Category Archives: Medical writing

Left-branching doesn’t work!

Please read this sentence:


A group representing Washington County residents affected by the city’s plans for a city energy utility, a major mining concern, the University of Washington, and the city’s Chamber of Commerce are among the entities seeking to formally intervene in the city’s municipalization case before the Washington Public Utilities Commission. [I have disguised the names to protect the innocent…]


Could you process that sentence quickly? I thought not. Not only does the sentence clock in at 49 words (at least double the recommended word count for sentences), it also doesn’t get around to presenting the verb for 30 words. This means that we have no idea why we are reading those initial 30 words listing groups.

The Text Doctor would diagnose this as a classic left-branching sentence, explained by Stephen Pinker in The Sense of Style (New York, Viking, 2014). Contrast left-branching to right-branching sentences in which the subject appears before the verb at the beginning of the sentence so that the reader knows what the sentence is about. Pinker points out that “English is predominantly a right-branching language (unlike, say, Japanese or Turkish)…” (p. 109).

So, let’s recraft that left-branching sentence into a right-branching sentence:


Several entities [subject] seek to formally intervene [verbs] in the city’s municipalization case before the Washington Public Utilities Commission. Among these entities are a group representing Washington County residents affected by the city’s plans for a city energy utility; a major mining concern; the University of Washington; and the city’s Chamber of Commerce.


That’s four more words than the original, but the two shorter sentences are easier to process. As I teach in my technical writing webinars, if you want your readers to read what you wrote, always opt for the shortest sentences possible and almost always revise your left-branching sentences into right-branching.

And, as I did here, always explain your jargon: The terms “left- and right-branching sentences” are classic linguistic shorthand (jargon) that linguists must explain to the 99.9% of the world who are not linguists. And lest you think that nobody but a linguist would care about left-branching, know that your readers do want to process sentences quickly.

Learn more about Dr. Frick’s wildly popular technical writing webinars.

Questions, questions everywhere–I hope they make me think!

“I have no special talent. I am only passionately curious.”
Albert Einstein, physicist, 1879-1955

I have serious doubts about Einstein’s not having special talent, but I do believe the second sentence and try to apply passionate curiosity to all facets of my life. I have been especially thinking about curiosity recently after publishing a 3-page article in the AMWA Journal (V3 N2, 2015) titled “Developing Better Discovery Skills.” In it, I list types of questions that are useful.

In this blog post, I’ll write about closed-ended questions and open-ended questions. Closed-ended questions usually elicit a “yes” or “no” answer or specific, verifiable data. These produce valuable answers, but they allow the person whom you are questioning to provide only the specific answer; if you want more information on that topic, you’ll have to continue questioning them. Examples of closed-ended questions include:

  • What format (software) do you need?
  • What is the word limit? Page limit?
  • How many citations do you need me to edit?
  • How will I return my document to you?
  • What style guide should I adhere to?
  • What is the deadline? Can that be extended?

Open-ended questions stimulate thought and encourage continued conversation. These cannot be answered in few words or with a simple “yes” or “no” answer. Examples of open-ended question include:

  • How did we get to this point? What led up to this?
  • Why is it important to get this information out to our people?
  • What are the risks of not sending this information?
  • How will you come to the decision of what to include in this article?
  • Describe the audience, specifically their demographics.
  • What might be the biggest challenges in getting approval for this article?

To accomplish discovery as quickly as possible, it’s important to ask both open- and closed-ended questions in every situation. Before you face a client or attend a meeting, brainstorm all sorts of questions (if you know a 2-year-old, you’ll know what I’m talking about). Even if you don’t get to ask all of them, you’ll have plenty to fall back on.

I brainstorm questions when I’m walking the dog (I wish I could remember to take my phone or something to write with—I do my best brainstorming out in fresh air!).

Left-branching example of the week

A left-branching sentence is one in which the subject and verb do not appear until the sentence has wandered around for quite some time:

“Only offering height modifications in certain areas, explicitly describing what the city wants buildings to look like in [City] Junction and charging non-residential developments a fee to pay for affordable housing are three ideas [City] planners may implement this spring…”

The subject and verb of this sentence is “…three ideas [city] planners may implement this spring,” but we must read read 32 words before we can know what this sentence is all about.

We could right-branch this sentence this way:

[City] planners may implement the following three ideas this spring:

  • Only offering height modifications in certain areas
  • Explicitly describing what the city wants buildings to look like in [City] Junction
  • Charging non-residential developments a fee to pay for affordable housing

This revision also breaks out the long series items into a bulleted list, which makes the sentence easier to scan and comprehend. No extra charge!

We should always strive to make it easier for our audiences to read our sentences.

Why bother with a style guide?

If you write or edit more than one document a day or work with other writers and editors, you need a style guide to provide guidance on style (language conventions with respect to spelling, punctuation, capitalization, and typographic arrangement and display). You can create a style guide at the personal, department, or corporate level (depending on the politics in your workplace).

For example, will you write:

  • Provider Services Department or Provider Services department?
  • Post-operative or postoperative?
  • Bullet points with periods at the end?
  • Zero through nine as words and 10 and above as numerals?

If you want consistency in your documents, you must have a style guide to direct these and hundreds of other style decisions.

Base your style guide on a published style manual

Published style manuals include The Gregg Reference Manual or The American Medical Association Manual of Style. You can buy most style manuals on Amazon. To compare 12 currently published style manuals, download this style manual guide that I wrote with my colleague Elizabeth Frick. (You read that right―the other Elizabeth Frick [Betsy Frick] and I have collaborated on several books and documents).

Here’s the short version of that matrix:

  • For most technical and business documents, consider using The Gregg Reference Manual.
  • For medical documents, you must use The American Medical Association Manual of Style and/or Scientific Style and Format (the CSE Manual for Authors, Editors, and Publishers).
  • For academic publishing, consider The Chicago Manual of Style. This manual is generally not appropriate for technical or business writing.
  • For publishing psychological research, use APA (Publication Manual of the American Psychological Association). APA is generally not appropriate for technical or business writing.
  • For government writing, consider The Gregg Reference Manual and/or the U.S. Government Printing Office Style Manual (GPO Style Manual).
  • For journalism and marketing or sales writing, use AP (The Associated Press Manual of Style).  AP is rarely appropriate for technical or business writing.
  • For software documentation, use the Microsoft Manual of Style or Read Me First.

It’s important to realize that your chosen published style manual merely acts as the basis of your style guide―you can go against or “contra” any of the style manual’s advice. For example, if your chosen style manual requires a period after the abbreviation “Inc.” but your company does not use the period, you could list your style followed by the parenthetical (contra Gregg 122f). In a culture driven by individualism, not having to conform to a style manual on every decision may be comforting if you or others chafe at any hint of being controlled.

On the other hand, it may be even more comforting to know that you don’t have to create a style manual from scratch. Save time and base your style on a chosen published style manual, adapting it to work for your organization.


Maybe I do know what I know: Enduring principles for writing for both web and print

In my August newsletter, I shared my angst about whether what I teach in my technical writing classes is really informed by research or is simply based on instinct. My headline read: “How do I know what I know?” (My 8-year-old grandson saw that headline and said, “You just know what you know, Grandma! At least, I do.” Oh, to be always as self-assured as an 8-year-old!)

Fortunately, I’m no longer in angst because I have just read Letting Go of the Words: Writing Web Content that Works, Second Edition, by Ginny Redish, a fellow Fellow of STC. I had not read the first edition because of the book’s subtitle; I don’t write web content for a living nor do I usually teach people who write web content. However, my editor suggested reading Redish’s material on personas, and I got hooked on the whole book.

Ginny’s book confirmed that most of my cherished language beliefs do have a solid research foundation, at least for web readers. I recognize that there are differences between web and print-based reading, but I believe that most of the web principles that Ginny shares will generalize to the printed page as well (this may be an intellectual leap that we could argue).

Here are three principles from Ginny’s book that I also love to teach:

  1. Using color is problematic for at least two reasons: Some readers have color deficiencies, and colors carry cultural connotations that you might not be able to predict (pp. 50-52).
  2. Don’t center text, even in table columns, because centering violates the reader’s need for alignment (pp. 59-60).
  3. Readers seeking information look first at your first paragraph and then at the first words of list items (p. 139), so put the “bottom line on top” (i.e., lead with the most important information).

Although I do agree with most of Ginny’s points and practices, a few left me wondering:

  • She argues in favor of “turning sentences into more visual forms, like lists and tables” (p. 62), and I concur; but I wonder why she lowercases the first letter of each listed point. This practice contradicts what I see in almost all lists in technical writing today (again, I don’t know if any research argues one way or the other).
  • She recommends sans serif typefaces for both web and print-based text (p. 62). I’ve always taught that sans serif is best for web writing, e-mail, and slides, but serif is best for print-based text. I was fascinated to read that the research that claims that serif typefaces are better for sustained reading (print-based text) is now more than 60 years old. Ginny claims that “research on web content has not shown a consistent winner between serif and sans serif for either reading speed or comprehension.” However, her assertion that “preference almost always favors the familiar sans serif fonts [for the web]” is not as definitive as I would like.

Despite these minor concerns, I’m glad that I have studied Ginny’s book―it’s packed with excellent tips and persuasive case studies and makeovers. Above all, I found myself reinforced by her underlying principle: Before writing anything for any audience, always imagine a conversation with the reader:

  • What do they think?
  • What do they know?
  • What do they need to know?
  • What will they do with the information?

I don’t need research to tell me that this consideration of my audience’s wants and needs is valid―it’s just compassionate common sense.

And I’m glad that I had to rethink my assumptions: I had made an assumption that I didn’t need to read Ginny’s book because it was framed to help web writers. It turns out that most of her principles apply to the kind of writing that I do teach, and I wish I had read it earlier.

How do I know what I know?

Don’t worry. I’m not going all metaphysical on you. But I’ve recently begun to question one of my long-held beliefs about writing, and I feel conflicted.

Here’s how it came about: In my last newsletter, I wrote a review of Marcia Riefer Johnston’s new book Word Up! How to Write Powerful Sentences and Paragraphs.

I had high praise for her book, but I did challenge her chapter, “The Last Word,” in which she quotes many revered writing experts who say that the writer’s most important point should be placed at the end of the sentence, paragraph, or document. This structure is also known as the “periodic style,” and Johnston recommends its use for “every genre, from oratory to poetry to memoir.” 

The periodic (left-branching) style is the complete antithesis of what I teach: I believe that the best sentence structure for technical and business writing is right-branching rather than left-branching (see my 2008 blog for more explanation).

To understand left-branching versus right-branching style, compare these two sentences:

  • The functional state of our mold, options for correction, and responsibility are the topics I would like to discuss. [Left-branching: You don’t know until the end of the sentence why the three items are presented at the beginning of the sentence or why they’re important.]
  • I would like to discuss the non-functional state of our mold, options for correction, and responsibility. [Right-branching and clearer because you know immediately why the three items are presented.]

And then I got to thinking about the origin of my faith in right-branching sentences: I had discovered the term in a course on building sentences that I took from The Teaching Company[1], but I have yet to find any evidence-based research that proves that readers process right-branching sentences faster or better than left-branching sentences or vice versa. (I will admit that my search has not been exhaustive. This reminds me of former presidential candidate Herman Cain, who was known to say: “I do not have facts to back this up…”)

Nevertheless, I do believe that right-branching sentences are easier to process and understand than periodic sentences. But I know that it’s not enough to cling to my belief without researching what others have found in the way of evidence, so I’m embarking upon a literature search promptly.

And here’s where you come in: Please help me by taking my brief survey on sentences, which will be a good start toward qualitative research. I’ll proceed from there to quantitative research. Thank you!

[1] Landon, Brooks, Building Great Sentences: Exploring the Writers Craft, The Teaching Company, Chantilly, VA, 2008.

My favorite things: As perfect as it gets

I always regret that I cannot be a perfect editor. I aim for perfection, but it rarely happens for me (and I suspect, for other editors).

That’s why I was intrigued with “PerfectIt,” software that states on its website that it “runs a series of tests that suggest possible errors. At each stage it lets you choose whether those should be changed.”

PerfectIt checks for consistency of hyphenation; capitalization; numbers/words; capitalization in headings; abbreviations and acronyms (definitions/spelling); bullets; lists; figures; and tables. All these editing inconsistencies drive me crazy, and having software to flag these issues is a gift. PerfectIt has a lot more features that I don’t use at this point (but you might).

The free trial convinced me that I was missing errors and inconsistencies that were found by PerfectIt, so I bought a single license for $49. I run it as an add-on in Microsoft® Word as my last pass through the document (after global searching, onscreen editing, printing out and proofing, and running spellcheck). It works best on longer documents than shorter ones (apparently because a long document provides a bigger set of examples so that the software can determine the dominant style in the document).

As with any new software, I tested it on a few sample documents before launching it on a crucial project; it does take some self-training, which is enhanced by an excellent 4-page set of instructions. In my first use of PerfectIt, I managed to remove the first letter of each word in a 10-page document.

If you are an editor searching for another tool to help you edit mind-numbing larger documents, try PerfectIt!

(I make no money by recommending this or any other cool products that I like.)

Should you use “and” or “but” to start a sentence?

One of my newsletter readers wrote to ask:

Hi Bette:  Do you agree with the information below? (I’m from the old school, where I was taught never to begin a sentence with “and” or “but.”)

Contrary to what your high school English teacher told you, there’s no reason not to begin a sentence with but or and; in fact, these words often make a sentence more forceful and graceful. They are almost always better than beginning with however or additionally. Beginning with but or and does make your writing less formal?but worse things could happen to most writing than becoming less formal.

Note, though, that if you open with but or and, you usually don’t need a comma: not “But, we did it anyway”; it’s enough to say “But we did it anyway.” The only time you need a comma after a sentence-opening conjunction is when you want to sneak a clause right between the conjunction and the rest of the sentence: “But, as you know, we did it anyway.’


I don’t agree with using a coordinating conjunction (“and” or “but”) to start a sentence in formal technical and business writing because a coordinating conjunction, by definition, joins two words or phrases in a sentence. I have no problem with using a coordinating conjunction to start a sentence in informal writing (fiction, poetry, blogs, texts, some e-mails, advertising and marketing writing, and personal writing). However, everyone has a different formality scale in their head. I always urge my writing students to write just a little more formally than their reader might, much as they would dress a bit more formally for a job interview than they might on the job.

Further, I suggest, “When in doubt, don’t.”

That said, it is clear to me that more and more people are writing less and less formally. I don’t think that that shift is always appropriate. I’ll continue NOT using “and” or “but” to start a sentence for all my formal technical, business, and medical communication.

Your thoughts?


Organizations for writers to belong to

Thanks to Barb Woldin of American Medical Writers Association (AMWA), who posted this list of organizations that writers might want to belong to:

These last few are compliments of Pat McNees Web site, Writers and Editors, through Barb Woldin:

And the two organizations that I belong to:

Society for Technical Communication,

American Medical Writers Association,