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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The taggers get extra credit in their circles for placing any of their handiwork in areas that are difficult to access. A good example of this are those taggers who place graffiti on overpasses or in high-security areas.

Content providers or people who, like me, write for money mainly for corporate clients, can also get extra credit for writing materials that reach readers who are difficult to reach.  It’s a common request I get from many of my clients: We want to reach doctors, but they get so much mail already. We want to reach hospital administrators, but they are hard to access. We want to talk to our patients, but we just don’t know how to get their attention.

So a skillful tagger gets his writing in a danger zone and a skillful content provider figures out ways to access people that are difficult to access.

How can you write something that will capture attention of a difficult-to-interest group? That is a topic that could fill a book, but here are a few pointers.

1. You have to write something that your target audience will care about. If you’re trying to capture the attention of a group for something that interests you but not them, you’re doomed to fail. You have to know your target audience and figure out (a) what they are desperate to know, find out, or learn and (b) how they generally like to get their information. That’s a job for research, not your intuition or best guess.

2. You have to offer real content which in most cases is going to mean real answers, real solutions, and real products. If you deliver fluff to your audience, they’ll be mad at you. It’s actually more productive not to reach an audience than reach an audience only to annoy it.

3. You have to be willing to get outside of your comfort zone. If you could reach these guys doing the kinds of things you usually do (working in your comfort zone), you wouldn’t have this problem. Clearly, you’re going to have to try something new. This may mean new media (video, audio, online content) and new vehicles (YouTube, Twitter). It may mean going back to old-school stuff (an offline newsletter, a classified ad). It may be a hybrid (try a classified ad that offers a free report they can get by calling an 800 number or going to a website).

4. You can’t give up. Rome was not built in a day. Those who reach tough-to-reach audiences do so because they tried lots of different things and were willing to give themselves permission to fail. Permission to fail means having some money and time that you are willing to risk as you try to achieve your goal. Just learn from your mistakes along the way.

5. Find ways (before you start) to measure your success. This may be a clicker on a website or a coupon or some kind of direct response. Work with your marketing guys to figure out a way to measure results and determine in advance what might be considered successful. Then track your numbers.

6. Encourage your writers to learn, learn, learn. Groups that are hard to reach are hard to reach because they do not find much useful in the usual places. This means that the usual approach to writing is going to turn them off. In most cases, this writing is not useful to them because the writers do not offer useful, valuable, practical, realistic information. The way to achieve success is to offer information that will help these people; give them information that they not only want, give them the stuff they are desperate to know. This means that writers have to do lots of research. Don’t keep your writer in a cubicle and expect them to address a difficult audience effectively. Let me them out to roam and learn the nuances of the market.

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However, most good medical marketing types need to know how to write passably well, so here is how. I cannot promise that I can make you an adept and agile writer, but I can probably fix a few things you are doing wrong.

So here are my top 10 tips to fix your writing without having to read a book, go back to school, or sign up for a home-study course.

1. WRITE LIKE YOU TALK. That sounds counter-intuitive but remember, if your English teacher knew how to teach you to write you wouldn’t be in this fix right now. Most of us are able to communicate our ideas passably well when we speak. So when in doubt, just write down what you want to say. (Some of us sit down “to write” and that sounds ponderous and scary. Instead, sit down and write down what you want to say when you actually do get around to “writing.” Nine times out of ten that draft is going to be close to good-enough.)

2. USE THE RIGHT WORDS. There is a laundry commercial on right now in which the company promotes a vehicle it uses to go into disaster areas and wash clothes for people living in the area. A woman beams at this service and says something to the effect that people have no idea how basic the essentials are until you don’t have them. Wonderful sentiment, wrong words. She probably meant to say that people have no idea how essential the basics are. Edit everything you write and ask yourself: “What am I actually saying here? What do these words really mean?”

3. HAVE SOMETHING TO SAY. Most people who write poorly really do not have anything to say. Make sure before you start that you have something worth sharing.

4. FORGET THE RULES. Some people say that you should write in the active voice only and avoid the passive. That isn’t true if you are writing scientific texts, academic texts, or how-to manuals. In those cases, the passive is much more useful (and better understood). Some people say you should use a lot of action verbs. That is great if you’re writing a novel but it won’t necessarily help a how-to text or a contract. Some writing-counselors suggest you use lots of adjectives. That is going to make your brochure seem overdone. The point is: forget the rules. Write like you talk and say what you mean.

5. THINK 1-2-3. A lot of bad writing occurs because the author is trying to describe a sequence of events or steps and omits one or puts them in the wrong order. I once read a manual that said things like, “Attach the barrel to the syringe, after having filled the barrel with sterile solution prepared according to directions in the refill manual.” This is a disaster. A person reading this has to backup too far … You’re telling him to attach the barrel to the syringe but then he has to go back and fill it with the sterile solution … and then back up from there to prepare the solution … and to do that he has to find another manual. Always go in order.

6. MAKE LIFE EASY ON YOUR READER. Here is another one of my favorite disaster manuals. This was a software manual. The company produced four different versions of a software product which were all quite similar to each other. Each software version had its own manual. Now assuming the software was named Bronze, Silver, Gold and Platinum, the Gold Manual stated simply, “This product has all of the features of the Platinum Software Product with the exception of A, B, and C.” What the manual did not do was write about those features or provide the Platinum Manual. It assumed that if you had the Gold version of the software, you could get the Platinum manual (which you could not) and then you would read it and mark out the things that did not apply (which you could only figure out if you had the Gold manual). This was possibly the worst written thing I ever read although it was grammatically correct and contained no typos.  It made it almost impossible for the reader to know what the reader needed to know.

7. HAVE A PERSONALITY. Most medical companies are busy beating personality out of their brands, but isn’t personality what makes Nike and McDonald’s and Apple so special? I agree that a medical brochure about oncology drugs should not be a joke book, but emotions such as enthusiasm, passion, wit, and intelligence are very acceptable. Do not be afraid to let your personality (and your enthusiasm) shine through in your writing. Remember, at the end of the day, marketing is about one guy talking to another guy. Personality helps.

8. DO YOUR HOMEWORK. Medical companies often try to keep writers isolated and away from patients, sales reps, customers, and medical procedures. The best writing is done by people who know what they’re talking about. Don’t write about what an operation is like until you’ve seen one (or two or ten). Don’t explain how to program an infusion pump until you know how to do it yourself. The more you know, the better you’ll write.

9. HIRE HELP. Many people hesitate to hire writers and editors, but they are very useful and I say this even if you more or less write most of the article or brochure or content yourself. These folks can smooth out rough edges, give you great feedback, and check to be sure that your grammar is kosher and the footnotes are in the right format. Most professional writers work with editors; do you think you need less support?

10. READ WHAT YOU WROTE, ideally a day or two later, and try to put yourself in your readers’ shoes. Does the text make sense? Does it do what you want it to do (inform, persuade, convince, instruct)?

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You have to know why you have writer’s block. You have it because somewhere in your past you took an English class and in that English class you had a scary sort of teacher who made you feel inadequate. This was a person who ranted and railed about inscrutable things like dangling participles and misplaced modifiers. She usually talked about things like syntax, and it was her life’s mission to speak and write perfect English.

You might think you left her back at your old high school, but you didn’t. It’s gotten a whole lot worse than that. Now she has become your inner English teacher.

Your inner English teacher will prevent you from ever writing well or effectively. The reason is that she is misguided enough to believe that it is better to not write at all than to write something that might be imperfect. And since the rules for perfection are inscrutable, unknowable, and usually revealed to you after you’ve violated them, you are naturally fearful.

She is the reason you have writer’s block. Here is what you must do. Kill her. Now I am talking about getting rid of the little imaginary person in your head. Shut her up once and for all.

Only after she is gone can you relax for a second. Now here is how you write when you have writer’s block:

1. Find something you like to write on–computer, legal pad, spiral notebook, even a whiteboard will do. Without worrying for one instant if you are using proper English and grammar, write down very roughly and briefly what you are trying to say. This can be in sentences, bullet points, as a list, or just in key words.
2. Review what you’ve written and make sure you have covered all of the points. If you’re writing about a new product and want to mention four specific features, make sure you’ve listed all four features.
3. Review what you’ve written for a second and decide what emotion or action you want to convey. Are you trying to be persuasive? Enthusiastic? Are you trying to warn somebody? Do you want to try to sound clinical? Humorous? See if you can’t get a little bit of that emotion into your rough draft.
4. Now without trying to write well, sit down to write your draft. Remember that drafts are rough. Mistakes are allowed. Do not allow yourself to get distracted by the dictionary or thesaurus. Using your outline or whatever it is you’ve created (your “notes” in the first three steps), write what you want to say as if you were saying it to your target audience. If you’re writing about a new medical product to physicians, just pretend you’re talking to a particularly friendly doctor and tell him your ideas. Use your notes to be sure you don’t forget any key points.  (By the way, if it’s easier, just speak your thoughts into a recorder and then get your recording transcribed: instant draft.)
5. Just to annoy the late inner English teacher, spell a few words wrong on purpose.
6. Read over your draft at least once to be sure that you covered your main points and that it makes sense. It does not have to read like you’re a candidate for the Pulitzer Prize but it should make sense.
7. Put your draft away for at least 24 hours, if this is possible. Then come back and re-read it.
8. Now it’s time to polish. This is the real work of writing. Now it’s time to fix the spelling. Get out the thesaurus if you’re unhappy with some word choices. Look up the grammar issues or ask somebody with good editorial skills to edit your manuscript. You may have to flesh out the text in a few places. More likely, you may have to trim down some other areas where you got carried away.

That’s it. That’s how writers write. It’s also why a lot of people hire their writing done.

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