on the importance of writing well
TRANSCRIPT
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