He or she is annoyed and on the cusp of getting mad.

When do we turn to manuals? We read the instructions generally when we cannot make something work despite repeated, failed attempts. We read the manual only in a last-ditch attempt to stave off disaster. The state of mind of such a person is aggravated, confused, angry, unhappy, and frustrated. Add to that the extra layer of suffering  caused by virtue of the fact that this person is a trained medical professional trying to do his or her job and there is possibly a patient involved who might be neglected, inconvenienced, or even harmed by the perpetuation of this situation.

Let’s review. Your labeling is being read by a person who is angry and trying to keep calm under pressure so as not to exacerbate an already frustrating and potentially dangerous situation.

Bearing this in mind, ask yourself: is your labeling clear? Is it helpful? Can a person in the aforementioned frame of mind use your labeling with good success?

Most medical companies write their instructions for use and manuals for regulatory bodies. It is true, of course, that regulatory bodies go through these things with a fine-toothed comb and that manuals and other labeling must meet stringent requirements.

Many medical companies (and regulatory bodies) act like it’s enough when the labeling passes muster. But it isn’t. Remember, there is an angry clinician trying to use your product who right now is practically ripping through the pages of your manual.

How clear is your manual? You ought to do some testing by having coworkers not involved in labeling be charged with finding specific information using only the product labeling and see how well they do. But enough amusements. Here are 10 ways to make sure your labeling is really helping clinicians to help their patients.

1. Put in a killer table of contents.  Never mind this auto-generated stuff or graphically attractive list. Write the table of contents (ToC) first and write it clearly and in a way that flows logically for your product. Then put in heads and subheads. Don’t be cute or clever; be descriptive. (Save your wit for your friends.) I think a manual writer ought to spend more time on the ToC than on anything else in the manual–it’s a vital navigation tool. It’s the map to the manual. The angry clinician tearing through the manual is likely going to try to get his bearings by glancing at the ToC. You have one fast chance to try to restore the flagging relationship you have with this doctor, so don’t blow it with a confusing, haphazard, or altogether missing ToC.

2. Do an avant-garde type of index. An index appears at the back of the book and allows the clinician to look up terms in alphabetical order and find out where they occur in the manual. Avoid using indexing programs unless you know what you’re doing. In fact, forget the traditional index.  Instead, do the index “backward.” Make a list of all of the things your angry clinician is going to be likely to want to look up. Put them in angry-clinician-ese. Then, using this list, match the manual sections to those topics or questions. For instance, I don’t see why more indices (that’s the plural, look it up) don’t say things like “how to turn the device on” or “how to set up the patient profile.” That’s what the clinician wants to know. Then list where to find that information. If you do a traditional index, it will just say, “Programming, device” or “Patient data” or whatever buzzwords are in the book. Think like a person.

3. Use readable type and readable fonts. Most labeling uses pretty decent fonts, but I have seen instructions for use and manuals that use microscopic type or (my personal least-favorite) pale gray type on light gray paper. Think of angry clinician. Maybe, among all of the many pitfalls of his bad day, he has also misplaced his glasses. Give him a fighting chance at reading the labeling. You don’t have to do giant print, but strive for legibility rather than whatever your designer-du-jour thinks is cool.

4. Put in lots of line art. Some manuals nowadays use photography because, I suppose, digital cameras are ubiquitous. Photography does not work well in manuals because unless your shots are extremely well composed and taken by a professional photographer they are going to be confusing (most photographs will provide lots of extraneous information that’s hard to sort out) and not reproduce well. Line art–simple drawings showing what goes where or how something is set up–is much easier for a person to interpret. These drawings home in on only the key elements (hands opening a package, for instance) and can highlight what is important and minimize or omit what is not necessary. I could show how to open a box from a pull tab much easier in a line art drawing than a photograph. Line art requires an artist, but it makes your manual much clearer. (Remember angry clinician?) It also facilitates translation–that is, the money you spend on the artist you may save on translation fees down the road since one picture is worth… well, you know.

5. Be redundant. Many reviewers of labeling will criticize a manual as redundant if they see a subject handled in more than one place. That shows why reviewers should never be hired as writers. Nobody (except maybe a reviewer) is ever going to read your manual from cover to cover like a novel. Nobody is going to read page after page and then get aggravated because you mentioned how to set up the device on page 3 and again on page 33. But if a reference on how to set up the device would be logical on page 33 and an angry clinician is thumbing through your manual desperate for answers and does not see that information on page 33 … he goes from being the angry clinician to being the very angry clinician. Put information everywhere it seems logical, even if it appears more than once.

6. As much as possible, avoid the “see page…” syndrome. You know how this works. You write about how to program your product and you wind up saying, “set this up, see page 9.” Then you add, “to use this product with an electronic record system, see page 21.” And you conclude with, “for specific warnings on when never to use this product, see page 42.” Remember angry guy? Angry guy does not like to flip through pages. In truth, there may be times when you cannot avoid this or times when it is the more elegant solution. But remember, angry guy is not really worried about elegance. He’s worried about getting the information he needs, in clear terms, quickly. If you do use a “see page…” make sure it’s for something that nobody cares about, such as “for a list of our corporate offices, see page 202.”

7. Use the same words over and over. Your English teacher lied to you when she told you that you should avoid using the same word over and over in a sentence. In the world of technical writing, you want to be clear about what you mean. If your product has a reservoir, never use another term for it even if you use reservoir eight times in one sentence. Do not call that think a tank in one section or a storage area in another and then a well and then a reservoir. To the angry clinician, each part of your product has one name. The reservoir is the reservoir.

8. Never sacrifice clarity for style or good English. That’s right. If you have a choice between writing elegant English or even correct English and being clear, always pick being clear. Remember angry clinician? Do you think at this moment he’s worried about a misplaced modifier? No, he wants to know how to turn the programmer off or how much morphine to inject in the pain pump or where to attach the printer cable. Be clear at all costs.

9. Write in a logical sequence. Most of your writing in how-to texts should be a series of steps. Most of the time, it works best to have short paragraphs followed by numbered lists or bullet points of what to do. Make sure this goes in order. Here is something that will make angry clinician look for a gun: Step 6. Insert the yellow plug into the programmer after having sterilized the plugs and after having run through the basic programming sequences described on page 27. This is out of order. You need to say things in the order in which they are done: 1. run through the basic programming sequences, 2. sterilize the yellow plug (how?), and 3. insert the yellow plug into the programmer.

10. Hire a professional writer. Most manuals are written by engineers (scientific types), regulatory personnel (legal types), and the FDA (bureaucrats). Give your customers a fighting chance by getting a real writer involved. In my experience, these groups are not opposed to good, clear writing, they just can’t do it. It’s kind of like the way most of us feel about classical music. So hire a real writer.

Remember angry clinician! You have a chance to redeem yourself and make him a happy customer, but only if you get your labeling right.

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