Category: Symptoms Of Medicus Imconprehensibilis

4. Making Clear the Risk of Testosterone

1/25/2017

This blog post looks at an excerpt from an article published in the New England Journal of Medicine. (1) We underlined the long words.

The generalizability of these results is limited, however, because we excluded men with a high risk of prostate cancer and men with moderately severe urinary tract symptoms. Furthermore, the sample size was inadequate to assess reliably the effect of testosterone on the risk of these conditions. (WSEG = 46/23.0/23.4/15.6)

The WSEG score shows: this 46-word excerpt has an average sentence length of 23.0. Its reading ease score is 23.4 and grade level, 15.6. To us, this looks like garden-variety medical writing. We understand it, but it isn’t as clear as it might be.

Revising to improve reading ease

How might we revise to improve reading ease? For one thing, we would expect a text written in plain English to use sentences closer to 15 words average, and 25 words at most. The first sentence is 27 words long; we can easily split it in two.

This excerpt also uses more long words than it needs to. Nine of the 45 words, or 20%, have three syllables or more (9/46 = 20%). We can also replace some of the long words with shorter ones. In the excerpt, we underlined the long words and bolded the essential scientific terms. The table below shows our thoughts on replacing long words with shorter ones.

Trying to replace long words with shorter words

Long words	Shorter words that mean about the same thing
generalizability	general, generalize, can generalize
however	but, although
furthermore	too, also, and
inadequate	not enough, too small, too few, not robust
reliably	rely, reliable, repeatable, precise, accurate
conditions	illness, problem, disease

Precise vs. Accurate

As we looked for shorter words, it led us to ask, What does assess reliably mean here? The definition of assess is to estimate or judge the value, character, etc., of; evaluate (e.g., to assess one's efforts.)(2) In this context, the word assess alone implies a sound assessment. Therefore, the phrase assess reliably seems redundant.

Does it mean the assessment is precise, accurate or both? Precise means repeated measurements show the same results. Accurate means measurements come close to the true value. (3)

Since we weren’t sure what the excerpt was trying to say, we left out the word reliably.

Our Revision

Here is our attempt to revise to improve reading ease.

Original	Revised
The generalizability of these results is limited, however, because we excluded men with a high risk of prostate cancer and men with moderately severe urinary tract symptoms. Furthermore, the sample size was inadequate to assess reliably the effect of testosterone on the risk of these conditions. (WSEG = 46/23.0/23.4/15.6)	But we can’t generalize much from these results. Why? Since we left out men with a high risk of prostate cancer or moderately severe urinary tract symptoms. The sample size was also too small to judge how testosterone affects the risk of these conditions. (WSEG= 44/11.0/68.7/6.4)

We reduced long words to just 13% (6/45 = 13%). Is this the best revision? Perhaps you can think of something better. The point is: when you try, you can often improve reading ease a lot.

How much does reading ease change?

The chart below shows before and after WSEG scores.

WSEG	Meaning	Original	Revised	Change
W	Total words	46	44	-2
S	Average sentence length	23.0	11.0	-12.0
E	Flesch Reading ease	23.4	68.7	40.4
G	Flesch-Kincaid grade level	15.6	6.4	- 9.2

These data show a reader would find the revision much easier to read. If the whole article were revised in plain English, it could reach a much wider audience.

Conclusion

In this blog post, we looked at an excerpt that used long sentences and long words —two classic symptoms of medicus incomprehensibilis. We revised to fix these issues. We talk more about reading ease in Chapters 1 and 2 of Plain English for Doctors and Other Medical Scientists (Oxford University Press, 2017).

This blog post is fourth in a series on the Symptoms of Medicus Incomprehensibilis.

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(1) Snyder P, et al., “Effects of Testosterone Treatment in Older Men,” NEJM 374, no. 7 (2016): 622.
(2) Dictionary.com, s.v. “Assess," http://www.dictionary.com/browse/assess?s=t.
(3) Wikipedia, s.v. “Accuracy and precision,” https://en.wikipedia.org/wiki/Accuracy_and_precision (accessed 1/23/17).

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3. Breast Cancer Detection in Passive Voice

12/8/2016

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One symptom of medicus incomprehensibilis is passive voice. Passive voice means that the subject of the sentence receives the action rather than doing the action. Passive voice can be a useful writing technique, but it works best when you use it sparingly. Sometimes, it can make a sentence sound vague, wordy or abstract. Medical writing tends to overuse passive voice.

For this post, we look at an excerpt from an article published in The Journal of the American Medical Association(1) that uses three sentences in passive voice and one in active voice. We underlined the words in each sentence that make it passive.

Mammograms from women attending routine breast cancer screening at these centers during the study period were included. These were arranged into batches of approximately 40 women pursuant to standard practice in the United Kingdom. All mammograms taken during the study period were included in the trial, regardless of when they were examined. Each batch contained all cases from a single mammography acquisition machine in a single day. (WSEG = 67/16.7/ 35.7/12.5)

Note that the first and third sentences both say that mammograms … were included. The mammograms didn’t do anything. Instead, somebody did something with them.

Passive voice often involves a form of the verb to be plus a past particle. The first sentence uses the word were, the past tense of to be, and included, the past participle of to include. In the second and third sentences, the words, were arranged, were included, and were examined show they also use passive voice.

Can we revise the excerpt to improve reading ease? The only special terms we see are mammogram and mammography, and they are commonly understood. Therefore, we think we can probably revise to improve reading ease.

Our Revision

Here is our attempt to revise the excerpt to use less passive voice and improve reading ease.

Original

Revised

Mammograms from women attending routine breast cancer screening at these centers during the study period were included. These were arranged into batches of approximately 40 women pursuant to standard practice in the United Kingdom. All mammograms taken during the study period were included in the trial, regardless of when they were examined. Each batch contained all cases from a single mammography acquisition machine in a single day. (WSEG= 67/16.7/35.7/12.5)

The trial used the mammograms from women who came for routine breast cancer screening at the centers. It covered mammograms taken during the study period without regard to when they were read. They were arranged into batches of about 40 women under UK standard practice. Each batch contained all mammograms from one machine for one day.
(WSEG = 56/14.0/61.6/8.2)

In our revision, only the third sentence has its main clause in passive voice (i.e., they were arranged). The second sentence also uses a dependent clause in passive voice (i.e., they were read). We did this to keep a consistent subject with the previous sentence.

Is this a good paraphrase of the original? Do you find it easier to grasp? Perhaps, you can think of a better way to say the same thing.

**Comparing WSEG Scores**

Let’s compare WSEG scores for the original and our revised version.

WSEG	Meaning	Original	Revised	Change
W	Total words	67	56	-11
S	Average sentence length	16.7	14.0	-2.7
E	Flesch reading ease	35.7	61.6	25.9
G	Flesch-Kincaid grade level	12.5	8.2	-4.3

These data show a reader would likely find the revision easier to read. If the whole article were revised in plain English, it could reach a wider audience.

Conclusion

In this post, we looked at an excerpt that used passive voice—one symptom of medicus incomprehensibilis. We showed how we would revise to use less passive voice and make it easier to read. We talk about passive voice in Chapter 4 of Plain English for Doctors and Other Medical Scientists (Oxford University Press, Spring 2017).

This post is third in a series on Symptoms of Medicus Incomprehensibilis.
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(1) Taylor-Phillips S, et al. “Effect of Using the Same vs Different Order for Second Readings of Screening Mammograms on Rates of Breast Cancer Detection: A Randomized Clinical Trial,” JAMA 315, no. 18 (2016): 1957.

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1. Physical Activity and Long Words

11/8/2016

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Here is an excerpt from an article published in the Lancet (1).

Inclusion criteria were that data be from national or subnational cross-sectional populations based surveys undertaken with random sampling, reporting prevalence of inactivity based on the current or former recommendations, and including all domains of activity (work, household, transport, leisure). (WSEG =39/39.0/0.0/25.6)

This 39-word sentence uses many long words. We underlined each word with three syllables or more. (But we didn’t count a two-syllable word that takes on a third syllable by adding an -s or –ing ending.) We call these long words. The percentage of long words is high (11 long words/39 total words =28.2%).

The long sentence and long words result in a reading ease score of 0.0 on a scale from 0.0 to 100.0. The grade level is 25.6. This is equivalent to medical school plus 5.6 more years of training.

How can we improve reading ease?

Since this excerpt does not contain complex science, we can probably find a way to revise it to improve reading ease. One technique for improving reading ease is to break up a long sentence. Another is to replace long words with shorter words, where you can. Table 1 shows our thinking, as we tried to find shorter words to replace the long words.

Table 1. Trying to replace long words with shorter words

Long word	Shorter words
inclusion	to Include
criteria	reason, how to choose
national	country
subnational	region, part of country
cross-sectional	cross sectional
population	people, resident
undertaken	undertake, take
prevalence	rate
inactivity	lack of activity
recommendations	recommend, suggest
activity	exercise, active, movement

Here is our attempt to revise the excerpt to minimize long words (Table 2).

Table 2. Revising to improve reading ease

Original	Revised
Inclusion criteria were that data be from national or subnational cross-sectional populations based surveys undertaken with random sampling, reporting prevalence of inactivity based on the current or former recommendations, and including all domains of activity (work, household, transport, leisure). (WSEG =39/39.0/0.0/25.6)	How did we choose what data to include? It had to be from a survey of a cross section of people from a country or region. The survey had to report on a lack of activity based on current or former recommendations. The survey also had to report on all kinds of activity (work, housework, transport, leisure). (WSEG = 57/14.2/66.2/7.5)

Our revision uses four sentences instead of one. It uses only two long words. The percentage of long words is much lower (2 long words/57 total words = 3.5%).

Is this a good paraphrase of the original? Do you find it easier to grasp? Perhaps, you can think of a better way to say the same thing.

Let’s compare WSEG [Way-seg] scores for the excerpt and our revision (Table 3).

Table 3. Comparing WSEG scores

WSEG	Meaning	Original	Revised	Change
W	Total words	39	57	18
S	Average sentence length	39.0	14.2	-24.8
E	Flesh reading ease score	0.0	66.2	66.2
G	Flesh-Kincaid grade level	25.6	7.5	-18.1

These data show a reader would likely find the revised version easier to read. Our revision uses 18 more words, but since the words are shorter, it takes up less space. Average sentence length is lower. These changes improve the reading ease score by 66.2 points. The grade level decreases from 25.6 to 7.5. The WSEG score for the revision seems more in line with this excerpt’s level of science content. If the whole article could be revised in plain English, it could reach a much wider audience.

Conclusion

In this post, we looked at a long sentence and long words—two symptoms of medicus incomprehensibilis. We showed how we would revise to break up the long sentence and use fewer long words. These simple changes made the excerpt much easier to read. We talk more about sentence length and word length in Chapters 1 and 2 of Plain English for Doctors and Other Medical Scientists (Oxford University Press, Spring 2017).

This blog post is first in a series on Symptoms of Medicus Incomprehensibilis.

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(1) Sallis J, et al., "Progress in Physical Activity over the Olympic Quadrennium," Lancet 388, no. 10051 (2016), under "Adult Estimates."

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4. Making Clear the Risk of Testosterone

Revising to improve reading ease

Trying to replace long words with shorter words

Precise vs. Accurate

Our Revision

How much does reading ease change?

Conclusion

3. Breast Cancer Detection in Passive Voice

Our Revision

**Comparing WSEG Scores**

Conclusion

1. Physical Activity and Long Words

How can we improve reading ease?

Table 1. Trying to replace long words with shorter words

Table 2. Revising to improve reading ease

Table 3. Comparing WSEG scores

Conclusion

Categories

Archives

4. Making Clear the Risk of Testosterone

Revising to improve reading ease

Trying to replace long words with shorter words

Precise vs. Accurate

Our Revision

How much does reading ease change?

Conclusion

3. Breast Cancer Detection in Passive Voice

Our Revision

Comparing WSEG Scores

Conclusion

1. Physical Activity and Long Words

​How can we improve reading ease?

Table 1. Trying to replace long words with shorter words

Table 2. Revising to improve reading ease

Table 3. Comparing WSEG scores

Conclusion

Categories

Archives

**Comparing WSEG Scores**

How can we improve reading ease?