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Improve Your English Punctuation

Charles Highway — Tue, 30 Jun 2009 15:07:03 +0000

How good is your written English, let alone your punctuation?

Here is a guide from WikiHow that should get you writing your assignments with more literal pizazz. A medical student should at least know the basics; a great medical student should know how to bend the rules to his/her will.

Enjoy.

How to Use English Punctuation Correctly

from wikiHow – The How to Manual That You Can Edit

With the dawn of the Internet, the birth of Internet slang, and the growing age of SMS, many individuals are forgetting the fundamental aspects of English punctuation. Would you like to write a great paper for one of your classes? Maybe you need to submit a polished, impeccable proposal to your boss. If so, it will help to know proper usage of punctuation. Consider this article a crash course in English punctuation, and read on.

Steps

End your sentences with a period (full stop), question mark, or exclamation point (exclamation mark or shout mark).
- Use the period (full stop) to denote a full stop at the end of a statement. The period ( . ) is one of the most commonly used punctuation marks.
  - The accessibility of the computer has increased tremendously over the past several years.
- The question mark ( ? ), used at the end of a sentence, suggests an interrogatory remark or inquiry.
  - What has humanity done about the growing concern of global warming?
- The exclamation point (exclamation mark, shout mark)( ! ) suggests excitement or emphasis in a sentence.
  - I can’t believe how difficult the exam was!
Use the semicolon and colon properly.
- The semicolon ( ; ) has a few uses.
  - Use a semicolon to separate two related but independent clauses. Note that, if the two clauses are very wordy or complex, it is better to use a period instead.
    - People continue to worry about the future; our failure to conserve resources has put the world at risk.
  - Use a semicolon to separate a complex series of items, especially those that contain commas.
    - I went to the show with Jake, my close friend; his friend, Jane; and her best friend, Jenna.
- The colon ( : ) has multiple uses.
  - Use the colon to introduce a list. Be careful not to use a colon when denoting a regular series. Usually, the word following suggests the use of a colon. Use only after a full sentence which ends in a noun.
    - The professor has given me three options: to retake the exam, to accept the extra credit assignment, or to fail the class.
    - INCORRECT – The Easter basket contained: Easter eggs, chocolate rabbits, and other candy.
Understand the differences between a hyphen and a dash.
- The hyphen ( - ) was once a common punctuation mark on typewriters, when a long word might have been split between two lines. The hyphen is still used in a number of other areas:
  - Use a hyphen when adding a prefix to some words. The purpose of this hyphen is to make the word easier to read. If you were to leave the hyphen out of a word like re-examine, it would be reexamine, which would be harder to read. Understand that some words do not require a hyphen to separate the prefix from the word, such as restate, pretest, and undo. Let a dictionary be your guide for when to use the hyphen after a prefix. When you use a hyphen, the two words have to rely on each other. Example: re-arrange.
    - Cara is his ex-girlfriend.
  - Use hyphens when creating compound words from separate words.
    - The up-to-date newspaper reporters were quick to jump on the latest scandal.
  - Use a hyphen when writing numbers out as words. Separate the two words of any number under one hundred with a hyphen.
    - There are fifty-two playing cards in a deck. (“The amount is one hundred and eighty” is a common error in US English, where the “and” is usually omitted. Elsewhere in the English-speaking world, however, the “and” is usually included.)
      - Be careful with spelling out numbers above one hundred—if the number is used as an adjective, it is completely hyphenated, since all compound adjectives are hyphenated (I have one-hundred tapes). Otherwise, a hyphen should only occur if a number greater than 100 occurs within the larger number, e.g., He lived to be one hundred twenty-one.
- The dash ( – or — ) should be used when making a brief interruption within a statement, a sudden change of thought, an additional comment, or a dramatic qualification. It can also be used to add a parenthetical statement, such as for further clarification, but should still be relevant to the sentence. Otherwise, use parentheses. Keep in mind that the rest of the sentence should still flow naturally. Try to remove the statement within the dash from the sentence; if the sentence appears disjointed or does not make sense, then you may need to revise. There should be spaces before and after the dash in British English.
  - An introductory clause is a brief phrase that comes—yes, you guessed it—at the beginning of a sentence.
  - This is the end of our sentence—or so we thought.
Use the double quotation mark and single quotation mark/apostrophe for different purposes.
- The double quotation ( “ ) encloses a direct quotation, whether made by a person or taken from a piece of literature.
  - “I can’t wait to see him perform!“ John exclaimed.
  - According to the article, the value of the dollar in developing nations is “strongly influenced by its aesthetic value, rather than its face value.“
- The single quotation mark or apostrophe ( ‘ ) has a variety of uses.
  - Use the apostrophe together with the letter s to indicate possession. Be aware of the difference in using an apostrophe with singular or plural nouns. A singular noun will use ’s, whereas the plural version of that singular noun will use s’. Also, be mindful of nouns that are always considered to be plural, such as children and people — here, you should use ’s. Be aware of pronouns that are already possessive and do not require apostrophes, such as hers and its (it’s is used only for the contractions of it is and it has). Their is possessive without apostrophe or s, except as a predicate adjective, where it becomes theirs.
    - The hamster‘s water tube needs to be refilled.
      - A singular noun with possession.
    - In the pet store, the hamsters‘ bedding needed to be changed.
      - A pluralized singular noun with possession.
    - These children‘s test scores are the highest in the nation.
      - A plural noun with possession.
  - Use the apostrophe to combine two words to make a contraction. For example, cannot becomes can’t, you are becomes you’re, and they have becomes they’ve.
  - Use the single quotation mark within a regular quotation to indicate a quotation within a quotation.
    - Ali said, “Anna told me, ‘I wasn’t sure if you wanted to come!‘“
  - Note that an apostrophe is not used with ’s’ to make a plural noun from a singular. This is a very common mistake and should be avoided.
    - CORRECT – apple → apples
    - INCORRECT – apple → apple’s
Indicate a break or pause within a sentence with the comma ( , ). This is another commonly used punctuation mark. There are several instances where you might use a comma:
- Use the comma when denoting an appositive, or a break within a sentence that supplements and adds information to the subject.
  - Bill Gates, CEO of Microsoft, is the developer of the operating system known as Windows.
- Use the comma when denoting a series. This is a set of three or more “list” items within a sentence. To save space in newspapers, some writers may omit the last comma.
  - The fruit basket contained apples, bananas, and oranges.
  - The computer store was filled with video games, computer hardware and other electronic paraphernalia.
- Use a comma if your subject has two or more adjectives describing it. This is somewhat similar to a series, except that it is incorrect to place a comma after the final adjective.
  - CORRECT – The powerful, resonating sound caught our attention.
  - INCORRECT – The powerful, resonating, sound caught our attention.
- Use a comma when referring to a city and state. It is also necessary to use a comma to separate the city and state from the rest of the sentence.
  - I am originally from Freehold, NJ.
  - Los Angeles, CA, is one of the largest cities in the United States.
- Use a comma to separate an introductory phrase (which is usually one or more prepositional phrases) from the rest of the sentence. An introductory phrase briefly introduces the sentence, but is not part of the sentence’s subject or predicate, and it therefore should be separated from the main clause by a comma.
  - After the show, John and I went out to dinner.
  - On the back of my couch, my cat’s claws have slowly been carving a large hole.
- Use the comma to separate two independent clauses. Having two independent clauses in a sentence simply means that you can split the sentence into two. If your sentence contains two independent clauses that are separated by a conjunction (such as and, as, but, for, nor, so, or yet ), place a comma before the conjunction.
  - Ryan went to the beach yesterday, but he forgot his sunscreen.
  - Water bills usually rise during the summer, as people are thirstier during hot and humid days.
- Use a comma when making a direct address. When calling one’s attention by name, separate the person’s name and the rest of the statement with a comma. Note that this kind of comma is used rarely in writing, because this is something that we do normally while speaking.
  - Amber, could you come here for a moment?
- Use a comma to separate direct quotations. A comma should come after the last word before a quotation that is being introduced. It is not necessary to use a comma in an indirect quote. A comma is usually not necessary if you are not quoting an entire statement.
  - While I was at his house, John asked me if I wanted anything to eat.
    - An indirect quotation that does not require a comma.
  - While I was at his house, John asked, “Do you want anything to eat?”
    - A direct quotation.
  - According to the client, the lawyer was “lazy and incompetent.”
    - A partial direct quotation that does not require a comma.
Understand the difference between parentheses, brackets, and braces.
- Use parentheses ( ( ) ) to clarify, to place an afterthought, or to add a personal comment. Be sure to include the period after the closing parenthesis.
  - Steve Case (AOL’s former CEO) resigned from the Time-Warner board of directors in 2005.
    - Used for clarification. Here, commas can replace the parentheses.
  - You will need a flashlight for the camping trip (don’t forget the batteries!).
    - An afterthought. Note that the period (full stop) follows the last parentheses — not before the first. Also note that replacing the parentheses with a comma may not be entirely suitable here, and is better off with a period or a semicolon.
  - Most grammarians believe that parentheses and commas are always interchangeable (I disagree).
    - A personal comment.
- Use brackets ( [ ] ) to signify an editor’s note in a regular piece of writing. You can also use brackets to clarify or to revise a direct quote so that it appeals to your own writing. Brackets are often used to encompass the word “sic” (Latin for thus), suggesting that the previous word or phrase was written “as is”, with the error intended to be displayed.
  - “[The blast] was absolutely devastating,” said Susan Smith, a local bystander at the scene of the incident.
    - “It was absolutely devastating!” – the actual quote by Susan Smith.
- Braces ( { } ) are most widely used in denoting a numeric set in mathematics. Though generally uncommon, braces can also be used in regular writing to indicate a set of equal, independent choices.
  - { 1, 2, 5, 10, 20 }
  - Choose your favorite utensil { fork, knife, spoon } and bring it to me.
Know how to use the slash ( / ).
- Use the slash to separate “and” and “or”, when appropriate. The phrase “and/or” suggests that a series of options are not mutually exclusive.
  - “To register, you will need your driver’s license and/or your birth certificate.”
- The slash is used when quoting lyrics and poetry to denote a line break. Be sure to add spaces between your slashes here.
  - “Row, row, row your boat / gently down the stream / Merrily, merrily, merrily, merrily, / life is but a dream.”
- The slash can replace the word “and” to join two nouns. By replacing “and” with a slash, you suggest that there is equal important to both characteristics. Use these replacements in moderation to place greater emphasis where “and” may not do so—as well as as not to confuse the reader. You can also do the same for “or”, as in “his/her”. However you should not use the slash to separate independent clauses, as shown below.
  - “The student and part-time employee has very little free time.” → “The student/part-time employee has very little free time.”
  - “Do you want to go to the grocery store, or would you prefer to go to the mall?” → “Do you want to go to the grocery store / would you prefer to go to the mall? – This is incorrect.

Video

Tips

If you write in a professional capacity, be sure to follow any guidelines or style guides provided by your employer. In some cases, their rules can be at odds with what you read here or elsewhere, but their rules always take precedence. For example, some companies use serial commas (a, b, and c) and others do not (a, b and c).
Many grammar experts believe that parentheses and commas are often interchangeable when setting off information. While this is sometimes true, there are some cases where a set of parentheses might be more suitable, such as in indicating one’s personal thought.
Although dashes and parentheses have similar uses, remember that parentheses indicate a stronger “side notion” than dashes.
There are exceptions to the hyphen-dash rule. In making compound words, when one of the words is itself composed of two words, use an en dash ( – ) rather than a hyphen, as in, “He took the Paris–New York route.” En dashes are also used between numbers, as in page numbers or years, to denote a range. (“A discussion on personal finance is found in pages 45–62.”)
The placement of punctuation marks before or after a closing quotation mark varies. American English leaves the punctuation mark inside the quotation if it is part of the quotation, “like so.” (Commas and periods (full stops) are always put inside the quotation marks for a sentence in American English, regardless of whether the quotation has punctuation at the end. Other types of punctuation marks are put outside the quotation if they are not part of the quotation.) British English tends to leave the punctuation mark outside the quotation, “like so”.
- At times, British English will switch back and forth between the inside and outside, depending on the context. For example, interrogative quotations may keep the question mark inside the quotation, as in, “Do you like this question?”
In formal writing, try to avoid excessive use of question marks and exclamation points. Most of your sentences should be declarative statements.
Dashes are usually considered to be informal. You might want to replace the use of a dash with a set of parentheses, or even commas. Similarly, limit the frequency of dash use in your writing; they should be reserved to emphasize a couple of important points.
If you decide against the serial comma in your work, make sure that the meaning of the sentence can stand without its use. Think about the classic example of a sentence in which the serial comma is needed: “My heroes are my parents, Mother Teresa and the Pope.”
If you find that a sentence seems to drag on, find a way to add a comma or two, so that it is easier on the reader’s eyes. If a sentence becomes too long, then consider splitting it into two or more sentences.
Never be afraid to have short sentences in your writing by splitting up long sentences that contain several points. Your reader will appreciate writing that is clear and concise with briefer statements, as opposed to a one-page paragraph with twenty words per sentence.

Warnings

While using English punctuation inappropriately may help your writing to flow much more smoothly, generally creating a more “intelligent” appearance, don’t overdo it. It’s best to err on the side of omission than to add several superfluous apostrophes and commas.
Try to keep the different languages’ punctuation from each other, so you do not confuse languages and their punctuation rules with each other.

Related wikiHows

Sources and Citations

Wikipedia’s guide to the Apostrophe

Article provided by wikiHow, a wiki how-to manual. Please edit this article and find author credits at the original wikiHow article on How to Use English Punctuation Correctly. All content on wikiHow can be shared under a Creative Commons license.

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MOST ESSENTIAL USMLE Step 1 Preparation Textbooks

The Windsor Knot

Charles Highway — Thu, 09 Apr 2009 12:50:42 +0000

The Windsor Knot

No one takes you seriously as a medical student and no will take you seriously if you aren’t able to tie a Windsor Knot – the golden standard for neck ties.

These guides should solve all your problems.

The Windsor Tie Tutorial Video

A step by step picture guide can be found at tie-a-tie.net

Also See:

Best 5 Anatomy Books

Table Manners, Drinking and Email Etiquette

Charles Highway — Thu, 09 Apr 2009 12:36:48 +0000

As a medical student, you will be faced with various situations which require you to mingle with other people, whether you want to or not. These encounters are necessary in the sense that they may help you network with future supervisors or administrative heads. So if you have to mingle then do it while not upsetting anybody.

Here are a few rules for basic etiquette in the selected areas of dining, drinking and email. Enjoy!

TABLE MANNERS

When to begin. This seems to be one that many people are confused about. The one that says no one eats until all are served. This is simply not true. Once two have been served, you may begin. A friend of mine puts it thus, “When two have seats, all may eat.” I don’t know what the hell that means, but it does put people at ease. In restaurants, this can feel awkward as you wait for the food to come out together. But nevertheless, you would be correct in eating. And your well-mannered companions should insist that you begin. Who wants to eat hot food cold?

During the meal the fork should be placed in the middle of the plate with the handle to the right and just over the edge of the plate when not in use. The knife will rest at the top third of the plate with the handle and the knife point touching the edge. Never put a utensil on the table cloth once it has been used.

Never leave a spoon in the soup dish. When you have finished or are taking a break from the soup, place the spoon on a soup plate, or in the absence of such, on your main plate. To repeat, never put a used spoon on the table and do not leave it sitting in the bowl. Another fine point, when eating soup always push the spoon away from you, as in “the ship goes out to sea” not toward you.

Napkin in your chair. Your napkin stays in the seat of your chair if you leave the table during the meal. In fancy restaurants, the waiter will come by in your absence and refold the napkin and place it beside your plate. This annoys me a bit, but that’s the way it goes. Never leave a dirty napkin on the table in sight of other dinner guests. When the meal is finished, place the napkin to the left of your plate – or in the center if the plate has been cleared. Do not refold it.

Removing a bad bite. If you find something wrong with the bite in your mouth – gristle, bone, what have you – remove it the same way it went in: with your fork. It isn’t easy. It isn’t graceful. Just do it. And do it smoothly, quietly, unobtrusively, with no fuss. Wait until the conversation turns away from you and pull this maneuver as nonchalantly as possible. Return the food to your plate, disguised beneath the radishes so no one can see it. Do not spit it into your napkin unless there is some extreme reason and if it’s that extreme, excuse yourself.

After the meal. When you have finished eating place the fork and the knife in the 4:20 position (shown above) or across the middle of the plate, parallel to the edge of the table with the handles to the right and ending on the edge, not hanging over. Either way is correct. The fork will be nearest you with the tines turned up. The sharp side of the knife points toward you as well. Why, you ask, is this important? Because this simple universal act signals to the staff, waiter or otherwise, that you have finished your meal. Then why is this important when dining at home? Because practice makes perfect and this should become a second nature habit. On the Continent across the pond the tines are turned down at meal’s end. SP once affected this method — along with a couple of other European rules — when I returned from a trip abroad while in high school. My aunt — a stickler for perfect table manners — stopped in mid-conversation to ask what I was doing. I replied that this was the way people did it in Europe. She responded with a terse, “Well, we are not in Europe.” I have never strayed since.

Source: Social Primer

DRINKING PARTY

SP’s number one priority when throwing a party is the guest list because — surprise! – people make the party. It matters not how much you invest in décor, how beautiful and impressive your house, or whether you dole out nifty gifts or trinkets, if your guest list is not right, your party will be a disaster. Pull out the address or facebook. Invite the people who make a party, and then tell them to bring their friends. Use the excuse of a drinks party as a chance to get to know more interesting people. Drinks parties by nature are informal and new people are much more likely to accept an invitation to this than to a dinner party. Guest can come and go as they please so there is not the fear of being stuck at a table with a conversation hog.

Rule Number 2: Make access to alcohol easy and fast. Put the bar and the booze where guest can get to it and not get bottle-necked into some tight squeeze situation. If you are having more than 40 guests, you’ll need two bars on opposite ends of the room, house or venue. If the weather permits, put one bar outside and another inside. As for stocking the bar, you will need the four horsemen: Scotch, Bourbon, Vodka and Gin. Women love white wine and champagne. Men will want beer. Mixers should include club soda two to one over tonic water. SP prefers San Pellegrino. Guests always seem to want cranberry juice. Slice some lemons and limes. You’ll need a bucket of ice, a wine key and a bottle opener. The beer and wine can chill in a cooler on the ground if you don’t have a gorgeous silver bowl. As for glasses, I love a one size fits all job but if you have the means and the space you should provide an old-fashioned glass for mixed drinks and wine goblet for wine and water. I love those red Solo cups if you have nothing to prove, but some snoots might look down on that. Provide coke, diet coke, sprite and ginger ale for the non-drinkers. For Pete’s sake do NOT run out of ice. Figure two pounds per person in normal weather. Double that if you’re outside in the heat.

Rule Number 3: Music is key so make it popular and accessible. I know people love those moody, lounge-y compilations but they do not make for a good party. Put on the classics, the sing-alongs and hopefully the dance-alongs. I usually offer a program of music throughout the evening. The first hours are for classics: Sinatra, Dean Martin, Nina Simone, Billy Holiday. The middle hour calls for classic rock. This loosens people up and they find common ground with strangers. Even well-edited 80’s new wave will work here. The last hour calls for dance music, and I mean common interest dance music. Classic hip hop, jam bands, pop music and yes, even disco. Fellows, you can scoff at vintage Madonna, but girls love it and will dance all night to that woman. If the girls are dancing, the party is a hit. Save the druggie ecstasy trance dance stuff for your next rave. It is not happy music. You need to have some soul.

Rule Number 4: Food. Well, you have to have it. It’s irresponsible to ply people with booze and deny them food to soak it up. Chips and nuts are fine, but for the same price get some cheese, crackers, olives, and fruit. I can’t tell you how popular a plate of biscuits and a sliced ham with a side bowl of mustard and mayonnaise is. If you or your friends can cook (or heat up a frozen bag), make some meatballs. Put your gourmet friends to work and ask them to bring their party food. I would stay clear of those layered dip things. They only look good until someone drags a chip through, then they turn slightly grotesque.

Rule Number 5: Clean as you go. If you don’t have staff to help, you should pick up cups, clean up the sticky spills and empty the ash trays. Make the place as welcoming to the last guest to arrive as it was for the first. On the subject of hiring staff, don’t underestimate the value of good help. This will enable you to enjoy yourself exponentially. If you have a housekeeper, ask her to work for you the night of the party (paying her extra of course). Put an ad on Craigslist for a bartender. You can usually find someone — experienced at that — for about what it will cost for two big handles of hooch.

Rule Number 6: Handle your liquor. Now as a host you are probably fond of the booze yourself, not that SP knows anything about that. Remember to pace yourself. It is your duty to make sure your guests are having a good time, meeting each other, and not becoming wall flowers. If you are blotto drunk you are not being a good host. Good parties don’t just happen. They are the result of hard work and attention to detail. You have to be on guard that the ice or the liquor doesn’t run out. You need to gauge the mood and make sure the music is right. If the law arrives uninvited, you will need to deal with them. It happens. Finally, you’ll have to pay attention to those who might need a ride home or a sleep-it-off on your sofa. People do get out of hand. It comes with the territory. Finally, have fun. You know SP will.

Source: Social Primer

EMAIL ETIQUETTE (32 TIPS)

1. Be concise and to the point.

Do not make an e-mail longer than it needs to be. Remember that reading an e-mail is harder than reading printed communications and a long e-mail can be very discouraging to read.

2. Answer all questions, and pre-empt further questions.

An email reply must answer all questions, and pre-empt further questions – If you do not answer all the questions in the original email, you will receive further e-mails regarding the unanswered questions, which will not only waste your time and your customer’s time but also cause considerable frustration. Moreover, if you are able to pre-empt relevant questions, your customer will be grateful and impressed with your efficient and thoughtful customer service. Imagine for instance that a customer sends you an email asking which credit cards you accept. Instead of just listing the credit card types, you can guess that their next question will be about how they can order, so you also include some order information and a URL to your order page. Customers will definitely appreciate this.

3. Use proper spelling, grammar & punctuation.

This is not only important because improper spelling, grammar and punctuation give a bad impression of your company, it is also important for conveying the message properly. E-mails with no full stops or commas are difficult to read and can sometimes even change the meaning of the text. And, if your program has a spell checking option, why not use it?

4. Make it personal.

Not only should the e-mail be personally addressed, it should also include personal i.e. customized content. For this reason auto replies are usually not very effective. However, templates can be used effectively in this way, see next tip.

5. Use templates for frequently used responses.

Some questions you get over and over again, such as directions to your office or how to subscribe to your newsletter. Save these texts as response templates and paste these into your message when you need them. You can save your templates in a Word document, or use pre-formatted emails. Even better is a tool such as ReplyMate for Outlook (allows you to use 10 templates for free).

6. Answer swiftly.

Customers send an e-mail because they wish to receive a quick response. If they did not want a quick response they would send a letter or a fax. Therefore, each e-mail should be replied to within at least 24 hours, and preferably within the same working day. If the email is complicated, just send an email back saying that you have received it and that you will get back to them. This will put the customer’s mind at rest and usually customers will then be very patient!

7. Do not attach unnecessary files.

By sending large attachments you can annoy customers and even bring down their e-mail system. Wherever possible try to compress attachments and only send attachments when they are productive. Moreover, you need to have a good virus scanner in place since your customers will not be very happy if you send them documents full of viruses!

8. Use proper structure & layout.

Since reading from a screen is more difficult than reading from paper, the structure and lay out is very important for e-mail messages. Use short paragraphs and blank lines between each paragraph. When making points, number them or mark each point as separate to keep the overview.

9. Do not overuse the high priority option.

We all know the story of the boy who cried wolf. If you overuse the high priority option, it will lose its function when you really need it. Moreover, even if a mail has high priority, your message will come across as slightly aggressive if you flag it as ‘high priority’.

10. Do not write in CAPITALS.

IF YOU WRITE IN CAPITALS IT SEEMS AS IF YOU ARE SHOUTING. This can be highly annoying and might trigger an unwanted response in the form of a flame mail. Therefore, try not to send any email text in capitals.

11. Don’t leave out the message thread.

When you reply to an email, you must include the original mail in your reply, in other words click ‘Reply’, instead of ‘New Mail’. Some people say that you must remove the previous message since this has already been sent and is therefore unnecessary. However, I could not agree less. If you receive many emails you obviously cannot remember each individual email. This means that a ‘threadless email’ will not provide enough information and you will have to spend a frustratingly long time to find out the context of the email in order to deal with it. Leaving the thread might take a fraction longer in download time, but it will save the recipient much more time and frustration in looking for the related emails in their inbox!

12. Add disclaimers to your emails.

It is important to add disclaimers to your internal and external mails, since this can help protect your company from liability. Consider the following scenario: an employee accidentally forwards a virus to a customer by email. The customer decides to sue your company for damages. If you add a disclaimer at the bottom of every external mail, saying that the recipient must check each email for viruses and that it cannot be held liable for any transmitted viruses, this will surely be of help to you in court (read more about email disclaimers). Another example: an employee sues the company for allowing a racist email to circulate the office. If your company has an email policy in place and adds an email disclaimer to every mail that states that employees are expressly required not to make defamatory statements, you have a good case of proving that the company did everything it could to prevent offensive emails.

13. Read the email before you send it.

A lot of people don’t bother to read an email before they send it out, as can be seen from the many spelling and grammar mistakes contained in emails. Apart from this, reading your email through the eyes of the recipient will help you send a more effective message and avoid misunderstandings and inappropriate comments.

14. Do not overuse Reply to All.

Only use Reply to All if you really need your message to be seen by each person who received the original message.

15. Mailings > use the Bcc: field or do a mail merge.

When sending an email mailing, some people place all the email addresses in the To: field. There are two drawbacks to this practice: (1) the recipient knows that you have sent the same message to a large number of recipients, and (2) you are publicizing someone else’s email address without their permission. One way to get round this is to place all addresses in the Bcc: field. However, the recipient will only see the address from the To: field in their email, so if this was empty, the To: field will be blank and this might look like spamming. You could include the mailing list email address in the To: field, or even better, if you have Microsoft Outlook and Word you can do a mail merge and create one message for each recipient. A mail merge also allows you to use fields in the message so that you can for instance address each recipient personally. For more information on how to do a Word mail merge, consult the Help in Word.

16. Take care with abbreviations and emoticons.

In business emails, try not to use abbreviations such as BTW (by the way) and LOL (laugh out loud). The recipient might not be aware of the meanings of the abbreviations and in business emails these are generally not appropriate. The same goes for emoticons, such as the smiley . If you are not sure whether your recipient knows what it means, it is better not to use it.

17. Be careful with formatting.

Remember that when you use formatting in your emails, the sender might not be able to view formatting, or might see different fonts than you had intended. When using colors, use a color that is easy to read on the background.

18. Take care with rich text and HTML messages.

Be aware that when you send an email in rich text or HTML format, the sender might only be able to receive plain text emails. If this is the case, the recipient will receive your message as a .txt attachment. Most email clients however, including Microsoft Outlook, are able to receive HTML and rich text messages.

19. Do not forward chain letters.

Do not forward chain letters. We can safely say that all of them are hoaxes. Just delete the letters as soon as you receive them.

20. Do not request delivery and read receipts.

This will almost always annoy your recipient before he or she has even read your message. Besides, it usually does not work anyway since the recipient could have blocked that function, or his/her software might not support it, so what is the use of using it? If you want to know whether an email was received it is better to ask the recipient to let you know if it was received.

21. Do not ask to recall a message.

Biggest chances are that your message has already been delivered and read. A recall request would look very silly in that case wouldn’t it? It is better just to send an email to say that you have made a mistake. This will look much more honest than trying to recall a message.

22. Do not copy a message or attachment without permission.

Do not copy a message or attachment belonging to another user without permission of the originator. If you do not ask permission first, you might be infringing on copyright laws.

23. Do not use email to discuss confidential information.

Sending an email is like sending a postcard. If you don’t want your email to be displayed on a bulletin board, don’t send it. Moreover, never make any libelous, sexist or racially discriminating comments in emails, even if they are meant to be a joke.

24. Use a meaningful subject.

Try to use a subject that is meaningful to the recipient as well as yourself. For instance, when you send an email to a company requesting information about a product, it is better to mention the actual name of the product, e.g. ‘Product A information’ than to just say ‘product information’ or the company’s name in the subject.

25. Use active instead of passive.

Try to use the active voice of a verb wherever possible. For instance, ‘We will process your order today’, sounds better than ‘Your order will be processed today’. The first sounds more personal, whereas the latter, especially when used frequently, sounds unnecessarily formal.

26. Avoid using URGENT and IMPORTANT.

Even more so than the high-priority option, you must at all times try to avoid these types of words in an email or subject line. Only use this if it is a really, really urgent or important message.

27. Avoid long sentences.

Try to keep your sentences to a maximum of 15-20 words. Email is meant to be a quick medium and requires a different kind of writing than letters. Also take care not to send emails that are too long. If a person receives an email that looks like a dissertation, chances are that they will not even attempt to read it!

28. Don’t send or forward emails containing libelous, defamatory, offensive, racist or obscene remarks.

By sending or even just forwarding one libelous, or offensive remark in an email, you and your company can face court cases resulting in multi-million dollar penalties.

29. Don’t forward virus hoaxes and chain letters.

If you receive an email message warning you of a new unstoppable virus that will immediately delete everything from your computer, this is most probably a hoax. By forwarding hoaxes you use valuable bandwidth and sometimes virus hoaxes contain viruses themselves, by attaching a so-called file that will stop the dangerous virus. The same goes for chain letters that promise incredible riches or ask your help for a charitable cause. Even if the content seems to be bona fide, the senders are usually not. Since it is impossible to find out whether a chain letter is real or not, the best place for it is the recycle bin.

30. Keep your language gender neutral.

In this day and age, avoid using sexist language such as: ‘The user should add a signature by configuring his email program’. Apart from using he/she, you can also use the neutral gender: ”The user should add a signature by configuring the email program’.

31. Don’t reply to spam.

By replying to spam or by unsubscribing, you are confirming that your email address is ‘live’. Confirming this will only generate even more spam. Therefore, just hit the delete button or use email software to remove spam automatically.

32. Use cc: field sparingly.

Try not to use the cc: field unless the recipient in the cc: field knows why they are receiving a copy of the message. Using the cc: field can be confusing since the recipients might not know who is supposed to act on the message. Also, when responding to a cc: message, should you include the other recipient in the cc: field as well? This will depend on the situation. In general, do not include the person in the cc: field unless you have a particular reason for wanting this person to see your response. Again, make sure that this person will know why they are receiving a copy.

Source: Email Replies

Case Presentation Tips

Charles Highway — Mon, 06 Apr 2009 13:00:54 +0000

Case Presentations

Essential tips to make a brilliant and concise case presentation in front of the hospital doctors.

Case Presentation Basic Structure:

Presenting Complaint
History of Presenting Complaint
Past Medical History
Medications and Allergies
Social History
Physical Examination Findings and Lab results
Provisional Diagnosis and Management Plan

Identifying Information/Chief Complaint

Content – contains 4 elements, expressed in a single sentence:
1. The patient’s age and sex
2. The patient’s active ongoing medical problems, mentioned by name only, and including only the most important, i.e., no more than 3 or 4
3. The patient’s reason for presentation
4. The duration of symptoms
Examples:
“Mr Smith is a 42 year old man with diabetes mellitus and hyperlipidemia who presents with 3 days of intermittent chest pain”"Mrs. White is a 59 year old woman with prior diagnosis of breast cancer, rheumatoid arthritis, and hypertension who presents with 2 months of bilateral leg weakness”

“Mr. Jones is a 48 year old man who is transferred from Juneau General Hospital for further evaluation of a left lung mass”
A litmus test for a successful introductory sentence is being able to answer “no” to the following question:”Do any surprises appear after this sentence?”For example, if a presentation begins with “A 46 year old man presents with 2 weeks of dyspnea” but then reveals 2 minutes later that the patient is “HIV positive”, your listener (who has been trying to solve your case from the initial sentence) will suddenly realize that all of his or her clinical reasoning has been flawed.

History of Present Illness (HPI)

The HPI is the fundamental part of the oral presentation and the source of 90% of correct diagnoses.

Content
1. All “positive” elements (i.e., what occurred) precede all “negative” elements (what was absent)
2. “Positive” statements:
  1. Are presented in chronologic order
  2. Are attentive to detail
    - Frequently used descriptors include patient’s own words, whether intermittent/constant, duration, frequency, whether changing over time (progressive, stable, improving), aggravating/alleviating features, associated symptoms, prior episodes, attribution (i.e., the patient’s own interpretation of his or her symptoms), and, if pain, quality, location, depth, radiation, severity (1-10 scale)
  3. If the current problem is a direct extension of a previous ongoing active medical problem, the HPI begins with a 1-2 sentence summary of that ongoing medical problem, using “key words”:
  1. 1. Date of diagnosis?
    2. How was diagnosis made?
    3. Current symptoms and treatment?
    4. Are any complications present?
    5. Are any objective measures of the chronic problem available? (e.g., a1c for diabetes, FEV1 for COPD)
3. “Negative” statements – include 3 categories of findings that, although absent, are important to mention:
  1. Constitutional complaints (fevers, sweats, weight change)
  2. Symptoms relevant to organ symptom (if the patient has chest pain, report here which chest symptoms were absent, i.e., cough, dyspnea, sputum, hemoptysis, dysphagia)
  3. Important risk factors (ask yourself the question “what could my patient have been exposed to cause this problem?”)
4. Prior workup to date (e.g., if the patient is transferred from another hospital), and status on transfer.

(Some presenters prefer inverting the order of #3 and #4…try both ways and see which sounds best to you)

Examples

Identifying information/chief complaint – no surprises after this sentence		Mr. Smith is a 62 year old man with coronary artery disease, diabetes, and hyperlipidemia who is transferred to our hospital for further evaluation of 3 weeks of episodic chest pain.
You believe his present illness is a direct extension of his prior CAD; therefore you begin with a 2 sentence summary of his prior CAD, using key words describing date of diagnosis, how diagnosed, and objective measure (perfusion scan)		Mr. Smith has a long history of coronary disease, originally diagnosed 5 years ago when he presented with crescendo angina was found to have 3 vessel disease and underwent 3 vessel CABG. A myocardial perfusion scan 2 years ago revealed no evidence of ischemia.
“Positive” elements, emphasizing (1) chronology and (2) attention to detail		He was in his usual state of health, without angina or other chest symptoms, until 3 weeks ago when he noticed the gradual onset of episodic chest pain and dyspnea. He describes his chest pain as a “tightness” or “vise-like” sensation, 3-5/10, occurring once or twice daily, usually lasting minutes at a time, located deep in his left chest without radiation, mostly occurring during exertion but also occurring at rest and waking him at night, and associated with dyspnea. This morning, while eating breakfast, he experienced a more severe version of the identical pain, 8/10, which did not resolve until 30 minutes after lying down and taking 3 nitroglycerin tablets.
“Negative” elements, including constitutional complaints, other organ-specific symptoms, and important risk factors		There is no history of fever, weight change, cough, sputum production, hemoptysis, dysphagia, or edema. The patient is a diabetic and has a strong family history of coronary disease. He does not smoke and his ldl cholesterol 6 months ago was 82.
Workup for current problem but before he came to your hospital		The patient went to an outside emergency department this morning for evaluation. Although he was pain-free, his electrocardiogram revealed T wave inversion in leads 1, L, V5 and V6 which was new when compared to a tracing 1 year ago. His creatine kinase and troponin levels were normal and he was transferred to our service for further evaluation.

Physical examination

Content
- Begin with “general description and vital signs”
- Include all abnormal findings
- Among normal findings, include only those essential to the understanding of the chief complaint
Example

On physical examination, he appeared in no distress and was pain free. His blood pressure was 120/80, pulse 80 and regular, respirations 18, temperature 98.4 and oxygen saturation is 98% on 2L. There is no goiter. His lungs are clear. Estimated central venous pressure is 8 cm water. There is no precordial pulsation or chest wall tenderness. There is a left ventricular S4 but no murmurs or rubs. His abdominal examination is normal and there is no edema

Laboratory

Content
- Include all abnormal labs, with comparison to previous value
- Among normal labs, includes only those relevant to the chief complaint
- Any labs presented should appear in traditional order (electrolytes/creatinine/glucose, complete blood count, other chemistries, urinalysis, CXR, ECG, gram stains and analysis of body fluids)
Example

On laboratory testing, his chem 7 is normal except for a glucose of 160 and creatinine of 1.4 (his creatinine 6 months ago was 1.3). CBC was normal. CPK and troponin at admission and 8 hours later are normal. CXR revealed wires from his CABG, normal heart size, and clear lungs. ECG revealed the inverted T waves in the anterolateral leads as previously described.

Assessment and Plan

Content
1. Begin with a positive statement of the patient’s problem, which is either a (1) symptom, (2) sign, (3) abnormal laboratory test, or (4) diagnosis
2. Ask yourself “At the moment I am presenting the case, what is the principal unresolved issue?”
  1. If the principal unresolved issue is diagnosis, your assessment focuses on differential diagnosis: (i) list the 3-5 most likely diagnoses, (ii) state which diagnosis is most likely and why, and (iii) state why other diagnostic possibilities are less likely (draw your evidence from the H and P you just presented)
  2. If the principal unresolved issue is therapy, your assessment: (i) states the diagnosis or problem, (ii) states which therapy you gave or plan to give, and why you made this decision, (iii) states which complications you might anticipate.
3. If you are presenting the morning after overnight call, the case presentation usually ends with a 1-2 sentence summary of what happened overnight, after implementation of your initial decisions.
Example

In summary, the patient has progressive episodic chest pain that is classic for crescendo angina because of its exertional nature and the patient’s known coronary disease. Pericarditis is less likely because of the absence of characteristic rub, pleuritic pain and ECG of pericarditis. Dissecting aortic aneurysm is unlikely because the pain is episodic and there is no pulse differential on examination and no widened mediastinum on CXR. Pulmonary embolism is unlikely because he has no risk factors and we have a better alternative diagnosis.

We treated him overnight as unstable angina, using enoxaparin, aspirin, and metoprolol. He had no further pain and overnight telemetry revealed only sinus rhythm. This morning’s ECG is unchanged from admission. We plan to obtain cardiac catheterization later today to better define the etiology of his pain.

Delivery Tips

Be aware of your posture.

Maintain eye contact – glance at your notes only as necessary.

Present with a clear, energetic, and interested voice. You have become a “storyteller”, and are giving information of crucial importance in the life and care of another human being.

Follow the outline of the OCP in a linear fashion – do not skip around.

Keep your language precise.

Use positive statements rather than negative statements: “Chest Xray shows normal heart size” is better that “chest X ray shows no cardiomegaly”. “In summary, this patient’s problem is acute dyspnea” is better that “the patient’s problem is rule-out pneumonia”.

Do not rationalize or editorialize as you present, just tell the “facts” as they were obtained by you. Remember, you are telling the patient’s story, not your own. Example: at the end of the History of the Present Illness, you would not say: “I would have gathered more information, but the patient’s breakfast came and the nurse kept interrupting to change the patient’s dressing, administer medications, and check vital signs.”

Notes by Steve McGee MD

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