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TIP 4. Use Active Voice And Active Constructions

Use the active voice and active constructions as much as possible.

ACTIVE VS PASSIVE VOICE

We performed the study.
Active voice: the subject "we" is actively doing what the verb describes

The study was performed.
Passive voice: The subject "study" is acted upon by other agents.



EXAMPLE 11.A study was performed on the causes behind the decrease in the identification of child abuse in the ER by the Social Services staff.

Rev 11. The Social Services staff evaluated the causes behind the decreased identification of child abuse in the ER.

Note on Example 11: This sentence demonstrates a common problem with passive sentences: who is doing what? We could interpret the activity of the Social Services staff to be 1) performance of the study, 2) identification of child abuse, or 3) perpetration of child abuse (unlikely, but a grammatically viable interpretation!). If we put the staff in the driver's seat (i.e. subject of the sentence), their role is unambiguous.


EXAMPLE 12.Clinical records were abstracted for demographic data, history, the results of their diagnostic evaluation, and the subsequent course of their hypertension.

Rev 12. We enrolled patients with hypertension, and abstracted from their clinical records data on demographics, history, diagnosis, and clinical course.

Note on Example 12: In this passive voice sentence, the subject is "clinical records" and the verb is "were abstracted." The plural subject should identify the "they" in "their diagnostic evaluation" and "their hypertension," but these two "theirs" are floating without an identity. Unidentified sentence elements commonly haunt uncontrolled passive sentences. In the revision, these ambiguous relationships are clarified through use of a better chosen subject ("we") and two active verbs ("enrolled" and "abstracted"). In clinical research reports, patients are often "ghosts" haunting a sentence, playing a role which is assumed but not grammatically specified.


EXAMPLE 13.End stage renal disease patients with severe disability can continue dialysis in a more convenient and comfortable setting at home, and yet be relatively cost-effective.

Rev 13. Home dialysis of ESRD patients with severe disability is more convenient and comfortable for the patient, and relatively cost-effective.

Note on Example 13: Although this sentence does not use a passive verb, it uses a passive construction with the result that the subject gets lost in the second clause. Clearly these patients are not "cost-effective." Choice of a better subject activates the sentence and eliminates the confusion.