Writing Clinic: Choose Your Topic Carefully, Part 3

Michael Gerchufsky, ELS, is the managing editor of Consultant. E-mail him with thoughts on this post at

In the first Writing Clinic blog post, part 1 of "Choose Your Topic Carefully," I recommended a few first steps to authoring and contributing a clinical case report or review article to Consultant. In part 2, I discussed choosing a topic with the appropriate scope, and finding your article's "hook" or your "angle."

Here in part 3, I'd like to build on the idea of finding a hook, and discuss zebras vs horses and the pros and cons of choosing either as a topic.

When You Hear Hoofbeats …

Of course, you're familiar with the adage, “When you hear hoofbeats, think horses, not zebras," first attributed to Theodore Woodward, MD, at the University of Maryland School of Medicine 70 or so years ago. That colorful turn of phrase has endured because of its inherent truth: It stands to reason that most of the time, a given patient's diagnosis will be on a relatively short list of the more common health problems in the age group, the geographic area, the time of year, and so on. The challenge is determining when a patient's diagnosis is on the very long list of conditions that are less common, rare, extremely rare, and so unbelievably rare that they just might name the condition after you for having discovered it.

Keep the hoofbeats aphorism in mind when choosing a topic to write about, and apply it to the audience. As I noted in part 1 of this blog post series, the main focus of Consultant is primary care medicine. So, generally speaking, the topics that are most likely to edify your colleagues and provide them with practical clinical information they can use are the diseases, conditions, and patient characteristics that most primary care providers see in daily practice.

Now, if you recently diagnosed a case of torsonic polarity syndrome, or spontaneous dental hydroplosion, or spastic involuntary texting syndrome, by all means, write it up! There is a real need for information on many of the most rare diseases, and the path to your having made the diagnosis itself might offer a practical teaching message. But if you're searching for a topic about which to write an article, it's better to choose one from the realm of horses, not zebras, for maximal usefulness and impact.

Common Primary Care Diagnoses

In order to narrow your search for a viable topic, it's a good idea to take a look at the most common diagnoses. These are widely available on the Web, and a quick search should yield a number of lists that are based on information from authoritative sources.

For example, here are the top 10 most common diagnoses in primary care in 2019 (from

  1. Essential hypertension
  2. Hyperlipidemia
  3. Type 2 diabetes
  4. Adult medical examination
  5. Immunization
  6. Hypothyroidism
  7. Gastroesophageal reflux disease
  8. Atherosclerotic heart disease
  9. Hyperlipidemia
  10. Vitamin D deficiency

And here are the top reasons for primary care visits (from

  1. Hypertension
  2. Upper respiratory tract infections
  3. Depression or anxiety
  4. Back pain
  5. Routine health maintenance
  6. Arthritis (excluding back)
  7. Dermatitis
  8. Acute otitis media
  9. Diabetes
  10. Cough
  11. Medication management
  12. Urinary tract infection

If your topic isn’t on this list or one like it, you just might have chosen a zebra.

Recommended Resources

Before I discuss choosing your approach after you have decided on a topic, I wanted to recommend a few resources that I think can help answer questions and offer good advice about the entire process of writing for the medical literature.

• The AMA Manual of Style. Now in its 11th edition, this is is the medical writer's (and editor's) bible. In my career, I have literally worn out a few copies of this book, which I use daily for answers to questions about style, composition, and more about medical writing. It's also available online at

Dorland's Illustrated Medical Dictionary. Is it Henoch-Schönlein syndrome, or Schönlein-Henoch syndrome, or Henoch-Schönlein purpura, or anaphylactoid purpura, or IgA vasculitis? Does it Schönlein require an umlaut? Dorland's (or another medical dictionary) is an essential tool for accepted use and spelling of medical terminology, in print or online at

How to Write and Publish a Scientific Paper, by Robert A. Day and Barbara Gastel. This classic how-to guide explains almost everything you'll need to know about the process.

How to Write and Publish Papers in the Medical Sciences, by Edward J. Huth. While arguably not as comprehensive as Day and Gastel’s book, Huth's book offers a second point of view on many of the common questions in medical writing.

Coming Soon ...

In the next few blog posts, I'll discuss the nuts-and-bolts approach to writing after you have decided on a topic for your article. Stay tuned, and thanks for reading.