Writing Clinic: Nuts and Bolts of the Manuscript, Part 2

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

In previous Writing Clinic blog posts, part 1, part 2, and part 3 of “Choose Your Topic Carefully,” I recommended a few first steps to contributing an article to Consultant. In part 1, part 2, and part 3 of “Choosing an Approach,” I discussed the array of possible article formats in the journal and other tips for approaching the writing of an article. I also advised about contacting the editor and performing a literature search. Last time, I opened the discussion of the nuts and bolts of the manuscript by answering “How long should it be?”

This post offers some advice about the extras — items that accompany the text write-up that lead to further understanding of the topic.

Nearly any article for the medical literature benefits from (if not requires) illustrations, clinical photographs, radiographs, and other scans, charts, tables, lists of information, and so on. In addition to underscoring an article’s clinical message and helping convey the teaching point, these extras offer additional “entry points” to an article—items that catch readers’ attention and draw them in to read more.

Here are some important points to remember about these extras:

Permissions: If the scans, photos, tables, and so on that you’d like to use are from another copyrighted source, permission must be obtained from the copyright holder. Let the editor know right away if this is the case, because sometimes permissions take some time to acquire, and in some cases are not able to be obtained at all, requiring another strategy. This applies to print materials, but also to any files downloaded from Web sites.

Remember HIPAA: If photos and scans you are using are from a patient’s record from your own practice, a few important reminders apply. First, any identifying details appearing in the file—such as a patient’s name, birthdate, or other identifiers on a scan—must be removed to ensure patient privacy. If a photo that shows a patient’s identifying details is to be included, a consent form must be completed by the patient (if over 18) or the patient’s legal guardian (if under 18). Note that identifying details don’t only include the patient’s face. Other identifiers could include, for example, a tattoo or even a unique item of jewelry if it is visible in the photo. If your practice doesn’t have such a consent/release form prepared for use, contact the editor.

Think “inside the box”: Extras don’t only include visual items like scans and photos. Think about information that may be slowing down or adding too much to the article, and consider converting it into an extra. Do you think an anatomy and physiology refresher would help? Put it in a sidebar article that can appear in a box. Is there a long list of symptoms, or a wide differential diagnosis? Consider a bullet list or a table.

Captions: Please include an explanation of what each graphic depicts. For example, what does a radiographic image show? What is the significance of the photo? 

One more important note about graphics files. Please do not embed photos and figures in Microsoft Word documents. Instead, include each graphic (.jpg, .gif, .pdf, .png, .bmp, etc) as a separate, discrete file. In the process of embedding graphics into Word documents, the resolution of graphics files may be significantly decreased to the point that they are unsuitable for publication in print or digitally.

Next time, I’ll offer tips about building a manuscript’s reference list and annotations in text.

Thanks for reading!