On the importance of writing well
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JOURNAL OF GENERAL INTERNAL MEDICINE, Volume 2 (May/Jun). 1987 ?.11 dance in resuscitation preferences} Finally, we were ex- tremely careful to avoid causal statements. However, Dr. Radwany's letter provides the opportunity to further clar- ify that associations documented in observational studies should not be interpreted as causal relationships (even when the associations support a causal hypothesis).-- Robert A. Pearlrnan, MD, and Richard Uhlmann, MD, Vet- erans Administration Medical Center and University of Washington, Seattle, Washington Reference 1. Pear)man RA, Uhlmann RF. The relationship between quality of life and resuscitation. J Am Geriatr Soc 1986;34:915 write well they cannot think well, and ff they cannot think well others will do their thinking for them. Turning to Dr. Lee's opening remarks I am reminded of the story of the Centurions who stood at the foot of the Cross. One said, "I hear He was a great teacher." "Yes," replied the other, "but he never published anything."-- Robert Matz, AID, Montefiore - North Central Bronx Hospital, Bronx, New York References 1. Lee RV: Writer's block. J Gen Intern Med 1987;2:62-4 2. Bean WB: Testament of dut-y, some strictures on moral responsibilities in clinical research, J Lab Ciin Med 1952;39:3-9 On the Importance of Writing Well To the Editors:-- I was disappointed in Lee's editorial, "Writer's Block. ''~ Why compose words with such heat? Does he really believe the good in medicine is so narrowly defined as to fit within his own construction? Students, like children, have keen sensitivities, though they don't always give clear expression to their feelings. I suspect the continuing interest in clinician role models re- flects not a desire for scientific illiteracy, but a wish to see realized the image of a selfless healer they are all raised to emulate. They want to see doctors working for patients out of love, not out of lust for academic fame or the fear of an unlettered, untenured banishment. "No man can serve two masters,"2 and it is nowhere more true than in a man's own breast. If you have never known an unpublished healer dedi- cated to the finest care of his capacities can provide, you have not met the greatest of physicians. -- Bruce Williams, MD, 2012 St. Christopher, Lexington, Kentucky "There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy."--Shakespeare References 1. Lee RV. Writer's block. J Gen Intern Med 1987;2:62-4 2. New Testament, Matthew, VI, 24 To the Editors:-- Never wishing to be on the business end of Dr. Richard Lee's pen 1 and being, in general, in agreement with much of what he says, I would, neverthe- less, like to respond, in part, to his editorial. I am convinced that the explosive growth of the medi- cal literature is to a significant degree related to the per- ceived necessity for young, academically inclined physi- cians to publish (or perish) and for older, established academicians to justify their grant support. Much of what is published is irrelevant and poorly written in pseudo-sci- entific jargon. It is, therefore, my belief that before urging physicians to publish their findings, results, or case reports as a reflection of academic prowess or membership in a learned profession, we should heed William B. Bean's words. In 1952 he said, 2 "The so-called medical literature is stuffed to bursting with junk, written in a hop-scotch style characterized by Brownian movement of uncontrolled parts of speech which seethe in restless unintelligibility." More to the point that I believe Dr. Lee is trying to make is George Orwell's comment that if people cannot The author replies:--I thank Dr. Matz and Dr. Wil- liams for their letters, both of which express not uncommon and deeply held sentiments. Dr. Matz is absolutely correct to bring in George Orwell's comment. Writing is an essen- tial discipline for people who need to think. It is also an essential discipline for people who educate a wider audi- ence than audiences composed of individual patients, bedside rounds, or grand rounds. Physicians are public as well as private servants and need to teach through the written word. Jesus Christ was a great teacher--and a superb academic administratofl He surrounded himsel~ with a group of literate and articulate apostles. Christian- ity would have died on the cross if it were not for Paul, Matthew, Mark, Luke, John, and the glorification and pres- ervation of writing by Augustine, a host of unnamed monks during the Middle Ages, and modern theologians such as Tillich and Kung. The crucial difference between the doctor and the quack is that the doctor has no secrets. Physicians write cases up so that their colleagues and the rest of the world can understand them and their thinking. Writing and writ- ing well is not a second master--it is only one of many talents that physicians must bring to the care of their pa- tients. Like all other talents it can be misused. There is no regulation that constricts physicians from writing for other than the standard medical literature. Physicians ought to be writing for their local newspapers, the lay press: not to describe their cases in detail but to relate their experiences, their impressions, their beliefs. We have only to look at the growing intrusion of uncaring and unpublished Bureaucrats in the economics of health care to begin to comprehend the disaster that follows a decline in the capacity of physicians and the medical pro- fession to communicate effectively. William Bean was absolutely right. But the way to correct deficiencies in the medical literature is not to stop writing but to practice writing with the same intensity that we practice medicine. Doctors ought to be literate--not just scientifically literate but socially, emotionally, politi- cally, and literarily literate. To have teaChers who cannot grade a student's patient writeup as carefully as an En- glish professor grades a paper mocks the notion of medi- cine as a learned profession. That Drs. Williams and Matz took the time to write and to refer to Shakespeare, the Bible, and the medical litera- ture is refreshing and reassuring.- Richard IT. Lee, MD, Department of Medicine, Children's Hospital of Buffalo and State University of New York at Buffalo, Buffalo, New York
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Transcript of On the importance of writing well
JOURNAL OF GENERAL INTERNAL MEDICINE, Volume 2 (May/Jun). 1987 ?. 11
d a n c e in resusc i ta t ion p re fe rences} Final ly, w e w e r e ex- t remely careful to avo id c a u s a l s ta tements . However , Dr. R a d w a n y ' s let ter p rov ides the oppor tuni ty to further c lar- ify that a s soc ia t ions d o c u m e n t e d in obse rva t i ona l s tudies should not b e in te rp re ted a s c a u s a l re la t ionships (even w h e n the a s soc ia t ions suppor t a c a u s a l h y p o t h e s i s ) . - - Rober t A. Pearlrnan, MD, and Richard Uhlmann, MD, Vet- erans Administration Medical Center and University of Washington, Seattle, Washington
Reference
1. Pear)man RA, Uhlmann RF. The relationship between quality of life and resuscitation. J Am Geriatr Soc 1986;34:915
write well they canno t think well, a n d ff they canno t think wel l o thers will do their thinking for them.
Turning to Dr. Lee 's o p e n i n g r e ma rks I a m r e m i n d e d of the story of the Centur ions who stood at the foot of the Cross. O n e said, "I h e a r He w a s a g r e a t t eacher . "
"Yes," rep l i ed the other, "but he n e v e r pub l i shed a n y t h i n g . " - - Robert Matz, AID, Montefiore - North Central Bronx Hospital, Bronx, New York
References
1. Lee RV: Writer's block. J Gen Intern Med 1987;2:62-4 2. Bean WB: Testament of dut-y, some strictures on moral responsibilities
in clinical research, J Lab Ciin Med 1952;39:3-9
On the Importance of Writing Well
To the Editors:-- I w a s d i s a p p o i n t e d in Lee 's editorial , "Writer 's Block. ''~ Why c o m p o s e words with such hea t? Does he rea l ly be l i eve the g o o d in med ic ine is so na r rowly de f ined a s to fit within his own construct ion?
Students, l ike children, h a v e k e e n sensitivities, though they don ' t a l w a y s g ive c l ea r express ion to their feel ings. I suspec t the cont inuing interes t in c l inician role mode l s re- flects not a des i r e for scientific i l l i teracy, but a wish to s e e r ea l i zed the i m a g e of a self less h e a l e r they a r e a l l r a i s e d to emula te . They w a n t to s e e doctors work ing for pa t ien ts out of love, not out of lust for a c a d e m i c f ame or the fear of a n unle t tered, u n t e n u r e d ban i shmen t . "No m a n c a n se rve two masters,"2 a n d it is n o w h e r e more true t han in a m a n ' s own breas t .
If you h a v e n e v e r k n o w n a n unpub l i shed h e a l e r ded i - c a t e d to the finest c a r e of his capac i t i e s c a n provide , you h a v e not met the g rea t e s t of phys ic ians . - - Bruce Williams, MD, 2012 St. Christopher, Lexington, Kentucky
"There a r e more th ings in h e a v e n a n d ear th , Horatio, t han a r e d r e a m t of in your p h i l o s o p h y . " - - S h a k e s p e a r e
References
1. Lee RV. Writer's block. J Gen Intern Med 1987;2:62-4 2. New Testament, Matthew, VI, 24
To the Editors:-- Never wish ing to b e on the bus iness e n d of Dr. R ichard Lee 's p e n 1 a n d being, in gene ra l , in a g r e e m e n t with much of w h a t he says , I would, never the - less, like to respond , in part , to his editorial .
I a m conv inced that the exp los ive growth of the med i - ca l l i te ra ture is to a s ignif icant d e g r e e r e l a t ed to the per - c e ived necess i ty for young, a c a d e m i c a l l y incl ined phys i - c i ans to publ i sh (or perish) a n d for older, e s t ab l i shed a c a d e m i c i a n s to justify their g r a n t support . Much of w h a t is pub l i shed is i r re levant a n d poor ly writ ten in pseudo-sc i - entific j a rgon . It is, therefore, m y belief that before urg ing phys i c i ans to publ i sh their f indings, results, or c a s e repor ts a s a ref lect ion of a c a d e m i c p rowess or m e m b e r s h i p in a l e a r n e d profession, w e should h e e d Wil l iam B. Bean ' s words . In 1952 he said, 2 "The so -ca l l ed m e d i c a l l i tera ture is stuffed to burs t ing with junk, wri t ten in a hop-sco tch style c h a r a c t e r i z e d b y Brownian m o v e m e n t of uncontrol led pa r t s of s p e e c h which s ee the in res t less unintelligibility."
More to the point that I be l i eve Dr. Lee is t rying to m a k e is G e o r g e Orwel l ' s comment that if peop l e canno t
The author replies:--I t hank Dr. Matz a n d Dr. Wil- l iams for their letters, both of which exp res s not uncommon a n d d e e p l y he ld sent iments . Dr. Matz is abso lu te ly correct to b r ing in G e o r g e Orwel l ' s comment . Writ ing is a n e s sen - t ial discipl ine for p e o p l e who n e e d to think. It is a l so a n e s sen t i a l discipl ine for peop l e who e d u c a t e a wide r aud i - ence t h a n a u d i e n c e s c o m p o s e d of ind iv idua l pat ients , b e d s i d e rounds, or g r a n d rounds. Phys ic ians a r e public a s wel l a s p r iva te s e rvan t s a n d n e e d to t e a c h through the writ ten word. Jesus Christ w a s a g r e a t t e a c h e r - - a n d a supe rb a c a d e m i c adminis t ra tof l He su r rounded himsel~ with a g roup of l i terate a n d a r t icu la te apos t les . Chr is t ian- ity would h a v e d i ed on the cross if it we re not for Paul, Mat thew, Mark, Luke, John, a n d the glorif icat ion a n d p res - e rva t ion of wri t ing b y August ine, a host of u n n a m e d monks dur ing the Middle Ages , a n d m o d e r n theo log ians such a s Tillich a n d Kung.
The cruc ia l d i f ference b e t w e e n the doctor a n d the q u a c k is that the doctor h a s no secrets . Phys ic ians write c a s e s up so that their co l l eagues a n d the rest of the world c a n u n d e r s t a n d them a n d their thinking. Writ ing a n d writ- ing well is not a s e c o n d m a s t e r - - i t is only one of m a n y ta lents that phys i c i ans must b r ing to the c a r e of their p a - tients. Like a l l o ther ta lents it c a n b e misused.
There is no regula t ion that constricts phys i c i ans from writ ing for o ther t han the s t a n d a r d me d ic a l l i terature. Phys ic ians ought to b e wri t ing for their local n e w s p a p e r s , the l a y press : not to d e s c r i b e their c a s e s in de ta i l but to r e l a t e their exper iences , their impressions , their beliefs. We h a v e only to look a t the g rowing intrusion of unca r ing a n d unpub l i shed Bureaucra t s in the economics of hea l th c a r e to beg in to c o m p r e h e n d the d i sas te r that follows a dec l ine in the c a p a c i t y of phys i c i ans a n d the med i ca l pro- fess ion to communica t e effectively.
Wil l iam Bean w a s abso lu t e ly right. But the w a y to correct def ic iencies in the m e d i c a l l i te ra ture is not to s top writ ing but to p rac t i ce writ ing with the s a m e intensi ty that w e p rac t i ce medic ine . Doctors ought to b e l i t e r a t e - - n o t just scientif ical ly l i te ra te but social ly, emotional ly , politi- cally, a n d l i terar i ly l i terate. To h a v e teaChers who canno t g r a d e a s tudent ' s pa t ien t wri teup a s careful ly a s a n En- gl ish professor g r a d e s a p a p e r mocks the notion of medi- c ine a s a l e a r n e d profession.
That Drs. Wil l iams a n d Matz took the t ime to write a n d to refer to S h a k e s p e a r e , the Bible, a n d the m e d i c a l l i tera- ture is re f resh ing a n d r e a s s u r i n g . - Richard IT. Lee, MD, Department of Medicine, Children's Hospital of Buffalo a n d S ta te University of New York at Buffalo, Buffalo, New York
