by Lois DeBakey, Ph.D., 1981, Houston, Texas 

and may not be reproduced in whole or in part without her written consent.]

I'm pleased to have the opportunity to address the question,

Doctor, are you speaking in tongues?

Even if you have not given your language much thought until now, I hope to show you

that verbal dexterity can enhance your effectiveness as a physician or scientist.

Let's begin with the definition of paper-writing from a scientific journal:

Given Freud's structural point of view... paper-writing can no longer be conceptualized

without considering the intersystemic complications which threaten it from within.

The conclusion, then, is inescapable. The paper-writing function of the ego is not always the only ego function instrumental in paper-writing.

Under circumstances which still await psychoanalytic elucidation... 

scientific papers are sometimes written in a complementary part-object relationship

between the paper-dictating function of the writer's ego and the dictation-taking function of a scribe or secretary.

You're puzzled. Is she going to be speaking in that kind of gibberish?

You're wondering.

Let me reassure you that I am not. I opened with that passage merely to illustrate an affliction 

of epidemic proportion among today's presumably educated people.

What may be called in the lingo characterizing it, lalopathy, logorrhea, verbigeration, or glossolalia is not confined to the biomedical disciplines,

but extends into business, the trades,  government, and all professions.

In medicine, I call this disabled language "Medicant." Ironically, the malady seems to be pedogogenic, induced by educational institutions.

It's highly contagious, passing freely from teacher to student, speaker to listener, and writer to reader.

Language is largely derivative. 

We mimic the expressions of those to whom we are exposed, and the faulty models we have are abundant and ubiquitous.

If you think the opening passage is atypical, let me cite several others, all from reputable publications.

In a word, no attempt is made to distinguish between what we observe in persons who are ill, on the one hand, and the general notions we form

in respect of like illnesses in different persons, together with the 'linguistic accessories' made use of by us 

for purposes of communication concerning the same, on the other.

In a word, he says.

Fifty-six words is more like it and turbid words, at that. 

Muddled thinking is often camouflaged by a welter of polysyllabic words. 

Fifty-six words is more like it and turbid words, at that. 

For example: Further, the institutions of the intellect face the task of differentiating themselves to a degree 

that is commensurate with the intellectual capital that

has been amassed... Because science and technology are increasingly pervasive of human activity,

they must accommodate themselves to the knowledge base, to the institutions wherein they can be contained, 

and must adjust themselves to the values that are associated with those institutional activities (and vice versa).

If only that author had read Shakespeare's advice, "a tale speeds best being simply told."

The verbal jambalaya I've cited calls to mind an experience I had on a plane some years ago.

My seat companion was the friendly sort who struck up a conversation soon after takeoff. 

After a while he asked me what kind of work I do. I said "I teach medical writing."

Well, a look of utter disbelief came over his face as he exclaimed, "You don't mean to tell me you actually teach them to write that way?"

No, I don't teach them to write that way, but apparently someone does, as witnessed this passage.

Our design incorporates a cross-tutorial semantic network into an intratutorial frame transition network, 

thus providing a built-in formal mechanism for insuring inherent coherence.

Inherent coherence? I'll settle for comprehensibility.

I found this passage in "The New Scientist."

It is argued that in order to define reality adequately, we must turn away from dogmatic ideas to a discipline wherein the representation

of the finite world as a selectivity implies actuality, only in consequence of the representation of the infinite world as a non-selectivity.

Clear as smog, wouldn't you say? When the English translation comes out,

let's all read it.

Even a Nobelist can slip into rather meaningless jargon.

The claim of science to universal validity is supportable only by virtue of strenuous commitment to global communication.

The canon of publication insists upon public awareness and criticism of avowedly new knowledge.

Full of sound and fury.

Signifying what?

Perhaps those enigmatic writers were taught by the author of this passage, 

found in a book on medical writing, no less.

As the physician speaks, so is he... Concise presentation takes precedence over laborious rumination

[With due regard to the laws of orthography, etymology, syntax, and collocation, for whatever is well conceived is clearly expressed.]

Careless communication is cosmic impiety. Doctor, you are speaking in tongues.

How erudite that sounds and how utterly unintelligible it is.

Why do people misuse language? One kind of abuse, gobbledygook,

issues from failure to think through an idea precisely and completely before trying to verbalize it, 

or a naive attempt to project a semblance of erudition.

Or purposeful use of big words to camouflage a lack of substance.

Early in medical school, students discover that they need to learn a second language

to understand their mentors, and, they assume, to be initiated into the profession.

Daily exposure desensitizes them to the awkward Latin-isms, the unanimated passive constructions,

and a tentative tone that characterize much contemporary medical usage.

The imprecision of "Medicant" has advantages elusory though they be. It protects the user from having to concentrate on what he wants to say, 

and from having to convey his thoughts cogently and intelligibly.

Latinate scientific terms, euphemisms, and pat phrases

may also help assuage the personal anxiety that stems from gaps in knowledge,

not only one's own, but in available medical knowledge.

The associated defensiveness however, may trigger withdrawal, silence, or bravado.

Abstruse language can be intimidating. Few people are courageous or secure enough 

to ask a speaker to translate his gibble-gabble into plain English.

If you say acrocephalosyndactylism fast enough,

who will dare ask what it means or even realize that you may not yourself know?

The patient, already apprehensive and uncomfortably dependent because of his illness, is unlikely to probe for clarification 

if his physician establishes a safe distance for himself by using incomprehensible language.

When, for example, a physician makes an offhand reference to obsessional defenses, hyperhidrosis, pruritus, neoplasm, pleurodynia, or ecchymosis,

the patient may be too frightened or too embarrassed to ask what these terms mean or how they are related to his ailment,

so he remains anxious and fearful.

Physicians would do well to supply a glossary to their patients.

Then, Doctor, we would know that when you say,

"Your metabolism has a low conversion factor,"

you mean you eat too much.

When you speak of diaphoreses, you're referring to profuse sweating.

and if you say you performed a unilateral nephrectomy on a patient, you mean you removed one of his kidneys.

Physicians who prefer Latinate terms to their more common synonyms hamper communication.

They will say alopecia for baldness, cholangitis for inflammation of the bile duct, coagulation for clotting, erythema for redness of the skin,

exanthematous lesion for rash, febrile for feverish,

pharyngitis for sore throat, and surgical intervention for operation.

Medicine remains cloaked in a certain mystery despite the increasing number of articles and books on health for the general public.

And the physician remains a figure of authority, someone to whom we entrust our most precious possession, our being, 

someone held in awe by many because of his special knowledge and our dependency on him when we are in discomfort or pain.

His words can induce trust or create anxiety

and therefore have a tremendous impact on the patient and his well-being.

A physician who refers to the irritable colon in 623, the duodenal ulcer in 205, the fracture in 531,

or the concussion on wing C, is apt to think of the patient as a problem, a disease, or a curiosity

rather than as a human being.

The public is offended by such dehumanizing language, since it ignores the patients' feelings, apprehensions, and vulnerability.

as well as his human dignity.

Some jargon is inept because of its connotation.

A patient labeled as salvageable

may feel he is being rescued from the junk-heap and that he may be disabled or handicapped as a result.

A physician who tells a colleague how relieved he is finally to be rid of the crock in 712

will understandably be considered callous by those who overhear him.

Medical jargon that involves gallows humor is particularly pernicious.

Terms like "gorked out" for comatose, "squash" for cranium, and "flight deck" for neurosurgical intensive care unit

are really indefensible.

Physicians and nurses who use irreverent abbreviations like these for the seriously ill, also have chosen the wrong profession

O.B.P., on a banana peel, P.B., pine box, A.D.D., at death's door, and M.F.C., measure for coffin.

None of those expressions enhances the image of physicians as genuinely dedicated to healing the ill. 

or as considerate, compassionate human beings

Words can make us feel sick or well, a sugar pill or placebo, administered as medication

has long been known to have an ameliorative effect on some patients.

And think of the flood of relief brought by the words, "All the tests were normal."

Certain medical terms, on the other hand, not only engender fear but may induce psychosomatic symptoms.

Consider the dreaded brain tumor, cancer, heart attack, kidney failure, pernicious anemia,

and stroke.

The physician would do well not to use these words without further explanation.

Failure of communication is a serious cause of patients' agitation,

whether related to lack of understanding of his illness, treatment, prognosis,

length of hospital stay, duration of convalescence, or fitness to resume work.

Much noncompliance with treatment prescribed by physicians is due to improper communication, 

and the results can be disastrous.

Perhaps only inconvenience resulted when a mother thought incubation period referred to how long her child should remain in bed,

but the patient who thought it was logical to take her heart pill, which happened to be digitalis, whenever she had heart pain,

instead of taking nitroglycerin,

was risking overdigitalization and possible death.

Even common non-technical phrases are interpreted differently by physician and patients.

In a recent study, 60 percent of physicians interpreted the statement, "If you have trouble call me," 

to mean "If the treatment doesn't work and you feel worse, get in touch with me,"

but only 30 percent of the patients interpreted it that way.

Interestingly, some patients considered the statement to be a brush-off.

Absolute terms like "always" and "never" as well as indeterminate words like "soon," "often," "usually," and "occasionally" can also be troublesome.

Does occasionally mean three times a week,

three times a year, not very often,

or rarely? It has been interpreted as all of those.

Ninety percent of the physicians surveyed interpreted

"going home from the hospital soon" to mean within two to four days,

or within an indeterminate time, whereas 20 percent of the patients thought it meant tomorrow.

Like other farms of "Medicant,"

such indefinite adverbs are evasive, not communicative.

The classifications used by hospital administrators for the clinical status of patients are also largely uninformative.

Words like "fair," "serious," and "stable but critical."

One recent bulletin read "serious but satisfactory."

The question is, of course,

satisfactory from whose point of view, the physician or the patient's?

Are those terms illuminating or concealing?

Then there is "terminally ill." Does the patient have one day, one week, one month, or one year to live?

Of course, only the supreme being knows that.

Speaking in a tongue others don't understand alienates them.

There is little doubt that ineffective communication has contributed to the declining image of physicians in the public press.

Incomprehensible language projects aloofness,

impersonality, smugness, and indifference.

Qualities that don't fit the physicians I know.

More important, it subverts the purpose of language, communication,

by creating confusion, ambiguity, misinterpretation, or obstruction.

The physician needs clues from his patient, but the emotional distress induced by lack of understanding

blocks the emission of clues.

"Medicant" therefore has practical disadvantages.

If patients misinterpret the physician's instructions,

they will be unable to cooperate effectively in their treatment

and if they resent the physician's unwillingness or inability to explain the significance of their symptoms,

they may ignore his prescribed treatment entirely or find another doctor.

Where rapport is crucial, emotional distance may be severe. Information is power.

In the physician-patient relation, the information resides largely in the physician, a situation that leaves the patient uncomfortably dependent.

The fact that the information concerns the patient's own mind or body

may make him feel embarrassed,

demoralized, or even demeaned.

Physicians speak in tongues not only to laymen, but among themselves as well.

Their colleagues, of course quickly learn to translate what they hear and read.

"It has long been known"

means, "I don't know the original source."

The etiology is multifactorial" means, "I don't know the cause."

"It might be argued that,"

means "I intend to beat my opponents to the punch."

"Although no definite conclusions can yet be drawn" means "The single case I've observed has allowed me

to add another paper to my bibliography," and "Much additional work will be required,"

means "I didn't do enough experiments to warrant any clearcut conclusions."

Much that appears in professional publications

is impenetrable, the prose being severely weighted with platitudes and saturated with jargon, clichés,

big words, abstractions, redundancy, and general wordiness,

all of which suggest an unwillingness or an inability to keep on a straight mental path

I'm going to illustrate some of these flaws

taken from published material

and in one or two instances, from final drafts.

My premise is that any intelligent, educated reader should understand the essence of a well-written article,

no matter how specialized or technical the subject may be.

When an educated reader does not understand an article, the fault almost always lies with the writing and the faulty thinking that preceded

or accompanied it.

The crucial word here is "thinking."

Faulty thinking, not faulty grammar, is without a doubt the major cause of poor medical communication,

and when the problem is faulty thinking,

correcting the grammar will not help because it can not correct substantive flaws

Since words are the medium we use not only to convey but also to formulate thought, faulty language is often due to faulty reasoning.

Unfortunately, faulty language can lead to illogic, ambiguity, or involuntary humor. 

For example, there was no evidence of cerebellar disturbance in the limb.

Thank goodness, at least we know that the patient's head isn't displaced.

Note this double entendre:

The mother should be allowed to undress and hold the baby.

Presumably, the examination is improved if the mother disrobes.

This one apparently slipped by reviewers and editors: For our open-heart procedures,

68 percent of our patients operated upon during the past two years have had no blood whatsoever.

Is the problem here one of grammar or of thought? 

However if the animals were killed shortly before death, the lungs were faintly red...

Is the problem here one of grammar or of thought? 

No, grammar won't help because the underlying idea is contradictory.

Absurdities like this illustrate graphically

the close link between clear thinking and clear writing,

and you can find such blunders in the most prestigious journals without really searching for them.

This dubious statement appeared

in the prestigious New England Journal of Medicine:

Autopsied men who ate more than 33 percent of the experimental meals were more likely to have gallstones.

I found this contradiction in the British Medical Journal:

Sudden death, though fortunately it is rare, is frequent.

The author apparently let his mind wander for a moment

and his pen followed it.

This contradiction appeared in the journal of the American Medical Association:

Of 25 penicillin-sensitive patients, one had fatal anaphylactic shock but recovered.

The physician who said of John Lennon's murder, "I am sure he was dead when he was shot," did not mean

that he was already dead when the shot was fired, but that the shot killed him.

A New York Times science writer wrote, "Women, too, were more likely to die if they were very overweight or underweight." 

Presumably if their weight was just right they were not likely to die.

The same article contained this shocker:

For women, very short or very long nights increased the death rate.

Now that's a perfectly grammatical sentence, you see, but it's simply not a factual statement.

You can, in fact, write an entire manuscript that observes all the so-called rules of grammar

and still have a paper that's inaccurate or even worthless.

When the underlying thought is flawed, the most eloquent language in the world cannot redeem it.

The person who writes, "Another story centered around the refusal," is not only committing a usage flaw, but a contradiction.

The center is a point, not a circumference, and the proper expression is therefore, "centered on."

Is the problem here one of grammar?

"The patient had lost a kidney,"

as though there is a chance he might recover it.

"The patient was throwing emboli," again improperly suggesting a deliberate action on the part of the patient.

The danger of that kind of medical slang, like that of all imprecise language,

is that it is habit-forming, and although understood in some contexts, can lead to misinterpretation in others.

Precision is especially crucial in medicine as illustrated by recent news stories of patients

like actress Peggy Cass who had an operation on the wrong leg.

Disciplining yourself to be precise will prevent that kind of gross error.

Being precise means avoiding medical shorthand like this, which makes the patients seem guilty of self-mutilation.

Two weeks ago the patient thrombosed his aortofemoral graft.

Many other barbarisms by repetitive use have settled into the medical vocabulary, but they are still inappropriate and should be avoided.

For example, the patient was operated.

The proper phase is "operated on."

Nor does a patient present to a hospital or present with a symptom

even though many editors permit, indeed may even insert those abominable phrases, as in this passage:

This 54-year-old painter presented to the Neurology Service with a 12-year history of progressive ataxia.

He had marked tremor of the right hand.

The painter presented what to the hospital?

Incidentally, "marked" is one of those overused and imprecise medical words that have become virtually meaningless

and should simply be discarded.

How often have you read or heard in a research report, the rats were injected?

But the rats were not injected, something was injected into the rats.

This notation appeared in a medical chart:

This patient deserves to have an arteriogram.

Now no one deserves to have an arteriogram. An innocent slip of the pen perhaps,

but still an unfortunate choice of terms.

Figures of speech can also be extremely effective when they're used properly,

but inept or mixed metaphors are jarring.

For example, the concept of the bladder as an inert container no longer holds water.

An orthopedist concocted this interesting metaphor:

These people, almost without exception, stay on their doctor's back.

If you use figures of speech,

make sure they are apt and congruous with the text.

Medical clichés abound, each generation of physicians inheriting a larger and larger legacy.

It is of course impossible to avoid all clichés

and there's no reason to do so,

but when you overuse them, you brand yourself as unoriginal, a copycat.

Careful writers avoid expressions like "all in all," "belabor the point," "beyond the scope of this paper," "cutting edge," "exciting new results"

"first and foremost,"

"hard data," "in a sense," "in the final analysis," "in terms of,"

"longitudinal studies,"

"multifaceted problem" "new avenues to be explored," "stimulating concept,"

"suffice it to say," "tip of the iceberg," "venture the opinion,"

and "warrants further investigation."

How weary we all are of a large body of information,

a thorough search of the literature,

the volume fills an important gap,

the patients were broken down by age and sex,

the new treatment represents a valuable addition to our therapeutic armamentarium.

Surgeons proudly report that,

the patient left the operating room in good condition.

A neurologist observes that the patient was unresponsive in bed.

Another form of junk language is vogue words, words of transient popularity,

like "medical arena,"

and "conceptual framework," "cost out," "firm up," "gut reaction," "infrastructure," "input,"

"interface," "matrix"

"module," "monolithic,"

"multidimensional continuum,"

"paradigm," "resource utilization," "target site," "thrust," and "viable."

Only the unimaginative "capture the data," "visualize a scenario," "orchestrate a project," or "impact the curriculum."

At a recent meeting I heard this: Successive iterations of naturalistic inquiries will be used

as the strategy to reveal interactive personological factors

and practice-related behavioral patterns

which might lend themselves to experimental hypothesis-testing studies and might ultimately be mediated by educational intervention.

Well, my head reeled from the word-salad. What did all those big words mean?

The speaker meant that he intended to interview physicians to discover personal and professional habits and then try to find ways of improving both.

If only that speaker had known that in language, as in mathematics,

the shortest distance between two points is a straight line.

And a straight line means not repeating the idea two or three times.

Not only is it condescending to your audience, it's boring,

and yet these tautologic phrases recur in medicine.

"Abdominal ascites," "anastomotic communication,"

"audible to the ears," "basic fundamental essentials," "black, tarry stools," "cardiogenic origin," "consensus of opinion,"

"contralateral side," "cut section,"

"diagnostic x-rays," "few in number,"

"human volunteer," as though there was another kind,

"neurogenic origin," "past history,"

as opposed presumably to future history.

"resultant effect," "soft in nature,"

"skin rash," "summarize briefly,"

"surrounded on all sides"

"tumor mass," and "watery in consistency."

As every journal reader knows, most medical articles can be reduced by one-third to one-half 

or more, without jeopardizing content. Eliminating obvious redundancies like this will help tremendously:

It was considered important that G.P. matching was an important consideration.

Redundant titles like this are fairly common in medical journals:

Surgical Postoperative Bleeding Associated with Aspirin Ingestion

And if you think Traumatic Surgery isn't redundant, just ask your surgical patients how traumatic

an operation is. What is meant, of course, is the surgery of trauma.

Another easy way to reduce verbosity is to eliminate introductory dead wood like, 

"It should also be stated here that," or "It is interesting to note that," or "It is important to remember that."

Such expressions contribute nothing to meaning, but only delay the communication of the real message.

So, strike them out and begin your sentence with the next word.

Do you have to be a grammar expert to write well?

The age-old complaint persists that grammar doesn't teach anyone to write.

But grammar is nothing more than a set of principles but which language functions.

Grammar keeps words straight to deliver their intended meaning efficiently.

Familiarity with the principles that govern the use of English allows you to exploit the strength of language to the utmost.

Unlike Latin, for example, English has few suffixes to identify the functions of words, and instead depends heavily on word order for meaning.

See how reversing the subject and object changes the meaning in English but not in Latin.

"Dog bites man" is not the same as "Man bites dog."

There is a vast difference also between

"Have you left anything?" and "Have you anything left?"

Because position is crucial, the careful writer learns to group words strategically.

You may not know a noun from a verb, but if you recognize that the ordering of English words 

affects their meaning, you can avoid grammatical infractions that lead to such distortions as this:

A fifteen year old white female was riding in the right front seat of a car driven by her father which hit a telephone pole

traveling at approximately 30 miles per hour. It was of course the car and not the telephone poll that was traveling.

One of the grossest grammatical violations is disagreement of subject and verb, 

an illiteracy that appears surprisingly often in scientific publications.

From the journal of the American Medical Association:

The results was reviewed by Lawrence et al.

Pronouns also create grammatical problems for some people.

They have difficulty keeping the cases and numbers straight.

From Nature: A year's free subscription for he or she whose nominee tops the list.

Notice, that is in an editor's note.

Such breaches are so jarring to the reader,

that they divert his attention from the substance.

Who and whom are another source of confusion. From the American Medical News:

Any physician who prescribes a controlled substance to a patient whom he knows is using a fictitious name is breaking the law.

We need a subject of "is using" not an object of "he knows," which is only a parenthetical phrase, so the proper word is "who" not "whom."

Note that the grammatical infelicity again appears in an editor's note.

Now if you think the who/whom distinction is much ado about nothing,

consider the difference between these two sentences:

"Whom are we to judge?" that is, which persons are we to make judgments about?

and "Who are we to judge?" that is, what right have we to stand in judgment?

Pronouns, as you may remember, take the place of or refer to nouns, but what does "it" refer to here?:

On the second day the knee was better

and on the third day it had completely disappeared.

The only word "it" can refer to is "knee" and that's nonsense.

The real referent, "pain" is not even mentioned.

Such grammatical improprieties are not merely inconsequential matters for pedants to quibble about,

but reflect a lapse in coherence from beginning to end of a sentence.

This physician complained in the New England Journal of Medicine that medical writing is weak because "voices are passive."

Then he proceeded, apparently by force of habit, to use the passive weakly.

"Breaking these rules," he writes, "is now employed in medicine by the educated writer to confuse his equally educated reader."

Notice how much more direct and forceful the active voice is. "The educated writer breaks these rules to confuse his equally educated reader."

Again, however, improving the grammar does not correct the inaccuracy of the underlying thought.

I have yet to meet a physician who deliberately breaks grammatical rules to confuse his reader, as that author contends.

Having shown you numerous examples of published infractions and infelicities, 

I must caution you,not to accept blindly changes that journal editors and editorial assistants make in your papers.

The faulty examples I've shown here today were either unrecognized by editorial assistants,

or in some instances may have been unwittingly inserted by them.

My files are bulging with inadvertent distortions and even grammatical infractions imposed by copy editors

and sent to me by offended authors seeking advice about what to do.

The copy editor at the New England Journal of Medicine, for example, erroneously thought the word "none" must always take a plural verb,

and it required a lengthy exchange of letters to disabuse him of that idea.

Another copy editor once changed my "consists in" to "consists of" because she thought it sounded better,

totally unaware that the two phrases have two distinct meanings.

A heavy-handed but inadequately informed and undertrained manuscript editor can do weird things to your prose, 

and you would do well to examine all editorial changes carefully before you accept them.

You have every right to insist that faulty or unnecessary editorial changes be removed and I urge you to do so.

It is one thing to take public responsibility for your own errors 

and quite another to be publicly accountable for those introduced by an anonymous editor.

Manuscript editors, like everyone else,

come in all degrees of education and competence.

A degree in English or journalism, incidentally, is not a valid credential for copyediting in medicine.

If you understand the basic principles of good scientific exposition,

you will be able to evaluate the propriety of editorial changes made in your writing

and to distinguish those that are judicious from those that are unnecessary or erroneous.

Even the writing of the masters, if scrutinized carefully enough,

will yield some infelicities,

and the quality of a piece of writing is not therefore to be condemned because of an occasional semantic or grammatical lapse.

Rather, it should be judged on its overall substantive, grammatical, and rhetorical quality,

which was not particularly notable in the articles from which the flawed examples cited here were taken.

I use the faulty examples I've illustrated not to censure the authors,

but to alert you to some of the common flaws in medical writing and speech, 

and to show you that communication can be notably improved by disciplining yourself

to think more clearly and to use language more precisely.

Memorizing rules of traditional grammar, using synonym books automatically,

and applying spurious readability formulas to writing are tedious and ineffective ways of improving verbal skills.

The path to competent writing is through patient study and reading, extensive practice, common sense, and good taste.

The patient study and extensive practice are what most people, including some editorial assistants, are unwilling to sustain.

Like everyone else today, they want instant expertise,

and it's simply not attainable in this discipline.

Reading the works of the literary masters; that is, outside of medicine, not only provides useful information and expands your vocabulary,

but affords models for you to emulate.

Reading is to the mind what exercise is to the body.

It will also help you acquire an eye for the felicitous phrase and the eloquent expression.

With extensive reading you will learn when to adhere to a grammatical proscriptions

and when you may safely ignore them.

And with practice and experience

you will find a middle course between undisciplined gibberish

and tyrannical purism.

To summarize, the ingredients of "Medicant" fall into three major categories:

informational, structural-organizational, and literary.

That is, those concerned with usage, grammar, punctuation, or spelling.

The first two categories are far more important than the last.

Most poor medical writing is caused by a poorly defined or invalid thesis, faulty data or argument,

disorderly organization, illogical development,

or unsubstantiated conclusions.

All the result of the author's failure to think through an idea clearly and completely before beginning to compose.

With major defects like those,

it is impossible to produce a cogent, unified report.

The principle "think first, write later" can save valuable time and prevent unnecessary vexation later,

when you try to unravel a thesis that is poorly or incompletely thought through.

Major substantive, organizational, or developmental defects require radical, corrective measures

and no amount of patching will redeem the writing.

What some call poor grammar is not therefore the physician's most serious problem,

and even if it were, its elimination would not rectify major informational and organizational defects.

Obscuring a message or concealing the lack of a valid thesis with meretricious language

is far more perfidious than the commission of a few grammatical sins.

So, I implore you, doctor...

please don't speak to me in tongues.

Such language is, in the words of T.S. Eliot,

 "full of high sentence but a bit obtuse; at times, indeed almost ridiculous."

Finally, I'd like to leave you with this advice for effective communication,

aptly expressed by Joseph Storey.

"Pregnant in matter, in expression brief. Let every sentence stand in bold relief."

Thank you.

[The End]