Writing lessons

Greetings from Chicago! Congratulations to Editor-in-Chief Prof. Raju Vaishya and the Indian Arthroscopy Society on the launch of this ambitious new journal, which reflects the energy and creativity of its parent organization. It has been my pleasure and privilege to become friends with many IAS members since attending my first IAS meeting 7 years ago in Mumbai. I’ve relished my opportunities to visit your wonderful country and exchange ideas with so many surgical experts. The collaboration between the Orthopaedic Journal of Sports Medicine and IAS as a supporting partner society has been an especially rewarding experience. Most recently, I enjoyed speaking to the IAS members via an online webinar; it was remarkable that such an event could be so well coordinated among participants almost half a world apart. Today, I would like to share with the readers some lessons that I have learned from a variety of sources over the years that may help you in your own scientific writing.

One of the tasks that fall to me as an editor is writing editorials for the American Journal of Sports Medicine. This is always a challenging and somewhat intimidating undertaking. Challenging, because I want the finished editorial to be knowledgeable and accurate; intimidating, because it is the only part of the journal that is not peer-reviewed prior to publication. I know that ultimately friends and readers will evaluate the finished product and form their own opinions.

As time has gone by, I have gradually developed my own personal approach to writing these opinion pieces, incorporating lessons from other speakers, friends, and writers whom I admire. One of these is Tom Henry, my former pastor, who has a talent to give powerful sermons that connect meaningfully with his congregants. Tom often starts off his sermons with an anecdote from his personal life that ultimately leads to the theological message he wants to communicate. At the end of the sermon, he always returns to the opening story and ties the main message back into it. This technique brings the speaker and listener closer together and allows the listener to form a personal attachment to the subject. Whenever possible, I try to start my editorials with a story from everyday life, sometimes my own, sometimes from current events, sometimes from literature, and then tie back into it at the end.

Of course, this is not always feasible. I am careful not to force an analogy if it does not arise naturally. This is a lesson I learned from one of my best friends, Leo Kocher, who has been our wrestling coach at the University of Chicago since I became Head Team Physician there in 1981. Leo always cautions his wrestlers never to try to force a maneuver if the situation is not suitable for it. In wrestling, using a move that does not fit the moment can land you with your back pressed firmly against the wrestling mat. In editorial writing, forcing an analogy that does not naturally fit the situation will confuse your readers instead of illuminating them.

I learned other important lessons from Elmore Leonard, a prolific author of popular novels who passed away in 2013. Leonard’s books have sold millions of copies and have been adapted into several successful movies and televisions shows. His stories are known for their colorful characters and realistic dialogue. In an interview, Leonard described how he composed a novel. He said that he simply created the characters and put them into an interesting situation, then allowed them to write most of the novel by just being themselves and doing what they would naturally do. Then, when the novel was about three-quarters finished, he would intervene and decide how to bring the story to a close. How did he know when the novel was about three-quarters finished? He decided that his books should be just long enough that you could read them from start to finish during a plane flight across North America.

One obvious lesson I learned from this interview was to make sure my editorials were not too long. I also paid attention to the way Leonard brought his novels to a close. At first glance, this may not seem very relevant to medical editorial writing. However, I think there are similarities. For me, choosing the topic is like creating the characters and initiating the plot. In an editorial, the characters are the relevant articles in the literature, and they determine what will happen in the main body of the editorial. After all the characters have spoken, I know that I must intervene and draw the “plot” to a close. To do so, I ask myself, what does this all mean to me? To orthopedic sports medicine specialists? To our patients? This tells me what the denouement of the editorial will be.

Many of these lessons can also be applied to reporting a scientific study. Clearly, a scientific report is more regimented than a sermon, a novel, or an editorial. However, there are relevant parallels. When you choose the topic you will investigate, you are selecting the characters and setting of your novel. The introduction is akin to the opening anecdote. It should not be a personal story, but it needs to tie the topic under investigation into everyday medical practice and convince the reader that learning the outcome of your study will help him or her take better care of real-life patients. The methods and results sections of the paper are like the middle part of the novel; they need to follow a strict format and tell the reader what you did and found. Just as the characters write the middle of the novel, the study that you initiated determines the content of these central portions of your paper. Then, you get to the discussion and conclusions of your report. This is where you again become the novelist, pulling the story together for the readers and telling them how you would interpret its outcome. Like a wrestler, you should be careful not to force a conclusion that does not logically follow from the findings of your study, or you might end up on your metaphoric back, staring up at the ceiling. Conclusions that do not follow naturally from the study data are a common reason for a journal to reject a submission.

Unlike editorials, scientific reports are preceded by an abstract. The abstract may be thought of as the “CliffsNotes” version of the paper. When I was a student, a large rack of these flashy black- and yellow-striped booklets was always prominently displayed in most US bookstores somewhere near the fiction section. These iconic publications were the creation of Clifton Keith Hillegass, who started production in his basement in Lincoln, Nebraska in 1958 with 16 titles from Shakespeare. Each booklet was specific for one work of literature and contained a pithy synopsis of the entire plot and questions to stimulate thought and analysis. Cliff sold his brainchild to a publisher in 1998 for a reported $14,200,000 and they are still produced today as CliffsNotes. These booklets were promoted by their creator as study guides to enhance a student’s understanding of the relevant work. However, more than 1 harried student, halfway through War and Peace and facing a test deadline, has undoubtedly taken the express route through the remainder of the novel via the CliffsNotes synopsis. Needless to say, such students would not perform very well on that pending exam if Cliff had not accurately summarized the original book. The same, if not greater, degree of accuracy is required when writing the abstract of a scientific paper. Most readers will peruse the abstract before deciding whether to commit the time needed to read the paper in its entirety, and many will never go on to read the rest of the paper. For this reason, it is imperative that the abstract precisely summarizes the study and explicitly report the most important data. A vague or inaccurate abstract could mislead a reader and possibly result in an inappropriate clinical application of the study findings.

Lessons like these, learned from a variety of life experiences, have helped me craft my personal approach to editorial writing. I hope that readers of the Journal of Arthroscopic Surgery and Sports Medicine will enjoy these insights and perhaps find them helpful in their own medical writing. Launching a new journal is an exciting undertaking, and I send my best wishes to the Indian Arthroscopy Society for continued success.