Sunday, March 28, 2010

Fun Word Site: Wordle.Net

What a fun site Wordle is! Paste in a bunch of text and create your own word cloud. For this sample, I used words in my tag cloud. Have fun!

Thursday, March 25, 2010

Let Designers Design

I try very hard to let authors author and designers design.

Seems rather simple, doesn't it?
But you would be surprised how many times in textbook publishing authors or even editors try to become designers, and it just doesn't work.

Years ago editors at my company actually designed the interior of books, and I must tell you, those designs were almost universally horrendous. Editors and the vast majority of authors are word people. They're linear, they think in words, phrases, and sentences. They tend to be not very good at colors, shapes, white space, and the like. Those elements belong more rightly with designers, those glorious, right-brained picture people.

I believe publishers like me should let authors and designers do what they do best.

For instance, I never tell an author what the dosage of a particular drug should be or which ICD-9-CM code should be used for a particular disease. They're the authors, they're supposed to know that clinical stuff. The only time I step in is when I know a piece of information is wrong, and even then I typically ask the author to check it and make sure I'm correct in a suggested edit.

I never tell a designer which colors to use for a cover or an interior design unless I want to make sure we don't select a color palette that's too close to the palette of a competing text.

I never tell designers what font to use for a heading or how big to make it unless the color or size impinges on the reader's ability to discern content hierarchy. Subheads should look subservient to main heads, and if they don't, there's a problem. Even then I don't specify what to do, I just tell them that, say, head 2s need to be more pronounced visually than head 3s.

I steer the overall vision for the book and the basic design to make sure they're meeting market needs but I try never to get into things so deeply that I become an author or a designer. Believe me, no one wants that.

Friday, March 19, 2010

Confusing Commas

On the list of most common grammatical errors, misused commas rank right up there with misspellings and Mrs. Batchelder's rank perfume and hissing s.

(Sorry about that, I got a bit carried away. Every time I think about an English class I flash back to crazy old Mrs. Batchelder's high school English classroom. Then I throw up.)

So let's tackle commas in a way I hope will make sense.
First up: Serial commas

I prefer serial commas because they help reduce confusion. Serial commas are commas used after the next to last item in a list. Here's an example:

The patient complained of nausea, vomiting, and headache.

The comma after "vomiting" is a serial comma. You don't have to use one, but I do think they can be helpful in certain situations. So when in doubt, use it.
Next: Introductory phrases

Commas after an introductory phrase are rapidly losing their grip on us, and thank goodness. These are examples of introductory phrases:

  • After awhile

  • On the other hand

  • After the patient had gone to the bathroom

These phrases set up the rest of the sentence. Your English teacher probably smacked you upside the head if you didn't use a comma after an introductory phrase, but he had better not do that now unless you're writing for beginning readers. If you're writing for adults with a reading level over, say, the 10th grade, you needn't worry about sticking a comma after a beginning-of-the-sentence phrase. Use them only if leaving them out makes the sentence confusing, as in:

You know it seems odd that the window was left open like that.

The writer probably meant the sentence this way:

You know, it seems odd that the window was left open like that.

That kind of situation demands a comma.
Separating "sentences"

This is probably the toughest one for people to remember: When do you use a comma when you have what we call a complex sentence?

Generally if you have two complete sentences on either side of an and, but, or, nor, or any other what you wanna call yer conjunctions, use a comma. For instance, if we put these two sentences together…

Mr. Robinson knocked over the lamp.


I ran into the room to find out what happened…

We would use a comma, as in:

Mr. Robinson knocked over the lamp, and I ran into the room to find out what happened.

Here, though, you would NOT use a comma:

Mr. Robinson knocked over the lamp and yelled for help.

Why no comma? Because "yelled for help" isn't a complete sentence.

Okay, class, that's enough for today.

Wednesday, March 17, 2010

Commonly Misused Phrases

Let's have some fun today. Here's a list of commonly misused phrases and what the correct phrase should be.

If you've used the phrase on the left, uh-oh, better get it right next time!

Uh-OhYes, Please
It's a pigment of your imaginationIt's a figment (imagined story) of your imagination.
It's a mute point.It's a moot (of little practical value) point. (Of course, if you're Joey Tribbiani, the point is moo.)
That's a bold-faced lie.Nope, sorry, it's a bald-faced lie. (For the history of this phrase, see
We need collaborating evidence.You more likely need corroborating (confirming) evidence.
It's a doggy-dog world out there.I don't know where you live, but where I live it's a dog-eat-dog world.
She's just a font of wisdom.If she's that smart, she's a fount (fountain or spring) of wisdom. Leave the fonts (typefaces) to us publishers.
Let's hone in on the problem.I'd much rather home (to navigate) in on it, thank you very much.
He must be lack toast and tolerant.Are you kidding me? If you've said this, just go home now.
Don't let your jealousy reel its ugly head.Hey, now, jealousies don't reel, they rear.
She scarred the heck out of me!If she burned you or cut you up with a razor, then surely she did scar (cause lasting tissue damage) the heck out of you. But I'll bet she just scared (afraid) the heck out of you.
He tripped over a wheel barrel.Aaaaaaaaaaargh! NO! He tripped over a wheelbarrow. People, people, do you never go to a Home Depot?

For more, visit

Saturday, March 13, 2010

Common Confusables: Preventative & Preventive

In healthcare we’re always talking about preventing illness and accidents. The magazine Prevention focuses on steps people can take to prevent illness and accidents.

But when it comes to preventive and preventative or, heaven help us, preventatativeness, we get into trouble.

Does preventative mean the same as preventive? Or is there a difference?

Yes, and yes.

Okay, here’s the deal.

You’ll hear from some folks that preventive is an adjective, as in “preventive medicine,” and that preventative is a noun, as in, “The herb is a preventative.” Those folks may cite the use of preventative as a noun and preventive as an adjective since the 17th century, and they would be correct.

Another group of folks insist that the terms possess identical meanings and can be used interchangeably. They as well would be correct.

Language is constantly evolving, and this is one of those evolutionary instances. When the experts can’t agree, as in this particular case, then the meanings are so close as to be essentially non-existent and the usage so mixed that no clear “winner” emerges.

So use whichever one you like. If someone calls you on it, believe me, you’ll find more than enough experts backing up your choice.

For me, I like preventive. I like how it sounds. To me it seems a bit more medical than preventative.

But that’s just me.

Thursday, March 11, 2010

Using Similes and Metaphors to Help Patients Learn

Similes and metaphors can act as cool, brisk breezes on a sweltering summer day. They can soothe a patient's frayed emotions, clarify a confusing concept, or build support for difficult lifestyle changes.

The trick is to use them wisely, not toss them about willy-nilly.

First, though, definitions.

A simile is a comparison of two unlike things, typically marked by use of "like" or "as." Here are a few examples:

  • The skin on his shin was as smooth as polished marble.

  • He has a face like an open book.

  • The dressing absorbed the fluid like a sponge picks up water.

A metaphor is an indirect comparison between two or more seemingly unrelated subjects, often taking a " blank is a (or an) blank " form. Examples:

  • Think of the urinary tract as a set of waterworks.

  • Your illness is a real puzzle.

  • The skull caved in.

Similes and metaphors can convey a great deal of information in just a few words. They can also help make complex information more meaningful to the patient, thus enhancing learning and, one hopes, improving health outcomes.

Although these literary constructs generally shouldn't be used in clinical documentation, they can be invaluable in talking with patients, explaining procedures, discussing at-home care, and in similar situations.

Imagine a healthcare professional, while discussing how new capillaries form in the heart when a vessel becomes partly blocked, says to the patient, "The capillaries grow around the blockage like ivy around a fence post."

You can just feel the patient learning and see the light bulb flashing over his head.

A few more examples:

  • It's the kind of itching that feels like ants running around your leg.

  • Please squeeze this ball gently, like it's a squeeze bottle of ketchup.

  • It sounds like the "ping" in a ping-pong match.

Just be careful and make sure the imagery is positive, not negative. Consider these examples as the kind you should avoid:

  • Cancer therapy as a "war"—This is a rather masculine, power-based, and even violent metaphor and may be misconstrued by the patient as if the war can be won if only she fights hard enough.

  • Comparing an arthritic knee to an old car—Don't try this one, especially if the person is, um, significantly life-experienced. (Read: Older.)

  • Disease as a "pit bull" or some such—Yikes! We may think that way as healthcare providers, but that doesn't mean the patient should.

Planning ahead

Most people can't think of really good similes and metaphors in healthcare right off the top of their head. So do this.

If you find yourself describing certain procedures or treatments frequently, sit down and think of three solid, clear metaphors or similes that won't scare a patient. Memorize them, and then use them the next time you're performing the procedure.

Then you'll be as ready as Custer was at Bull Run. Wait, what? That's not right, is it? Hmm, I'd better keep thinking of a good simile.


I'm indebted to two key sources for this post, and I thank them profusely.

Friday, March 5, 2010

How to Use Fewer Words and Still Sound Intelligent

One of my favorite movie lines is from the oldie Amadeus, in which Emperor Joseph II, after hearing one of Mozart's rapid-fire pieces, tries to tell the young composer why the piece just isn't suitable for a concert.

"There are simply," the rather haughty emperor says, "too many notes."

He was wrong, of course; this was Mozart, after all. But for the vast majority of us, using too many words never leads anywhere admirable.

I think a lot of unnecessary words and unnecessarily long phrases come from our own insecurities. We want to sound more intelligent, more officious, more leaderlike when we use big words. Too often, though, we come across sounding rather pretentious.

Here are a few common instances in which we tend to use too many words and how to cut back on 'em.

  • Rather than "prior to" or "in anticipation of," just use before.
  • Rather than "subsequent to" or "following on," use after.
  • Rather than "at the same time as" or "simultaneously with," use as.
  • Rather than "it is crucial that," "it is necessary that," "there is a need/necessity for," "it is important that," "it is incumbent upon," or "it cannot be avoided," just use should or must.
  • Rather than "is able to," "has the opportunity to," "is in a position to," "has the capacity for," or "has the ability to," just use can.

If you do this, I promise that you'll still sound intelligent and no one will think less of you.

Well, an emperor maybe, but who cares about them?

Wednesday, March 3, 2010

Neutralizing Your Words

Documenting a patient encounter—whether you're a medical assistant, nurse, physician, or whatever—demands objectivity and professional language.

Consider this notation in a patient's chart: "Patient became rude, difficult, and uncooperative."

Those three words (adjectives, in this instance) are dripping with bias, like frosting on a warm cinnamon bun. (Ooh, yummy!)

Who's to say what's "rude" or "difficult"? Maybe the patient considered himself standing up for his rights, that he was being assertive, not difficult.

Using words that contain inherent bias may work well for a novel but are completely out of place in a medical record. They open the healthcare professional to charges of unprofessionalism and inappropriate patient care.

There's a simple test for determining whether a word or group of words carries bias. Ask yourself, Can someone argue with this?

Let's say you're a student who notices strange trembling in a patient's hands. You go to your instructor and say, "Ms. Jonquin's hands are tremulous."

That's a good word because no one could argue that your observation is correct. Sure, your instructor could check Ms. Jonquin and make a more accurate observation, such as, "You're right, she's tremulous. But do you see her fingers? They look like they're rolling a pill. That's called pill-rolling tremors, a classic sign of Parkinson disease."

Those words are more accurate, but so is your word, tremulous.

But you'd better believe she would argue with your word choice if you charted, "Ms. Jonquin is scared because her hands are shaking."

"Scared" is a judgment you're bringing to the situation, not something you observed.

Similarly, words such as angry, upset, sad, or any other term describing an emotion (unless the patient says it herself) are judgments about a set of objectives observations. Anyone could argue with words like those, just as they could argue with these words: attack, threaten, argue, scream, and yell.

Stick with words of objectivity that no one could argue with, that no one could contradict.

Take great care in using words that could be considered inflammatory, lest you find yourself on trial without a tremulous leg to stand on.