Manuscript Writing

Click to increase image sizeClick to decrease image size

Phillip S. Leventhal

4Clinics

[email protected]

Writing first sentences

The New Statesman magazine runs a weekly competition. There are recurring favourites, such as the one for opening sentences of novels so awful that the reader will read no further. Some medical opening sentences are likely to have the same effect. Here is the first sentence of a chapter on renal blood flow, from a book about specialized cardiovascular physiology.

The kidneys are bilateral, bean shaped organs, which lie in a retroperitonal position on either side of the vertebral column beneath the diaphragm.

This curious mixture of Reader's Digest and anatomical detail is unnecessary for even a second year medical student, let alone someone reading a specialized textbook. (It is also inaccurate, because the kidneys are on each side, not either side, of the vertebral column.) A presentation on how to write papers (accessible via medicine.yale.edu) advises, ‘Grab the reader, drawing them immediately to the crucial issue that your paper addresses’. Too many papers start with information that can only be described as banal, the written equivalent of clearing the throat. Sometimes, a paper is improved instantly by just deleting the first sentence and starting with the second; sometimes a banal first sentence is an indication that a paper's introduction needs rewriting, often because the authors have fallen into the trap of thinking that the introduction should be a general review of the topic. While appropriate for a thesis, a general review is unnecessary – and boring – in a research paper that asks and answers a circumscribed question.

I found a paper in the journal Chest, which is the official journal of the American College of Chest Physicians. It is ranked 3rd of 46 respiratory journals on its impact factor, so it is a leading journal. The paper was titled: ‘Significance of pulmonary arterial pressure and diffusion capacity of the lung as prognosticator in patients with idiopathic pulmonary fibrosis’. (Some may find the single word prognosticator better than the phrase prognostic factor. I do not, and think rather that a prognosticator is a person who makes prognoses.) The opening sentence of the paper was ‘Idiopathic pulmonary fibrosis is a relatively common interstitial lung disease’, surely unnecessary for readers of Chest. Of the paper's 34 references, 29 were available as full text on the internet. Twelve of these had opening sentences that were little improvement, being variations on ‘Idiopathic pulmonary fibrosis is a progressive interstitial lung disease of unknown etiology and with a poor prognosis’. Just two papers had focused opening sentences that told readers what was coming next: ‘In idiopathic pulmonary fibrosis, there is an unmet need for an accurate noninvasive measure of disease severity’ and ‘Idiopathic pulmonary fibrosis has undergone important redefinition in the last several years, based largely on revised histopathologic classification criteria’.

I think the best – or worst – example I found in my search was the opener to ‘The search for an ideal method of abdominal fascial closure: a meta-analysis’. With blinding insight, the authors had written, ‘The ideal suture for closing abdominal fascia has yet to be determined’.

You can usually rely on orthopaedic surgeons to be straightforward. The opening sentence to ‘Dislocations after total hip-replacement arthroplasties’ was not waffle about hip replacements being an increasingly common weapon in the orthopaedic surgeon's armamentarium but, ‘Between January 1972 and June 1975, 300 total hip-replacement procedures were performed by five surgeons on the orthopaedic service of the Northwestern Memorial Hospital’; and right away we were in there with the surgeons looking at their results.

It is not a novel, and it is not a medical paper, but my favourite opening sentence is from one of my favourite books by one of my favourite authors, an author who has written a number of books about words: Bill Bryson. The best of his travel books is The lost continent. Its opening sentence – actually, its opening two sentences, its opening paragraph: but there are only eight words in all, and two of them are the name of a town – is a brilliant book, and I was unable to put the book down once I had read them:

‘I come from Des Moines. Somebody had to’.

Neville W Goodman

[email protected]