{"id":41117,"date":"2018-01-16T18:30:23","date_gmt":"2018-01-16T17:30:23","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=41117"},"modified":"2018-01-26T13:33:58","modified_gmt":"2018-01-26T12:33:58","slug":"richard-smith-the-corruption-of-medical-language","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/01\/16\/richard-smith-the-corruption-of-medical-language\/","title":{"rendered":"Richard Smith: The corruption of medical language"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-33037\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/richard_smith_2014-150x150.jpg\" alt=\"richard_smith_2014\" width=\"128\" height=\"128\" \/><\/a><span style=\"font-weight: 400\">A young doctor friend sends me a link to a piece he has written in the <\/span><i><span style=\"font-weight: 400\">Guardian<\/span><\/i><span style=\"font-weight: 400\"> newspaper. I praise the simplicity and clarity of the language and suggest that next time he sends a piece to an academic journal he uses the same language. \u201cBut will the editors accept it?\u201d he asks me. I\u2019d like to think that they\u2019d prefer it, but I fear that his anxiety about a piece in clear, simple language being rejected may be right, at least with some editors. Why on earth should that be?<\/span><\/p>\n<p><span style=\"font-weight: 400\">Almost everything, I believe, can be expressed in simple, clear language that everybody can understand, and authors often use complex language because they don\u2019t fully understand what they are trying to say. \u201cGood prose,\u201d said George Orwell, \u201cis like a window pane\u201d: you see straight through it to what the author is trying to say. I accept that there are ideas\u2014as in theoretical physics\u2014so complex that simple language will not suffice; but even with theoretical physics I think of the marvellous writing of Carlo Rovelli, who shows to everybody how theoretical physics has the magic of poetry. Of course, the language of theoretical physics is not words at all but mathematics\u2014and few of us know enough maths to understand it.<\/span><\/p>\n<p><span style=\"font-weight: 400\">I accept as well that if writing for a technical audience then it makes sense to use their language. Doctors will know what you mean by \u201cglomerulonephritis,\u201d and it wouldn\u2019t make sense when writing for doctors to explain each time what it is, especially as some doctors, most obviously nephrologists, will have in their minds a whole mountain of information about glomerulonephritis. But there aren\u2019t ideas in that mountain that could not be explained in clear, simple language if the author wanted to.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Too often, I suggest, academic journals are filled with complex language because authors are too lazy or too incompetent to write clearly or, worst of all, because they want to make their writing seem grander and more important than it actually is. Michael O\u2019Donnell, one of medicine\u2019s best writers, famously called this style of academic writing \u201c<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1713801\/pdf\/brmedj00031-0032.pdf\">decorated municipal gothic<\/a>.\u201d <\/span><span style=\"font-weight: 400\">Such writing, he said, \u201cmust be long, tortuous, opaque, uninteresting, and possess a \u2018built-in quality of unreadability.\u2019&#8221; Its main purpose, he argued, was not to inform the reader but to ennoble the writer.<\/span><\/p>\n<p><span style=\"font-weight: 400\">O\u2019Donnell identified two causes of \u201cdecorated municipal gothic.\u201d One is that academic writers are not concerned with readers but rather with extending their list of publications. Real writing is about condensation of ideas, whereas academics are often trying to get as many words as possible from a small amount of information.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The second cause is relevant to my young friend in that they believe that there is \u201ca norm out there to which they must conform.\u201d Understandably, they read the turgid prose in academic journals and think that is the way they must write to be published. In addition, they have often been badly taught\u2014taught, indeed, to write badly. They half remember, said O\u2019Donnell, \u201cthe rules their decrepit chemistry teacher taught them all those years ago: never use the first person; always use the passive construction; no colloquialisms; and Latin and Greek give an air of erudition\u2014rules that are totally outdated.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">I can remember being taught to write \u201cdecorated municipal gothic\u201d when writing a thesis as a medical student. I rage particularly about being told to write in the passive voice\u2014\u201cthe cat was sat on by the mat\u201d rather than \u201cthe cat sat on the mat,\u201d in case you are not sure. My teasing example immediately shows you that the active is easier to read. It also gives more information: instead of writing \u201cthe experiment was conducted,\u201d you have to disclose who conducted it. \u201cI did the experiment,\u201d or \u201cMickey Mouse did it.\u201d \u201cDid\u201d is Anglo-Saxon, \u201cconducted\u201d is the Latin (or is it Greek?). Indeed, the passive voice is dishonest and self-deluding: we fool ourselves that when doing science we become wholly objective, discarding all the human foibles that can get in the way of excellent science.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The snobbish tendency to rank \u201cdecorated municipal gothic\u201d above plain language is not unique to medicine. My wife, an artist, refers to the \u201cart bollocks\u201d that is used by art academics. J K Galbraith and A J P Taylor, both wonderful and insightful writers, were looked down on by academics for writing so clearly in a way that non-academics could read and enjoy. I suspect jealousy.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The best piece of writing on writing that I know is George Orwell\u2019s <\/span><a href=\"https:\/\/faculty.washington.edu\/rsoder\/EDLPS579\/HonorsOrwellPoliticsEnglishLanguage.pdf\"><i><span style=\"font-weight: 400\">Politics and the English Language<\/span><\/i><\/a><span style=\"font-weight: 400\">. <\/span><span style=\"font-weight: 400\">In the short essay he enumerates the rules of writing good English (mostly the opposite of those of the \u201cdecrepit chemistry teacher\u201d), but his central argument is that politics corrupts language. Good writing is saying something as clearly and simply as possible, but politicians are usually concerned with the opposite\u2014making grand statements that have no substance because substance is commitment. Political language, wrote Orwell, &#8220;is designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind.&#8221;<\/span><\/p>\n<p><span style=\"font-weight: 400\">\u201cDecorated municipal gothic\u201d is not quite concerned \u201cto make lies sound truthful and murder respectable,\u201d but it may be trying \u201cto give an appearance of solidity to pure wind\u201d or at least to make a few trivial observations seem important.<\/span><\/p>\n<p><span style=\"font-weight: 400\">I urge my young friend to persist with his simple language, but reading the language in many scientific journals I fear that he may have to translate his words into \u201cdecorated municipal gothic\u201d in order to advance his career. How sad.<\/span><\/p>\n<p><span style=\"font-weight: 400\"><strong>Author&#8217;s note:<\/strong> Since writing this blog and finishing the <\/span><i><span style=\"font-weight: 400\">Elements of Eloquence:<\/span><\/i> <i><span style=\"font-weight: 400\">How to Turn the Perfect English Phrase<\/span><\/i><span style=\"font-weight: 400\"> by Mark Forsyth I have partially recanted. You can read my recantation <a href=\"https:\/\/richardswsmith.wordpress.com\/2018\/01\/14\/recantation\/\">here<\/a>.<\/span><\/p>\n<p><em><strong>Richard Smith<\/strong>\u00a0was the editor of The BMJ until 2004.<\/em><\/p>\n<p><strong>Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A young doctor friend sends me a link to a piece he has written in the Guardian newspaper. I praise the simplicity and clarity of the language and suggest that [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/01\/16\/richard-smith-the-corruption-of-medical-language\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38364,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[955],"tags":[],"class_list":["post-41117","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-richard-smith"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Richard Smith: The corruption of medical language - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/01\/16\/richard-smith-the-corruption-of-medical-language\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Richard Smith: The corruption of medical language - The BMJ\" \/>\n<meta property=\"og:description\" content=\"A young doctor friend sends me a link to a piece he has written in the Guardian newspaper. 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