William Cayley: The value of the tweet

bill_cayley_2I’ve only recently begun tweeting, but have already been struck by the challenge of sometimes trying to convey complex ideas in 144 characters or less. The combinations of abbreviations, “hashtags,” and “@’s” can add complexity, but also confusion—the challenge is how to get the right balance of complexity, yet clarity.

Writing the “perfect tweet” is reminiscent of another short form, the 55 word story. Here, the challenge is to tell a narrative that is meaningful, motivating, or inspirational using precisely 55 words. Finding just the right combination of words to reach a total of 55 can be a challenge to one’s creativity far more than the demands of a larger project.

The haiku and sonnet present similar challenges, and they are ones I’ve not yet dared to face.

Then, there is the ultimate challenge for medical writers: the medical progress note!

While not high literature, a well written progress note seeks to convey depth and complexity, with brevity and clarity. Sadly, the spread of checklist medicine, especially as embodied in electronic medical records (EMRs), has led to increasingly voluminous dictation at the expense of clarity—the longer the checklist note, the less clear it is what in the world happened.

On the other hand, dictated progress notes also seem to be heading in the same direction. It seems that with each passing year, dictations from some physicians get longer and longer. “Covering all the bases” and “documenting what was done (or said)” are valid concerns (and I’m a liberal user of verbatim patient quotes in my documentation), yet when a note repeats the same detail three times but fails to convey a story, something has been lost.

When teaching, I find myself emphasizing over and over that the purpose of a written note (or a verbal presentation) is not merely to repeat or regurgitate what has been said or done, rather the goal of written or verbal communication in medicine is to convey a synthetic analysis of a patient’s history and exam. Nearly anyone can repeat a story, the job of a medical professional is to transform a story into a meaningful assessment of a situation.

Perhaps one antidote to the growing volume of often low value medical communication is more practice with short, structured forms of communication. Should we and our students be working regularly on the discipline of writing 55 word stories, haikus, sonnets, or even tweets, in order to sharpen our abilities at turning information we have received into meaningful, concise, and clear stories of what is happening with our patients?

Often, briefly said is best said!

William E Cayley Jr practices at the Augusta Family Medicine Clinic; teaches at the Eau Claire Family Medicine Residency; and is a professor at the University of Wisconsin, Department of Family Medicine.

Competing interests: I declare that I have read and understood BMJ policy on declaration of interests and I have no relevant interests to declare.