Michael Gerchufsky, ELS, is the managing editor of Consultant. E-mail him with thoughts on this post at mgerchufsky@hmpglobal.com.
In my last Writing Clinic blog post, part 1 of “Choose Your Topic Carefully,” I recommended a few first steps to authoring and contributing a clinical case report or review article to Consultant, including getting started, considering the audience, familiarizing yourself with the publication and the other journals in the field, and considering the timeliness of information about a topic, given the time needed for the peer-review, editorial, and publishing processes.
Here in part 2, I’ll discuss choosing a topic with the appropriate scope, and finding your article’s “hook” or your “angle.”
General (Broad) vs. Specific (Narrow)
Throughout my career as an editor of medical publications, I’ve come to realize that among physicians and other clinicians, perspectives about writing an article fall on a spectrum. At one end of the spectrum are those who consider 1000 words to be a daunting number that may as well be a billion, and at the other end are those who consider 1000 words to be the appropriate length of an introductory paragraph. Either end of the spectrum offers unique challenges to us editors. Thankfully, most contributors fall comfortably in the middle of the continuum.
Whether you find it difficult to write an article of more than a page or two in length or you find it difficult to rein in your word count, one of the keys to finding a happy medium is making arriving at an appropriate scope.
Broad Can Be Good …
I have seen so many writers get lost deep in the high weeds of a topic because they hadn’t sufficiently narrowed their scope. While writing about broad topics has its benefits—abundant research data, varying perspectives and opinions, a rich well of literature—it also has the potential to quickly become overwhelming.
Let’s say, for example, you want to write about a patient in whom you recently diagnosed type 2 diabetes incidentally during a well visit. You introduce the article with worldwide statistics about people of all ages with type 1 and type 2 diabetes. Then you write a section about the etiology and pathophysiology of diabetes, including detailed descriptions of the intestinal absorption of food, the breakdown of glycogen, and gluconeogenesis, along with an explanation of the role of insulin in maintaining normoglycemia. You begin to write a section on insulin resistance, renal resorption of glucose, and glycosuria, and you still want to include sections on the diagnostic tests for diabetes and on each medication class used to treat the condition, and …
Suddenly, you realize you’ve reached 3,000 words, and you haven’t even gotten to your patient’s case yet.
… But Narrow Is Better
Hundreds of textbooks have been written on diabetes, and we still have not exhausted the topic. In this case, focusing in more narrowly (and carefully considering the audience) will make writing this article much more manageable.
The core audience of Consultant—primary care providers—doesn’t need a primer on the physiology of the diabetic state. (Those textbooks I mentioned? It’s in there.) A narrow focus is the key.
So let’s back up, and find the angle or hook.
What’s the Hook?
An article’s hook is the point around which the information in it pivots. It often is an unexpected finding that serves as a reminder for your colleagues.
You think about your patient with an unexpected type 2 diabetes diagnosis. She was a 12-year-old African American girl who presented for a well visit with obesity, acanthosis nigricans, and suspected vaginal candidiasis. You begin to systematically detail the chronology of her visit, including findings of the history, physical examination, and laboratory tests; your process of differential diagnosis; your treatment plan; and the girl’s prognosis and the her course on follow-up visits. A brief mention of a few of the more interesting statistics and other information you uncovered in your research—maybe about type 2’s disproportionate prevalence in Black children, or about the incidence of concomitant Candida infections in girls with poorly controlled diabetes—certainly would add context to the case report.
Show AND Tell
An article’s hook—especially articles in Consultant—often is a clinical image. In fact, we rarely publish articles without a photograph, radiologic image, or other graphic element. Case reports of unusual dermatosis make little sense without a photo, and descriptions of orthopedic conditions are incomplete without radiographs or an MRI image. In the case of the girl above, photographs of her acanthosis nigricans would be appropriate.
A Topic That’s Close to You
One more bit of advice: Nobody wants to write about a topic they’re not naturally interested in; accordingly, nobody wants to read an article on a topic about which the author is not enthusiastic.
Choose a topic in your clinical wheelhouse, perhaps one that you see and treat with some frequency. Or choose a topic or a case that’s closer to you than that: You might be surprised at the percentage of case reports that involve an author’s family member—or even the author himself or herself.
Writing about a condition or case about which you or a relative or close friend has firsthand experience has risks and rewards. Medical records, images, and signed patient consent forms are readily obtainable; it's nearly impossible for the patient to be lost to follow-up, and the personal stake in the diagnosis, management, and outcome make for a more compelling narrative. On the other hand, treating family, friends, and oneself raises ethical concerns; whether those concerns extend to writing about family, friends, and oneself, even if the relationship or identity of the patient is concealed in the final article, is a matter of debate. Still, it’s something to consider.
Coming soon, watch for part 3 of “Choose Your Topic Carefully,” in which I’ll discuss zebras vs horses and the pros and cons of choosing either as a topic.