I ran across an intriguing article in the current issue of AMWA Journal: Use of the passive voice in medical journal articles. Amdur, Kirwan, and Morris.
The paper begins with a quote from Anitra Sheen:
“Passive voice is the bane of medical writing. It pervades medical literature with the haze and heaviness of stagnant air. Writers sometimes use passive voice in an attempt to make their work sound scholarly and scientific, when actually they are perpetuating a writing tradition that is fraught with ponderous and obscure language."Breathing Life into Medical Writing: A Handbook. St. Louis: Mosby; 1982:21-22
The authors then discuss the real facts: no data exist on the use of passive voice in medical writing and how it compares to other forms of written communication! They set out to fill this data void by calculating the use of passive voice construction in 3 types of articles from 3 major medical journals. They selected JAMA, New England Journal of Medicine (NEJM), and The Lancet because they have high impact factors and may model medical writing style for other journals. They also have different publishers and editorial staffs, and each issue addresses a variety of topics from a wide range of fields of medicine. From each of the 3 journals they selected 10 articles of each of 3 types, namely opinion papers, review articles, and original research reports. Thus, 90 articles from 2006 issues of these journals were selected randomly for inclusion in this study. For perspective, 30 articles from The Wall Street Journal (WSJ) provided a nonmedical control group. They chose WSJ because articles seemed similar regarding detailed analyses of complex subjects. Titles, headers, abstracts, references, and quotations were not included in the analysis.
Now for the fun part: each sentence in every article was hand-coded for passive or active construction:
Specifically, one of us (RA) evaluated every sentence in each article to determine the number of sentences with passive voice construction. For the first 20 articles, another one of us (JK) repeated the process so that both of us independently recorded the voice as active or passive in every sentence in the article. We then discussed any discrepancies and made a final determination that we both agreed on. After doing the 2-person analysis on 20 articles, there were no differences in our calculations in the next 10 articles, so, for the remaining 90 reviews, only one of us determined passive voice frequency without a double check by the other.
That makes taking daily vaginal swabs on mice seem glamorous! I am really happy that they went to the effort, for they then determined percent passive voice using Microsoft Word's grammar check. Other analyses included use of first person pronouns, and two forms of passive voice construction:
- Passive voice, doer mentioned: “Data were collected by a member of our research team from patients with pneumonia.”
- Passive voice, doer not mentioned: “Data were collected from patients with pneumonia.”
- Active voice: “A member of our research team collected data from patients with pneumonia.”
As shown in the figure, no differences in passive voice use was demonstrated among the 3 medical journals, all of which were substantially higher than WSJ with a median value of 3% passive voice. Use of passive voice did not differ with article type in medical journals. When research articles were studied by section, differences were found among sections, yet all displayed more passive voice than the WSJ sample (next figure).
So what's an author to do? Do we have to hire an English major to fix our writing? Lucky for us, the tools in our word processor estimate passive voice frequency pretty well as shown below:
The authors discuss many reasons for high frequency of passive voice use in medical writing, and they make some recommendations:
• Use the active voice in place of “doer mentioned” passive constructions.
• Limit the use of the passive voice to the Methods section of an Original Research Report because this is a section where describing who did the action distracts the reader from what was done methodologically.
• Use passive voice frequency in the overall paper as an endpoint for evaluating the quality of the writing.
• Medical journal editors should make a passive voice frequency of ≤10% a publication requirement for all types of articles.
All types of articles in all journals showed plenty of articles meeting the 10% limit, so the authors feel this goal is readily achievable. They also recognize that excessive passive voice construction is not the sole problem with medical writing; however, it is one we have the tools to fix quickly and easily.
Every writing course from middle school on up encourages the use of the active voice. Should this be a journal standard?
*By the way, I ran my text for this blog through the Word grammar check and I logged 9% passive voice sentences. W00T!