Bad grammar: A call to end the passive voice in radiological discourse

 - Writing Clinical Note

The passive voice has been relied on much too often by radiologists … 

Oops, let me write that again …

Radiologists rely on the passive voice much too often and should use the active voice whenever possible, according to a recent article published in  Academic Radiology.

The authors of the article—Richard B. Gunderman, MD, from the Indiana University School of Medicine’s department of radiology, and Laura A. Steinmeyer, a medical student at Indiana University—say the passive voice “appears to dominate” radiological discourse, and it could be having a negative effect on the specialty as a whole.

“We argue that the quality of writing in radiology—and by extension, the quality of thinking in the field—could be improved by shifting the balance toward greater reliance on active voice,” Gunderman and Steinmeyer wrote.

The authors provided a quick refresher course about the difference between the passive and active voices. If a writer is using the passive voice, they explained, the subject of the sentence is acted on (“The ball was kicked by Amelia”). But if a writer is using the active voice, the subject of the sentence is the actor (“Amelia kicked the ball”).

Citing such sources as  The Elements of StyleThe Columbia Guide to Standard American English, and George Orwell, the authors said the passive voice has been a bit of a punching bag for many years.

“Many good writers and English instructors warn against the use of the passive voice because it tends to make sentences seem awkward, flat, and unengaging,” Gunderman and Steinmeyer wrote.

But radiologists (and other physicians) continue to write and speak in the passive voice, and the authors wrote that some reasons for doing so make more sense than others. For instance, one understandable reason for a physician to use the passive voice is that they may want to put all the reader’s attention on the patient and the patient’s care.  

“In many cases, writers may simply assume that the identity of the agent is understood, and what is really interesting about the narrative is the particular procedure, equipment, or supplies that the agent chose to use in the patient's care,” Gunderman and Steinmeyer wrote.

Choosing the passive voice can also lead to less repetition of personal pronouns, so physicians may use it for that reason. But even that method has its negative side, the authors wrote, because it can make it hard to know who is doing what if more than one physician is involved in the research or procedure being described.

According to Gunderman and Steinmeyer, “questionable” reasons for using the passive voice include not wanting to place blame for any potential mistakes and—the one they dislike the most —“the fact that nearly everyone seems always to have done it this way.”

Even after focusing on the overuse of the passive voice, the authors understand it’s a hard habit to break. Gunderman told RadiologyBusiness.com he still finds himself using the passive voice instead of the active from time to time.

“I still find myself using the passive voice, particularly when reporting procedures, though I am working on it,” he said via email. “Since co-authoring the article, I have probably improved somewhat.”

Gunderman also said there are other grammar- and writing-related pet peeves that stand out in his mind. He listed “status/post” and “no evidence of abscess is seen” as some of the many “verbal tics in medicine” that he wishes would go away.

“How we speak reflects the quality of our thought, and by developing better habits of speech, we can improve the quality of education, research, and patient care,” Gunderman said.