Chris Lancelot on...the need for the personal

Words are important. They convey messages — in a precise and unambiguous manner, it is to be hoped. This is particularly important in medical communications where it is essential to leave no room for doubt.

Unfortunately — and rather surprisingly — the ‘scientific’ way in which we are taught to write carries within it the seeds of imprecision. I remember vividly the first school chemistry experiment I wrote up. I described it in the active voice: ‘We dissolved the copper sulphate crystals in some water…’, only to have my knuckles rapped. The correct form, I was forcefully told, was to use the passive: ‘Copper sulphate crystals were dissolved in water…’

From then on we all learned to write like that. Taking the first person out of the report makes it look and feel truly scientific — and somewhat dull, too.

But writing in the passive voice or the third person isn’t helpful in medical communications, because it loses the sense of whose job it is to do the work. ‘This patient needs a chest X-ray...’ writes the consultant. Good. Just one problem: is she saying she has ordered it or is she asking the GP to do it?

I could not count the times this has caused difficulties in our practice. ‘He will need a repeat of his thyroid function tests two weeks before the next outpatient attendance…’ (Yes, doctor — have you written out the form or is it up to me?). Or most hazardous of all, because of the implications if it’s not done properly: ‘This patient needs referring to the cardiology department…’ On each occasion my secretaries have to ring up to ask who is supposed to be doing what, because there is no obvious answer.

How refreshing when the penny drops and hospital doctors start writing in the first person again: ‘I’ve ordered a chest X-ray and the necessary blood tests, but please would you refer him to the cardiology department?’ Now that’s totally unambiguous. It may sound ‘unscientific’, but the message is clear — and clarity of communication is what medical correspondence is all about.

How many lives have been lost, I wonder, because an all-important test or referral wasn’t performed, each practitioner thinking the other was requesting it?

So let’s put the first person back into medical communications, shall we? It may sound less scientific — but it is a great deal safer.

- Dr Lancelot is a GP from Lancashire. Email him at

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