This post is for anyone coming from a medical background who is ready to venture into blog writing. Before taking another step forward,
STOP–you need to learn about the passive voice.
I say “learn” but you are most likely an expert–even if you don’t know it. Here is a test.
Which is the correct way to express the following:
A. Multiple attempts were made to increase the patient’s knee flexion in sitting.
B. I tried a bunch of times to get Mary to bend her knee more while she was sitting.
C. Mary hates her therapy. She says I am a physical terrorist.
If you chose A, then you have been trained well and you are a passive-voice pro. You can whip out an objective and professional chart note at a moment’s notice–but flat is how your next blog post will probably be written (see what I did there?).
I think you are getting the picture already, but to make sure, I am going to give you a quick overview. I will tell you why you need to pull back on your use of the passive voice, and when it is OK and even preferable to use it.
What is the passive voice?
Grammarians tell us there are two voices in writing: active and passive. In any given sentence, the distinction is based on whether the subject of the sentence is doing the action or being acted upon. For example:
Active voice: The surgeon removed Mr. Smith’s left leg.
Passive voice: Mr. Smith’s left leg was removed by the surgeon.
In the first sentence, the surgeon is the subject and he is doing the action (removing Mr. Smith’s leg). In the second sentence, Mr. Smith’s leg is the subject and it is being acted upon (the surgeon is removing it).
Notice in the second example “by the surgeon” can be removed and the sentence is still correct. Also, to change an active sentence into a passive one, some form of the verb to be is added.
Mr. Smith’s left leg WAS removed
by the surgeon.
Look for both of these constructs when trying to decide if something you wrote is in the passive voice.
Why you should lay off the passive voice
The experts say so
Outside of medicine and laboratory science, the passive voice has a pretty bad rap. The venerable William Zinsser in his book On Writing Well says:
Use active verbs unless there is no comfortable way to get around using a passive verb. The difference between an active-verb style and a passive-verb style–in clarity and vigor–is the difference between life and death for a writer.
Strunk and White were a little less dire about it:
The active voice is usually more direct and vigorous than the passive.[…] when a sentence is made stronger, it usually becomes shorter. Thus, brevity is a by-product of vigor.
It’s weak and lacks clarity
With the passive voice, sentence meaning becomes less clear and action is diluted. The reader is forced to hunt around to get the full meaning. Here is an example:
After just one round of chemo, a little progress was made.
How much information is that sentence really conveying? Who or what made progress? We have to find the answers elsewhere in the text.
Better yet, take a look at these examples from the post Famous Movie Quotes Ruined by the Passive Voice.
He is going to be made an offer by me that can’t be refused by him. (The Godfather)
A bigger boat is going to be needed by you. (Jaws)
It passes the buck
The passive voice also removes accountability for the action performed, and that can introduce a smarmy element. Here is an example:
Mistakes were made. Recovery was prolonged and pain was not managed well.
No one is at fault here. These things just happened to the patient. This may seem to decrease the liability of the medical staff, but skirting responsibility like this leaves a very bad taste.
When to bring the passive voice back in
All of this is not to say that you should NEVER use the passive voice. I just needed to beat you over the head with it a little considering your likely entrenchment. The longer you have been a clinician the more time and vigilance it will take to break the passive-voice habit.
Once you have done so, however, there are some instances when you get to (and should) bring it back in.
Use it for emphasis
Sometimes the context of your writing is better served with the passive voice. For example, consider these two sentences:
Doctors at Regional Hospital treat a thousand cases of glaucoma each year.
A thousand glaucoma patients are treated each year by doctors at Regional Hospital.
Both sentences mean the same thing, but the emphasis is on a different subject in each. The first sentence would be more appropriate in a story about the doctors at Regional Hospital. While the second would be better in a story that focused on glaucoma patients.
Use it for style
We use the passive voice when we speak. And blogging is one form of writing that aims to come close to everyday speech. That is the very reason it can be a great resource for patients. Medicine can be scary and patients often feel alienated by all the formality and jargon that gets thrown around. Explaining a condition or procedure in a blog post is a way to cut through that by using plain language and a friendly tone.
Sometimes that means writing in the passive voice. While using the passive voice should still be the exception rather than the rule (for all the reasons I mentioned above) it has it’s place– ‘Cause that’s how a friend might explain something.
Use it when you don’t know who did the action
Sometimes you just plain don’t know who it was that first diagnosed a patient’s problem ten years ago. They don’t remember, and the point of your story is not WHO diagnosed them, but the fact THAT they were diagnosed. So you say,
When Emily was ten, a small mass was seen on X-Ray at the base of her spine.
From there, you move the story along and use the active voice when you write about what the doctor she has NOW did.
Dr. Francis removed the twenty-year-old tumor in a three hour surgery, and Emily was finally pain free.
Use it to be diplomatic
We are talking about medical blogs here, so there is a place for objectivity and diplomacy. And the passive voice can provide that when used sparingly.
Consider a situation where you are writing for one of two pediatric surgery practices in a small town. Maybe the story is that the patient saw both surgeons and one sucked and the other was a big help. Instead of writing,
The other pediatric surgeon in town botched Jackie’s first procedure.
You could be more diplomatic with the help of the passive voice and write,
Jackie’s pain was not relieved by a previous procedure.
It is a well worn adage in grammar that you need to learn the rules before you can break them. And for those of us who come from a clinical background, there are a few rules we need to UN-learn first–and the passive voice is one of the big ones.
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