TIAN+Jun-ying

【Abstract】This paper focuses on situations in which the active or passive voices are used in medical writing.In writing medical paper，choose the active voice whenever possible.Choose the passive voice if you have a good reason to do so.

【Key words】Active voice；Passive voice；Medical writing

1 Definitions of active voice and passive voice

The terms active and passive voice refer to the way subjects and verbs are used in sentence construction.The main difference between active and passive voice lies in the amount of emphasis given to the person or object performing the action of the sentence，versus the amount of emphasis given to the person or object being acted upon.The passive voice emphasizes the person or object receiving the action（e.g.，Samples were analyzed）.The active voice，in contrast，emphasizes the person or object performing the action （e.g.，We analyzed samples）.In a sentence using active voice，the subject of the sentence performs the action described in the verb，e.g.，We collected liver samples from six hospitals in China.In a sentence using passive voice，the subject of the sentence receives the action described in the verb：e.g.Samples were collected from six hospitals by our research team.

In medical writing，the person or object performing the action is usually removed.In this case，the person or object performing the action is implied，e.g.Samples were collected from 6 hospitals.

2 Active Voice is Preferred in Medical and Scientific Journals

For the most part，you probably want to write in the active voice when possible.Thats because sentences written in active voice are generally clearer，livelier，more direct，more compact，and often more concise than passive-voice sentences.Most style guides advise scientific authors to prefer the active voice in their writing. According to Dictionary.com， active voice is preferable to passive voice because it gives“a sense of immediacy to the sentence.”

Nowadays，most medical and scientific style manuals support the active over the passive voice.For example，the American Medical Association's AMA Manual of Style recommends that "in general，authors should use the active voice， except in instances in which the author is unknown or the interest focuses on what is acted upon."1

Likewise，the British Medical Journal2， the Nature Journal3， and the Science Journal share the similar view4.

Unless you have a compelling reason to choose passive voice， use active voice.Dont be afraid to use the first person when applicable.

Example 1：We conducted a 1-year， randomized clinical trial to compare the effects of alternate-day fasting vs daily calorie restriction on body weight and risk indicators for cardiovascular disease.

Example 2：We obtained internal agency information for AC meetings with votes on drugs and devices held between 2008 and 2014 for which COI screening was required.

When the actor or researcher rather than what is being acted upon is the focus，or when it is important that readers know exactly who did （or said）what to whom，the active voice is appropriate or preferred

3 Use of Passive Voice

The passive voice is indirect，and it can be wordy，vague，or it can lead to other grammatical errors；but sometimes it is useful to emphasize the research， instead of the researcher.

Whether in the Methods or elsewhere in a manuscript，the passive voice redirects attention to the action（or the recipient）.Passive voice is useful to pull the emphasis of the sentence away from the researcher.It is especially applicable to the“Method”section of medical journals.If an author does emphasize the active voice over the passive in the Methods （or any section），most sentences will begin with we，which is distracting when overdone.1In that case，passive style sentences vary the structure and rhythm while keeping the emphasis on the work.

The passive voice would be appropriate if the process or materials rather than the actor are the focus， or when the performer is either obvious or unimportant.

1）To focus attention on the process or materials / objects， rather than on the actor

e.g.：Next，the liver tissue sample was exampled under microscope.

Analysis：In this example，the object（liver tissue sample） rather than the actor （the observer） is the focus.

2）The implied subject is obvious：

e.g.Hepatic microsomal HMGCR activity was assayed by a method modified from a previously published procedure.

Analysis：In this example，we know that the researchers performed assay of the hepatic microsomal HMGCR activity.Sentences like this one shift the focus from the doer of the action to the action itself.

3）The Implied subject is unknown/unimportant

Use passive voice to downplay the agent.In medical essays，passive voice is used when the performer of the action is unknown or unimportant

e.g.On average，QIDS scores were significantly reduced from baseline one week and three months post-treatment. Mario Klingemann.

In this example，we do not know what is reducing the QIDS scores； we only know that they are reduced.

3 Conclusion

Although many medical journals favor active voice because it is direct and concise，both voices are useful and necessary.Consider passive voice when the performer is either obvious or unimportant or if the process or materials/objects rather than the actor are the focus.Its advisable to choose active or passive voice according to the purpose of the sentence or based on which part of the sentence you wish to emphasize.

【References】

[1]Iverson C，Christiansen S，F(xiàn)lanagin A，et al.AMA Manual of Style：A Guide for Authors and Editors.10th ed.New York，NY：Oxford University Press；2007.

[2]The essentials of BMJ style.BMJ Publishing Group Web site：British Medical Journal.http：//resources.bmj.com/bmj/authors/bmj-house-style.Accessed March 5， 2009.

[3]How to write a paper：writing for a Nature journal.Nature Publishing Group Web site：Nature.http：//www.nature.com/authors/author_services/how_write.html.Accessed March 4，2009.

[4]Some notes on Science style.American Association for the Advancement of Science Web site：Science.http：//www.sciencemag.org/about/authors/prep/res/style.dtl. Accessed March 4，2009.

[責(zé)任編輯：田吉捷]