Welcome to the chapter newsletter for April 2024. CHAPTER NEWS FEATURES CHAPTER NEWS Member Survey We kindly request your participation in a brief member survey focused on out chapter newsletter. By taking a few minutes to complete the survey, you will help us tailor the newsletter’s content to better meet your needs and preferences. Thank […]
Welcome to the chapter newsletter for March 2024. CHAPTER NEWS FEATURES CHAPTER NEWS West Metro Medical Writers Social Hour Please join us for an informal get-together on March 16, 2024, at 9:30 am. We will meet at the Caribou Coffee in Lunds & Byerlys and hold the meeting in the large cafeteria in the grocery […]
By Naomi L. Ruff, PhD, ELS
Managing a freelance business requires knowing the labor laws covering employees and independent contractors (ICs). The laws themselves are clear: 1) employees are subject to a variety of regulations, such as tax withholding, and are entitled to a range of benefits, such as a minimum wage, and 2) ICs are not employees. The trouble lies in where and how to draw the line between these 2 categories of workers.
Origins of the modern problem: the Microsoft case
Efforts to distinguish ICs and employees have a long history, but the issue came to the forefront in the 1990s, when Microsoft was discovered to have misclassified numerous employees as ICs. The individuals in question signed contracts saying they were ICs and were sometimes paid more than employees but did not have taxes withheld or receive employee benefits. However, they were required to work regular hours on site, worked as part of regular project teams, received card keys and office equipment from the company, and performed the same functions as employees—that is, they were employees in all but name. The IRS cracked down, and later some of those “ICs” sued the company for back benefits and won, which was a very expensive outcome for the company. As a result, many large employers became a bit jittery about how they were classifying contractors.
Currently, several different tests at the federal and state levels are used to determine IC status, and employers must comply with all of them. Below, I will summarize these tests and some implications for those who truly are ICs.
Current federal tests
IRS
You may have heard of the IRS “20 questions”; these have now been combined into 3 categories to determine a worker’s status:
The answers to these questions need not all point in the same direction. Businesses are required to weigh all of these factors, consider which are relevant and which point to employee or IC status, and then make a decision based on how much control the business has over the worker. Businesses must also document how they made the decision.
Department of Labor: Fair Labor Standards Act
The new DoL Rule, which will take effect March 11, 2024, uses an “economic reality test” to determine whether an employment relationship exists. It considers 6 factors:
As I understand it, this rule actually reverts (more or less) to guidance that was in place before 2021. As with the IRS rules, in DoL’s latest rule no single factor has more weight than the others, and the overall balance of the factors must be used to determine the status.
The ABC test in current state law and possible future federal law
With the rise of the “gig economy,” notably rideshare companies like Uber and Lyft, new discussions emerged about whether the “ICs” working for these companies were actually misclassified employees. Ostensibly to address this issue, California passed Assembly Bill AB 5, which took effect on January 1, 2020, enshrining the “ABC test” into law. This test holds that a worker should be deemed an IC only if all 3 of the following criteria are met:
The immediate result was that many California companies were reluctant to hire freelance medical communicators: for example, is a medical writer performing work that is outside the usual course of a medical communications company’s business? The uncertainties made companies unwilling to take the risk.
In fact, the ABC test has all sorts of problems for all sorts of workers. Recognizing this, California originally exempted certain professions from the law (subjecting them instead to the Borello test). Protests from other groups led to updates with exceptions for “professional services,” a category that explicitly includes grant writers and “freelance writer[s], editor[s], or newspaper cartoonist[s] who [do] not provide content submissions to the putative employer more than 35 times per year,” among other categories.
Several other states have either adopted the ABC test or have considered it. So has the federal government, in a bill called the PRO Act of 2021.* Although it failed to pass in the Senate, many legislators (particularly Democrats, including both of our Minnesota Senators) strongly supported the bill and may introduce it again.
What you can do
The best defense is a good offense. Make sure that you structure your business in such a way that the majority of the various criteria used support your status as an IC:
Conclusions
None of us went into this field to become experts on labor law, but it behooves us to stay informed about the laws being proposed and passed and to ensure that we structure our businesses accordingly. In some cases, we may need to educate our clients that we do, in fact, truly meet the standards for classification as ICs and to inform our representatives at every governmental level about the effects that these laws can have on our businesses.
* Not to be confused with the Minnesota Pro Act, which is about access to reproductive health
Additional Reading
American Medical Writers Association. AMWA Position Statement on Legislation That Negatively Affects the Livelihood of Freelance Medical Communicators. 2020. https://www.amwa.org/page/position_statement
Murray J. How the IRS Determines Independent Contractor Status: Independent Contractor Tests Explained. The Balance: September 19, 2022. https://www.thebalancemoney.com/how-the-irs-determines-independent-contractor-status-398618
Reuters. Don’t Treat Contractors Like Employees. 2009. https://www.reuters.com/article/idUSTRE53063S/
Stone & Sallus, LLP. Independent Contractor Rights. Accessed February 22, 2024. https://www.stonesalluslaw.com/business-law/independent-contractor-rights/
US Department of Labor. Get the Facts on under the Fair Labor Standards Act [Infographic]. https://www.dol.gov/sites/dolgov/files/WHD/legacy/files/misclassification-facts.pdf
US Department of Labor, Wage and Hour Division. Fact Sheet 13: Employee or Independent Contractor Classification Under the Fair Labor Standards Act (FLSA). 2024. https://www.dol.gov/agencies/whd/fact-sheets/13-flsa-employment-relationship
By Tess Van Ee
Subject-verb agreement is familiar territory for medical writing professionals. We all know to write “The bones are broken,” not “The bones is broken.” Verbs match nouns, done.
But when the subject is unclear, subject-verb agreement can become less obvious.
Let’s start with relative pronouns in complex sentences. Relative pronouns (e.g., which, whom, that) refer to a noun mentioned earlier in a sentence. They streamline the flow of sentences with multiple clauses by removing repeating words.
However, relative pronouns can endanger subject-verb agreement because they add distance between a subject and its verb. The more words separating a subject from its verb, the greater the potential for confusion. Take the following sentence as an example.
“The sensory nerve branches at T2-T6 emerge from the multifidus spinae muscles at a right angle, which makes them more susceptible to compression and injury compared to nerves elsewhere in the back.”
The verb in the dependent clause (makes) is singular, but what is its subject? In other words, what makes the nerve branches more susceptible to compression? Where they emerge? Or the angles? Rewriting the sentence clarifies the subject:
“The sensory nerve branches at T2-T6 emerge from the multifidus spinae muscles at a right angle. This angle of emergence makes the nerves more susceptible to compression and injury compared to nerves elsewhere in the back.”
Joining subjects with coordinating conjugations (and, but, or) can also cause subject-verb confusion. Your choice of conjugation depends on whether the multiple subjects form a single, plural subject or whether each forms a separate, singular subject.
Here’s an example:
“My neurologist, gynecologist, and primary physician collaborate to care for my health.”
The three subjects are joined by “and” to show all three are involved. The plural verb (“collaborate”) reflects this trifecta of subjects. When the multidisciplinary care team is isolated by “or,” however, the singular verb reflects the change to three single subjects:
“My neurologist, gynecologist, or primary physician sends the records.”
The verb must be singular since the subject could be one or the others and not all three.
To check subject-verb agreement when using “or” in a sentence, try reading the sentence aloud using one subject at a time. In this case, the sentence reads correctly even when “gynecologist” and “primary physician” are removed.
For more on subject-verb agreement, check out this overview by Grammarist and this example-rich article by GrammarBook.com.
By Adam Fix
Part 4 of the AMWA certificate course deals with medical terminology. As someone without a medical background prior to joining AMWA, I found this part especially instructive.
How terms are combined
Many medical terms are calculated (so to speak) using this formula:
term = prefix + combining form + suffix.
Here are some examples:
Easy enough, right? Just watch out for added vowels. Sometimes vowels are added to make a word more pronounceable. In example 2 above, an “o” is added between “hyster” and “salping.”
Be careful to balance proper terminology with ease of reading. These medical terms don’t exactly roll off the tongue, and tossing in too many will thicken your writing into an indigestible word soup. Use your judgment and decide which terms are necessary and which can be omitted.
Acronyms vs. initialisms
Did you know that a lot of the things we call acronyms are technically initialisms? Acronyms are pronounced as words, whereas initialisms are pronounced letter by letter. For example:
Acronyms: AIDS, ELISA, AMWA (if you say it like “Am-wah”)
Initialisms: HIV, CPR, AMWA (if you say it “A-M-W-A”)
How do you prefer to pronounce AMWA? In my experience, most people say “Am-wah,” but hey if you prefer “A-M-W-A,” more power to you!
Amusing terms coined by AMWA workshop attendees
These are just for fun, taken from the guide (p. 36). Feel free to make up your own and share!
Questions, comments or new additions to the newsletter? Please contact the Publications Committee Chair. And remember, you can also read this newsletter on the chapter website. You can find previous newsletters on the website as well.
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Welcome to a combined edition of the chapter newsletter for the months of February 2024. CHAPTER NEWS FEATURES CHAPTER NEWS New Chapter Advisory Council Representative Naomi Ruff, PhD, will serve as the 2024 Chapter Advisory Council (CAC) representative for the North Central Chapter. The CAC is the organizational bridge between the chapters and the national […]
By Tess Van Ee
Organizing information into lists can improve flow and help writers stay within strict word counts.
However, complicated phrases, such as phrases already containing lists, can be difficult to corral. How can writers ensure sentences with embedded lists are crisp and clear and not a jumble of colons, commas, semicolons, and dashes?
The general rule of thumb for embedded lists is to use semicolons to separate phrases when one or more phrases include commas. Here’s an example:
Primary exclusion criteria include previous surgeries within the last year; chronic conditions such as diabetes, hypertension, or heart disease; previous clinically significant systemic illness or infection, including test-positive COVID-19; and participation in another clinical trial of a drug or device.
Embedded lists are usually long and complex. Watch for parallelism when building embedded lists. The sentence above lists each item as a noun (“surgeries,” “conditions,” “illness or infection,” “participation”). Adding a criterion like “younger than 18” without rephrasing this adjective into a noun would topple the sentence’s structural integrity (and, by extension, threaten the writer’s integrity).
Reading each item in the list with the beginning of the sentence helps ensure the list is grammatically sound. For example, “Primary exclusion criteria include…participation in another clinical trial of a drug or device.”
When an embedded list’s bulkiness threatens the message’s clarity, writers can break the list into multiple sentences or go vertical with a bulleted list.
Primary exclusion criteria include the following:
Punctuation for bulleted lists varies by style guide. The example above follows AMA style, where periods are unnecessary for bulleted phrases unless they are full sentences. APA style, in contrast, uses periods after phrases that complete a sentence, and the Chicago Manual of Style recommends using semicolons and periods in vertical lists to mirror horizontal embedded lists.
Vertical lists break up dense paragraphs for a more digestible reading experience but aren’t allowed in certain document types, like journal articles. Horizontal lists can become overwhelming, but they present complex information in a more conversational tone when done right. Choosing between the two depends on your document type, intended reader, and the volume of material you are getting across.
For more information on embedded or bulleted lists, check out the following sources:
By Paul W. Mamula, PhD
If you haven’t read any books by Sam Kean, I would suggest his latest book, The Icepick Surgeon: Murder, Fraud, Sabotage, Piracy, and Other Dastardly Deeds Perpetrated in the Name of Science.That’s quite a title. The book was published in 2021 and in a paperback edition in 2022. Kean’s book is a fascinating read that traces unethical work done in the name of scientific research from Cleopatra through contemporary society. One doesn’t have to read the book in order; one can pick and choose to suit individual interests. The 12 chapters cover considerable ground and are amply referenced. The book is a fast read, written in Kean’s witty style.
The book opens with a chapter on “scientific piracy” and the grandfather of naturalistic writing, William Dampier. Dampier wrote A New Voyage Around the World in 1697, in which he details his travels while serving as a navigator (and pirate) on several ships. The book detailed many new findings and even influenced Charles Darwin. Nearly 1,000 citations in the Oxford English Dictionary trace back to Dampier’s writings (e.g., banana, smuggler, avocado, chopsticks). Another fun fact was that Dampier was the navigator on the ship that rescued Alexander Selkirk, the marooned sailor whose tale served as the basis for Daniel Defoe’s Robinson Crusoe.
The book covers many other acts perpetrated in the name of science. Kean reviews the animal experiments used to create the electric chair – experiments that included electrocuting an elephant! Kean also provides a brief explanation of the ethically challenged Tuskegee Institute syphilis “study.” A more thorough treatment of this experiment is provided in Bad Blood: The Tuskegee Syphilis Experiment by James H. Jones, the Book Club selection for September 27, 2021.
The book ends with an appendix on the future of crime, which serves as a nice coda. Kean admits that the chapter is a hodgepodge but that it loosely addresses new technologies that will likely be used for crimes. It opens with the fascinating tale about the murder of a man on a base in the Arctic Ocean, one of the few places where no specific laws govern. The murderer was eventually tried in the United States but acquitted. The case caused a sensation and for Kean provoked questions about other places where no laws apply, e.g., Antarctica, outer space, and about new technologies with potential for misuse, notably computers and DNA technology.
Throughout The Icepick Surgeon, Kean peppers his writing with intriguing details, curious anecdotes, and fascinating footnotes.
Our book club has previously selected other Sam Kean books: The Disappearing Spoon: And Other True Tales of Madness, Love, and the History of the World from the Periodic Table of the Elements (January 28, 2013) and The Violinist’s Thumb: And Other Lost Tales of Love, War, and Genius, as Written by Our Genetic Code (April 25, 2016). The author also maintains a website (SamKean.com) for more information about his work.
By Paul W. Mamula, PhD
Our first book club meeting of 2024 took place on January 22nd. Apropos for those whose New Year resolutions include exercising more, we discussed Exercised: Why Something We Never Evolved to Do Is Healthy and Rewarding by Daniel E. Lieberman. We had a good turnout. In addition to regular attendees, one new member joined to learn about the book (and book club), and two others hadn’t read the book but were interested in the discussion.
The Book
Lieberman, a paleoanthropologist, provides a different take on physical activity and exercise in Exercised. The text is 338 pages long divided among 13 chapters and an Epilogue. The author leavens the hard science about human anatomy and activity—upright posture, feet, muscle composition, strength, sleep, comparative animal behavior—with an anthropological take on non-Western lifestyle, modern life, and physical activity and exercise. The book has no bibliography, but the notes section incorporates all references. All 13 chapters begin with an exercise myth (e.g., Myth 1: We Evolved to Exercise). The overarching theme is that humans never really exercised as we do now, but possess many adaptations and behaviors, such as upright posture and social groups, that assist activities of daily life. Exercise, as we know it, is a modern phenomenon; hunter-gatherers did not exercise, because energy was too precious to expend on unnecessary activities. Modern humans have eliminated the need for many of these activities but haven’t been able to overcome the physiological drive to store energy (as fat); as a result, we now need to exercise for health reasons.
The book is written in a witty, self-deprecating manner. Lieberman laces it with examples, anecdotes, quotes from the classics, and trivia. His observations on modern hunter-gatherers provide some provocative health comparisons. For those in the TLDR (too long, didn’t read) camp, the last three chapters (82 pages) comprising the Exercise in the Modern World section are the most valuable. The book’s message can be summed up its last lines: “Make exercise necessary and fun. Do mostly cardio, but also some weights. Some is better than none. Keep it up as you age” (p 339).
Good Points
We liked the book. I enjoyed it, because of the anthropological flavor infused into the research from physiology, sports, and medicine. Lieberman notes that most hunter-gatherers in the past spent little time doing vigorous exercise but engaged in considerable low-level physical activity, such as making weapons, digging for food, caring for children, and socializing. He distinguishes physical activity from exercise with examples from contemporary hunter-gatherers, including the Hadza of Tanzania; from subsistence farmers, the Pemja of Kenya; and from current rural folk, such as the Tarahumara of Mexico. These contemporary hunter-gatherers walk a lot by modern standards (often exceeding 7.5 miles per day). Lieberman notes events that modern Westerners might consider exercise but that traditional societies do not. For example, the Tarahumara play a game in which 2 teams compete in a multi-hour relay race that serves as a social event, but find our concept of exercise (e.g., running a marathon) alien. They ask why anyone would do that; it serves no purpose.
We found the book sprinkled with fun facts. Mary Knatterud said, “I was hooked on the book by the end of its Prologue, which reported that ‘[f]or more than a century, English convicts (among them Oscar Wilde) were condemned to trudge for hours a day on enormous steplike treadmills’ (page xiii).” She also said, “So many of his tidbits were fascinating, e.g., ‘According to a 2018 survey of millions of Americans, about half of adults and nearly three-quarters of teenagers report they don’t reach the base level of 150 minutes of physical activity per week’ (page xvi) and ‘only about 50 percent of patients undergoing antidepressant treatment get better’ (page 335).”
Knatterud stressed, “As someone who often wakes up ruminating, I was especially captivated by Lieberman’s comments, some bleakly humorous, on sleep, e.g., ‘zebras sleep only three or four hours a day because they are in constant fear of lions, whereas lions that eat the zebra typically enjoy about thirteen’ (page 77).” She added, “I was surprised by his debunking of 8 hours of sleep for humans as a harmful myth, given its ‘12 percent higher death rates’ vs. ‘six and a half to seven and a half hours’ (page 82).”
The book does contain many hard facts, too. I liked Chapter 5, entitled Speed: Neither Tortoise nor Hare (Myth 5: Normal Humans Trade off Speed for Endurance) with its explanation of fast twitch and slow twitch muscle fibers and their effects on sprints and endurance running. The comparison with animals illustrates how slow humans are. Evolutionarily, we compensate by having long endurance, allowing us to run down animals whose physiology in distance running makes them overheat, and thus catchable.
The book includes a few funny statistics, too. Knatterud quipped, “My favorite clause in the entire book was ‘regular chocolate consumption adds nearly a year to your life’ (page 281).”
Quibbles
Some of Lieberman’s points seems to be a stretch. When comparing human foot anatomy to that of other animals, his analysis shows that human feet were not well suited for fast locomotion. While true, it overlooks the skeletal adaptations that animals such as horses or great apes have for a particular niche. Although human gait may be more energy-efficient than that of great apes on two legs, the discussion overlooks the adaptations that great apes have for an arboreal life and a four-legged gait (mostly). The same is true for horses, whose long evolution produced a single-toed foot adapted to running on the plains.
In discussing chimpanzees’ relative muscular strength, Lieberman includes an anecdote that seemed to contradict his premise that adult chimps are not much stronger than adult humans. Knatterud bemoaned that her “least favorite passage in the book described the ‘reactive aggression’ by ‘an adult chimp named Travis who had spent his entire life peacefully as part of Sandra and Jerome Herold’s family. Then, in February 2009, at the age of fifteen, he flew off the handle after one of Sandra’s friends, Charla, picked up one of his favorite toys. Travis’s immediate and savage attack left Charla with no hands and without much of her face including her nose, eyes, and lips’ (page 146).” Not many humans could do that!
Chapter 8 (Myth 8: You Can’t Lose Weight by Walking) provides some useful examples about energy expenditure, but I questioned the use of 50 calories as the energy expenditure for walking a mile. Most of the estimates I have seen, even considering metabolic rate and weight, come out to around 100 calories.1,2 Even so, using this figure did not undermine Lieberman’s argument about the usefulness of low-intensity activities such as walking for weight loss.
We did have a few editorial and usage quibbles. (What group of writers and editors wouldn’t find a few?) As a longtime editor, Knatterud said, “I am always alert to semantic lapses, e.g., ‘thirty- four incidences [instead of incidents] of fights’ (page 154) and ‘the bedrock of most exercise regimes [instead of regimens]’ (page 292).” Additionally, she said, “I was irked by Lieberman’s frequent use, undefined, of ‘elderly,’ a term often deemed ageist and pejorative.”
Next Up
Our next book club will meet on April 22, 2024, to discuss Lifespan: Why We Age—And Why We Don’t Have to by David A. Sinclair, PhD with Matthew d LaPlante. Sinclair discovered sirtuins, molecules believed to influence aging. His research led to founding a company that markets resveratrol, a molecule found in grapes and red wine that acts as a sirtuin activator. Please join us for a stimulating discussion. Reading the book is not a prerequisite to attending. We hope to see you there!
References
1. Marcin A, Mathe B. How Many Calories Do You Burn While Walking. Healthline. Calories Burned Walking: 1 Mile, 1 Hour, Calculator [Accessed Jan 27, 2024]
2. Physical Activity Guidelines for Americans. About Physical Activity Guidelines. US Dept Health Hum Serv. Health.gov About the Physical Activity Guidelines | health.gov [Accessed Jan 27, 2024]
Questions, comments or new additions to the newsletter? Please contact the Publications Committee Chair. And remember, you can also read this newsletter on the chapter website. You can find previous newsletters on the website as well.
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Welcome to a combined edition of the chapter newsletter for the months of December 2023 and January 2024. CHAPTER NEWS FEATURES CHAPTER NEWS Call for Volunteers! The North Central chapter is currently looking for volunteers to fill the positions of President-Elect, Co-Secretary, and Co-Membership Chair. AMWA North Central is a volunteer-based organization. New chapter members […]
By Adam Fix
This past fall, Minnesota-based artist Barbara Porwit hosted an art exhibit celebrating the 10-year anniversary of her “Breast Cancer Superheroes” portrait project. The show was held from October 1 to November 26th at First Universalist Church in Minneapolis, Minnesota.
A decade ago, Barbara was moved by several women who were transforming health challenges into personal power, and the Breast Cancer Superhero portrait project was born. Barbara started with two questions:
The process evolved from there, culminating in large-scale portraits of women in their glory, capable of performing fantastic feats and overcoming great obstacles.
Barbara highlighted two foundational concepts to her work: “First, the universal heroes’ journey, where an ordinary person is called away from their everyday life and faced with a challenging ordeal. Second, the power of positive emotions. We hope everyone who experiences this project is reminded to celebrate the heroes in their lives — and in themselves.”
Radiation Diva – Jill Stanton
“Radiation Diva” was inspired by Jill Stanton’s vision of acquiring superpowers from her radiation treatments. As Barbara put it, this version of Jill “deflects cancer bullets in the fantastical space she occupies on canvas, with her disco-ball bra and her hospital bracelets transformed into Wonder Woman bracelets.”
Jill, reflecting on the experience, stated: “I’m just so impressed and grateful for how Barbara brought together all these experiences, and made it into something that brings strength, and also joy and laughter, that people who are going through this really need.”
Phoenix Rising – Lisa Dahlseid
Lisa Dahlseid, who underwent prophylactic double mastectomy and a year-long reconstruction, chose to be portrayed as the superhero Phoenix, known for her strength, courage, and invincibility. “She represents rising from the ashes, rebirth, vanquishing of something that could have spelled death,” Lisa said.
Wonder Woman Katy – Katy Tessman
“I was touched,” Katy Tessman reflected. “To be painted on a seven-foot-tall canvas as Wonder Woman was such a positive experience, working with Barbara and thinking a lot about the everyday hero that I was deep inside. I know that this painting is going to be even more inspiring to others. She tells you: ‘You got this.’”
“There are many different pathways in our lives,” Barbara added. “Some we choose, and some come to us unexpectedly. We can’t erase or escape all the tough stuff, but we can plant our own flowers along the way. These women have done so, and we hope to keep encouraging others to do the same.”
Project staff are currently seeking major sponsors to purchase the original paintings to donate to hospitals or clinics.
Future plans include a diversity expansion, offerings of high-quality reproductions for sale to interested sites, and merchandise utilized as fundraisers for cancer-support organizations.
For more information, contact Barbara Porwit at info@breastcancersuperheroes.com or breastcancersuperheroes.com.
By Adam Fix
Part 3 of the AMWA Essential Skills Certificate concerns sentence structure. If you’re thinking “Pshaw! I know how to structure a sentence!” … just wait.
Example: “The doctor recommended antibiotics.”
Example: “The doctor recommended antibiotics, and the patient agreed.”
Example: “Although the doctor recommended antibiotics, the patient declined.”
Example: “Although the doctor recommended antibiotics, the patient declined, and the patient’s wife agreed with him.”
So far, so good, right? But what about this sentence?
“The doctor said that the patient’s condition was serious.”
That is a complex sentence. The entire sentence is an independent clause, but it has a dependent clause (“that his condition was serious”) nested within it. This nested dependent clause functions as the direct object of the overarching independent clause.
Mind blown, right?
Parallel construction is a wonderful way to clarify a comparison or juxtaposition of some kind. But parallelism is not without pitfalls. Consider the following:
“When choosing medications for the pregnant patient, the surgeon must not only consider the illness to be treated but also the effects on the fetus.”
What’s the problem here? As written, “consider the illness to be treated” is parallel with “the effects on the fetus.” This is incorrect because one parallel phrase has a verb but the other does not. To fix, we simply move “not only” to come AFTER “consider,” like so:
“When choosing medications for the pregnant patient, the surgeon must consider not only the illness to be treated but also the effects on the fetus.”
Loose sentences begin with an independent clause and provide additional details in subsequent clauses last. It’s “loose” because readers can relax near the end, knowing that the essential details have already been conveyed in the opening independent clause. The additional details accumulate as the sentence progresses.
Example from the guide: “I focus on four priorities that are general safety concerns: temperature of the hot tap water, lead on window sills, a functioning smoke alarm and window guards.”
Periodic sentences, by contrast, begin with the additional details and provide the independent clause last. Like a musical phrase, they follow a regular beat (hence the name) to build tension and catch the reader’s interest. At the climax, the independent clause — somewhat like a tonic chord in music — provides the essential details and resolves the tension.
Example from the guide: “In addition to performing a routine newborn assessment and discussing care issues, I conduct an assessment of the home.”
Before taking this course, I’d never heard of loose (AKA cumulative) or periodic (climactic) sentences. Definitely a useful addition to any writer’s toolbox.
Questions, comments or new additions to the newsletter? Please contact the Publications Committee Chair. And remember, you can also read this newsletter on the chapter website. You can find previous newsletters on the website as well.
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Welcome to the November 2023 chapter newsletter. CHAPTER EVENTS CHAPTER NEWS FEATURES CHAPTER EVENTS AMWA Chapter Meetup Please join us for an informal networking and social event with local chapter members. Where: Urban Growler Brewing Company 2325 Endicott St, St Paul, MN 55114 When: November 16, 2023, at 5:30 pm Website and parking: https://www.urbangrowlerbrewing.com/get-a-hold-of-us Please […]
June Oshiro, PhD, ELS
Medical writers and editors often work on multiple projects with different timelines. As knowledge workers, we are expected to organize and prioritize our writing and editing projects and to manage administrative responsibilities. In addition to those tasks, we can have unscheduled external interruptions (e.g., instant messages from coworkers) and self-interruptions. To remain productive in these ordinary work settings, we must be able to effectively transition between numerous tasks (termed task switching) and to filter out thoughts unrelated to the work at hand.
Task switching involves mental and sometimes emotional transitions. With a mental transition, a person ideally stops thinking about the first task to fully focus on the second task. However, thoughts about the first task tend to persist. Dr. Sophie Leroy, a professor of management at the University of Washington, coined the phrase attention residue to describe this phenomenon [1], noting that attention residue is particularly pronounced if the first task remains unfinished when the second task begins. With an emotional transition, a person may resist moving from a pleasurable work activity to a mundane or stressful one [2]. This resistance can sometimes manifest as procrastination or avoidance.
Transitions can be planned (e.g., intentional work on multiple projects), but many are unplanned (e.g., interruptions). Unplanned transitions, particularly to unrelated topics, have clear costs in terms of time needed for reorientation back to the original task. Dr. Gloria Mark, a professor of informatics at the University of California, studied office workers and determined that they took an average of 23 minutes to resume work after being interrupted [3]. Interruptions also have an emotional cost. Dr. Mark reported that people who aimed to work faster to compensate for interruptions “experienced a higher workload, more stress, higher frustration, more time pressure, and effort.” [4]
If interruptions can be avoided, then a “deep immersion” approach may be particularly beneficial. Dr. Cal Newport, a professor of computer science at Georgetown University, posits that a single, long period of uninterrupted work may be more productive than multiple, shorter bursts because the mental overhead cost (e.g., the effort to remember where you left off, preparing to concentrate) is paid only once during a long work period [5]. However, if deep immersion with a singular focus is not professionally or personally feasible, then other strategies (detailed below) can be applied to protect productivity. Of note, multitasking should be avoided, particularly with complex tasks [6].
For some people, task switching is stressful. Whether a task switch is planned or imposed, allow time for a transition. A slow inhale (count to 4) followed by an even slower exhale (count to at least 6) helps activate the parasympathetic nervous system, which responds by slowing the heart rate and reducing blood pressure [7]. Consider breathing slowly for 1 minute while mentally preparing to set down the current task and pick up the next. Task transitions may also be a good time to stand up and to rest your eyes by looking at something that is not a screen.
Mundane tasks can be incorporated into the day’s agenda through planned transitions. Dr. Adam Grant, a professor of management and psychology at the University of Pennsylvania, suggests a sandwich approach of starting with a relatively interesting task, followed by a boring task, and finishing with a highly rewarding task [8]. This pattern also is consistent with many workers’ natural rhythm of an afternoon lull [9]. Time blocking is a similar approach in which scheduled blocks of time are reserved for exclusive work on a prespecified task or group of tasks [10]. In this way, routine work such as checking email could be accomplished during periods when interruptions are more likely (e.g., at the beginning or end of the day).
If a task seems overwhelmingly large or difficult, then consider breaking it down into smaller pieces (chunking) [11]. Writing a 50-page document may feel daunting, but maybe writing 1 page seems feasible. If 1 page is still too much, then how about 1 paragraph? One sentence? Alternatively, try chunking by time. Can you focus for 25 minutes? Ten minutes? Two minutes? Although a single chunk may feel like a small accomplishment, chunks often snowball in a way that builds motivational momentum.
If distraction is a problem, then the Pomodoro technique is particularly powerful [12]. It incorporates time chunking (25 minutes of singular focus, 5 minutes of rest; repeat several cycles; then take a longer break) plus methods to manage distracting thoughts (record unrelated ideas elsewhere; address them during rest breaks or subsequent focus periods). In addition, website blockers such as BlockSite (https://blocksite.co/) can be used to stop access to user-specified sites, and nonessential phone apps can be temporarily disabled with an app blocker such as Forest (https://www.forestapp.cc/).
If a work transition is associated with resistance (i.e., procrastination, avoidance), then the first step is to identify the underlying feeling [13]. Dr. Daniel Siegel, a professor of psychiatry at the UCLA School of Medicine, developed the approach “Name it to tame it” [14], based on studies showing that the act of identifying a negative emotion reduces the stress and anxiety caused by the emotion. Second, validate strong emotions to defuse their intensity [15]. (For example, state “I feel dread [emotion] about calling Mr. X because he is so abrasive [validation].”) Third, nonjudgmentally accept that you are experiencing the emotion [16], which may help reduce task-associated resistance. Fourth, remember why you need to do the task [8] because deliberate attention to the link between your work and your values may provide the activation energy needed to get started.
I hope that the tips in this article help you better navigate the myriad task-switching demands that are common in modern work. Remember: plan for transitions; chunk big projects; remove distractions; name, validate, and accept your emotions; and remember your purpose.
By Tess Van Ee
The Oxford comma is one of the greatest grammar debates of all time. Proponents say the little mark in a list of three or more words brings clarity. Opponents say it slows down a sentence, adding unnecessary bulk.
Which is it?
The answer depends first on your style guide. AMA, APA, MLA, and other major guides recommend using the Oxford comma. AP, the guide used mostly by journalists and news writers, leaves it out.
If your company or client doesn’t use a style guide, the choice to use the Oxford comma belongs to the writer. Just remember to stick with the same decision throughout the piece.
In some cases, an Oxford comma is necessary. For example, “I love my in-laws, Steve Martin and Gillian Anderson.” Does the author love her spouse’s parents and a famous comedian and actress, or are her in-laws an unlikely but equally loveable duo?
This sentence needs an Oxford comma.
Because the healthcare community generally follows AMA and APA style guides, medical writers often use the Oxford comma. However, some situations, like a boss or client’s preference or when pitching an article to a magazine, may require you to leave that comma out.
In these cases, writers can find ways to restructure sentences. Here’s a restructured version of the earlier sentence: “I love Steve Martin, Gillian Anderson and my in-laws.” Rearranging the words from specific to vague brings clarity.
Sources: APA Style Guide, Bartleby, GrammarBook, Grammarly, Proofed
By Paul W. Mamula, PhD
Our book club met virtually on September 25, 2023, to discuss Man’s 4th Best Hospital by Samuel Shem. Shem is the pen name of Stephen Bergman, a psychiatrist who wrote the book as a sequel to his 1978 classic novel, House of God, a fictional account of the stresses of medical residency. One need not have read House of God to follow Man’s 4th Best Hospital. The books have recently been discussed on the author’s website and in JAMA (1). We had a good turnout and a lively conversation.
The Book
Man’s 4th Best Hospital‘s plot revolves around restoring a fictional hospital—based on Beth Israel Hospital—to its number one national ranking. The corporate director, an old classmate of the “Fat Man” (one of the protagonists in House of God as well) gives him a large budget and the task of restoring the hospital’s ranking. The Fat Man reassembles his former interns (Chuck, Eat My Dust Eddie, the Runt, Hyper Hooper [2]), now established in their practices, and they get busy. They circumvent the hospital’s policies and disable the notorious electronic health system, HEAL (Healthy Electronic Assistance Link) to address the problems corporate policies have caused. HEAL’s emphasis is on billing and administration, and patients get lost in the shuffle, frustrating the physicians who must slog through computer screen after computer screen to complete patient visits. HEAL, they estimate, consumes about 80% of staff time, time better used for seeing and treating patients. One of the novel’s physicians mentions wryly that the words “patient” and “care” do not appear in the electronic health system’s name.
The team generates a system that provides more patient-friendly care. After dismantling HEAL, they implement their own system, one less computer-screen driven. They also address familiar problems—corporate oversight, electronic patient records, pharmaceutical industry ties, and rigid rules. The novel has multiple ethnic characters who populate the physicians’ world and fill their waiting rooms with medical problems that the avant-guard team successfully addresses. The workarounds are eventually found out and lead to a confrontation with a corporate computer expert and the CEO, culminating in a brutal crime (interestingly depicted by a blank page in the novel).
The Good Stuff
The writing style is witty and contemporary. Mary Knatterud said, “I relished Shem’s wry, dark humor, e.g., his main character’s reference to ‘my parents doing better as my parents, dead’ (page 7).” Many of Shem’s scenarios ring true, much as in his earlier novels. He paints a contemporary take on the problems facing current health care practices. As other readers noted, electronic health records, formulary limitations, and clinic issues pose familiar problems for patients (and physicians).
Of particular interest was the animosity toward HEAL and the corporate overseers. Both brought unnecessary complexity and hindered care. Knatterud added, “I loved the characters’ clearly justified resentment of ‘being called analog interfaces’ (page 136), and this nugget about the need for two-way human bonds: ‘Good relations are mutual; if they’re not mutual, they’re not all that good’ (page 161).
The underlying relationship between big pharma and hospital administrations also is prominent, and those familiar with drug marketing can relate. Knatterud emphasized, “I especially appreciated Shem’s calling out of pharmaceutical companies and physicians that push harmful drugs, e.g., ‘Merck, of the billion-dollar drugs Vioxx for arthritic pain—which causes heart attacks—and Fosamax for women’s osteoporotic bones—that can lead to broken bones’ (page 83). Later in the novel, he indicts the much-prescribed statins. He says, ‘Statins, like Pfizer’s Lipitor, can eat away muscles so your triceps hang down like wet noodles—irreversibly’ (page 169).”
Story Line Quibbles
Although the novel takes place in an urban medical center, portrayals of the Fat Man’s assistant Humberto, of the Irish policemen who help keep order in the clinic, and of other ethnic characters were flat and stereotypic. The book has many instances of stilted dialect, e.g., “Sí, sí. Merck Vioxx kill my madre! (p 83).”
Women characters are nearly absent. None of the main characters were women, which is strange given how common women physicians now are in medicine. The only women are Roy Bash’s wife, Berry, an old flame from his intern days who resurfaces briefly, and a couple of female MDs. Only Berry appears fully characterized; the others have fleeting appearances. The women all have subservient roles more typical of the 1950s than the 2020s. Basch’s anachronistic sexism begins early: His leering at the Costa Rican doctor who treats him after a fall is dated: “When she bent over to examine me, I could not help notice that her purple blouse was—to use a line from House—’unbuttoned down past Thursday,’ breasts cradled in the lace palms of a pink bra (p 6).” Wow. A female physician has recently provided some excellent criticisms of both books (3).
Basch’s financial problems didn’t win much sympathy from our group, either. The book opens with him and Berry at their Costa Rican finca (small estate) and sets the stage for later disclosures of financial stress. His huge mortgage and the need to rent out his house and live in its carriage house to make ends meet, his very young daughter’s expensive private school education ($15,000 per year), and his overwhelmingly busy medical practice create tension that grow as the novel progresses. Perhaps some of Basch’s stress might have been lessened with better financial choices.
No article would be complete without some editorial comments. I noticed a few typographical errors, as did other readers. Knatterud said, “I found a few irksome typos: heirarchical for hierarchical (page 18); verses for versus (page 297); and minues for minutes (page 309).” It’s strange that these should get missed, although having also worked as an editor, I can understand how a few mistakes might creep in.
In sum, the book is a worthwhile read. If you have had a recent hospital or clinic visit, particularly one with a physician typing away while you try to enumerate medical problems, this novel will resonate with you (and your physician).
A Little More About the Author
Samuel Shem has a website featuring podcasts and interviews about Man’s 4th Best Hospital and his other books (1). He has also just published another book, Our Hospital, a novel about the experiences of medical personnel during the beginning of the COVID pandemic.
Our Next Book
Our next book club meeting will be on January 29, 2024, when we will discuss Exercised: Why Something We Never Evolved to Do Is Healthy by Daniel E. Lieberman. For those with questions about exercise, this might be the book for you. Please join us, even if you have not read or finished the book.
Questions, comments or new additions to the newsletter? Please contact the Publications Committee Chair. And remember, you can also read this newsletter on the chapter website. You can find previous newsletters on the website as well.
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