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I started to write this monthly column in the Postgraduate Medical Journal in January 2008. Since then I have commented in each issue on topics related to reflective practice and medical humanities. Two successive editors have been tolerant enough to allow me to interpret that remit very broadly, and they have known how to nudge me diplomatically towards more clarity or circumspection when I strayed into waffle or ranting. As some readers may know, I have now joined the panel of columnists for the BMJ so this article will be my last in the back pages of this journal. In future, the column will be open to submissions from any reader who has something of interest and importance to say. I believe this is an excellent decision. I hope it will particularly encourage younger writers to submit articles.
I want to use this valedictory essay to share some memories and reflections on my own experiences as a columnist, together with some suggestions for anyone who would like to try their hand at being one occasionally or on a regular basis. I started as a medical columnist in 1980 for a periodical that has long since gone and I have continued more or less without a break for different journals ever since. Originally, I wrote all my articles on a typewriter. This involved amending typos by sloshing something called ‘correction fluid’ on the paper using a miniature brush, or by ripping the sheet out of the machine and starting all over again, before dispatching each article by fax machine or by putting it in a post box. If I needed to do background research or check citations for a piece, I had to visit a library, look through bound volumes of Index Medicus for the references, and search for the relevant journal on the shelves. In retrospect, this seems like a horribly arduous process, but it did not feel like that at the time. It inculcated a discipline that was incredibly useful, especially since it was impossible to remedy mistakes and avoid reputational risks after submitting a piece.
I used a personal computer from 1989 and it made writing fantastically easier. Later, connection to the web changed the experience beyond recognition. Adapting to successive innovations has made me aware of how writing is created by the technologies we use as much as in our heads. Almost all the articles I have written in the last 20 years have relied on forms of communication that would once have taken days or weeks to complete and are now practically instantaneous. These include internet searches for sources of information and for images, as well as queries and responses from expert colleagues and editorial staff, and rapid online approval of proofs.
Such electronic miracles have also brought their own demands. For example, any reader can now post an immediate challenge to a questionable fact or specious argument as soon as your writing comes out. The intimate connection between the published word and social media also means that writers are open to unmediated criticism and even hostility that require a thicker skin than any of us needed before. Writing today is quite unlike it was for a readership in 2008, let alone in 1980. We have no idea what it will be like by 2030. Any aspiring writer – including those who hope to appear here in the back pages of the Postgraduate Medical Journal – will need to embrace new technologies and publishing environments as they change from year to year.
There are also some very basic ground rules for non-academic medical writing that are almost insulting to spell out but I will mention a few since I sometimes meet would-be writers who are surprised by them. Here they are:
Never miss a deadline or exceed your word limit. If you do, you may never be asked to write again.
Respect the views of the editor and reviewers. They are generally right and you need them on your side.
Never submit an article without showing it to a friend, relative or colleague who is able to offer frank criticism. Follow their advice.
Assuming you are happy to observe this guidance, I would also suggest some other principles you should follow. Study the medium you aim to publish in. The style that appears in your organisation’s newsletter is different from the Lancet. Similarly, an opinion piece is not the same as a research article. Write simply and as closely as possible to normal speech. To paraphrase the great political writer George Orwell, never use a long word when a short one will do, and if you can cut out a word, do so. (If you read one other famous article about writing, it should be Orwell’s brilliant essay on ‘Politics and the English language.’1) Do not attempt to imitate standard journal prose, most of which is pompous or dreary. Study the medical writers you admire, and who write most clearly and with passion. Current ones I would recommend who write for journals in the United Kingdom include Rachel Clarke, Trish Greenhalgh, Phil Hammond, Iona Heath, Amir Khan, Richard Lehman, David Oliver and Helen Salisbury. If I see any of their names on a by-line, I read the article, whether it is an opinion piece or scientific research. It usually grips me to the end. Engage with other writers, as well as your readers, on social media. Read books, including fiction and history as well as medical ones and journals.
Any medical writer will give this kind of advice, but I would add some personal suggestions too. Surprise your readers. For example, if every writer in your favourite journal is banging on about resource shortages, or the evils of something like appraisal and revalidation, write about a favourable experience of your own that leads readers to question their absolutism. Follow a clear and transparent structure and narrative. Dividing your argument into three parts often works. Avoid sanctimony or implying that everyone who disagrees with you is wrong. Do not be shy of humour. Entertain and inform your readers, for example by including some apt lines from a poem or scripture, a historical comparison or an image from a work of art or film. The main purposes of writing (unless for research or career advancement) should be for enjoyment and sharing your thoughts with others, and you are unlikely to earn any significant sums compared with your day job.
I have been immensely fortunate down the years in the encouragement and support I have had from outstanding production teams and editors – these have included Dr Stephen Lock (the legendary editor of the BMJ while I was still a medical student) and Professor Bernard Cheung at the Postgraduate Medical Journal today. I look forward very much to a continuing connection with both these journals, and to being informed, surprised, entertained and impressed by what appears in these pages in the future. Above all, I would like to thank the countless readers of this journal who have engaged in exchanges with me over the past fifteen years and enriched my knowledge and understanding of medicine and the world around us.
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Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.