Advice on writing an op-ed

Thomas K. Lew, MD, knows you're bothered by medical misinformation, and he wants you to do something about it.

During a session titled "Get Your Voice Out There! How to Create an Effective Medical Op-Ed," Dr. Lew urged physicians to help educate the public through the media. His talk was part of CONVERGE 2024, the annual meeting of the Society of Hospital Medicine, held in San Diego in mid-April.

Dr. Lew, a clinical assistant professor of medicine at Stanford University in California and a member of USA Today's opinion board, has published more than 50 medical op-eds, and he noted his career in this field began in high school with an editorial urging students not to spit on the sidewalk.

The stakes have risen since then, said Dr. Lew, who offered op-eds he published on COVID-19 vaccination and gun violence as models. (Similar to most medical op-eds, he noted that the views expressed during the session were completely his own, not his institution's or anyone else's.)

"Our voices are needed more than ever," he told the audience. "If there's one thing that COVID taught me, it's that misinformation can kill. And if there's another thing that it taught me, it's that there's misinformation everywhere."

The process of fighting misinformation through an op-ed begins with choosing a subject. "I always advise writing about something that you're passionate about," Dr. Lew said. "Chances are that it's also something that makes other people mad as well."

It's also key to offer a unique viewpoint, to separate your submission from the many others a publication will receive. "Write something that leverages your expertise and experiences," he said. "We have an advantage here, as a hospitalist, because our every day is pretty unique."

That said, the topic should also be relevant to a general audience. "It may be super interesting to us writing about how many times a nurse pages you about a potassium of 3.5," but not to the public at large, Dr. Lew said. The topic should also be current, for example, don't focus on the bubonic plague outbreak of the 1300s.

Publications require op-eds to be original, not written by artificial intelligence, and typically about 500 to 750 words. "Sometimes the outlets want you to write a little bit longer, but after 750 words, you're really straining the audience's attention," he said.

Structurally, a good op-ed begins with a hook to draw readers in. "It really needs to be captivating and personal, and I think it's also a good time to slip in your identity as an expert. Put in a quick line about who you are and why you're a credible source," Dr. Lew said.

Readers have to be engaged very quickly, he noted. "Your piece may end up in the newspaper, but it's primarily going to be read on the internet. People have such short attention spans on the internet; if they don't like what they're seeing or get interested within the first second, you're going to lose them."

For example, his gun violence op-ed began with a graphic description of watching a surgeon try to repair gunshot wounds in the OR, and his COVID-19 piece began with a story of his own father experiencing chest pain at a time when hospitals were overflowing with unvaccinated COVID-19 patients.

"You want your reader to be in that operating room looking at that grotesque image or to think of themselves as a child whose parent might be having a myocardial infarction," Dr. Lew said.

Then add context and make your argument. "Basically, why are you writing this op-ed in the first place? You can also use this time to extend your credibility and establish who you are, and how you can talk about this problem from your expert lens," he said.

In addition to expertise, the argument should be supported with data. "All of us are really good at pulling data from research studies. … Use those skills," he said. "I would argue data points can also be a little more personal and more emotional." For example, in the gun violence article, Dr. Lew described how his parents were trapped in the hotel from which a man shot more than 400 music festival attendees in Las Vegas in 2017.

As for how many data points to include, he offered the rule of three. "Any less than three, then it may not be persuasive enough. Any more than three then runs the risk of it being too long or too boring."

Gather data like a doctor, but then remember that you are presenting to a nonphysician audience. "The average American reader reads at about a seventh- to eighth-grade level, so you really need to make all your words understandable," said Dr. Lew. "As much as possible, I try to avoid medical jargon." For example, he used the words "heart attack" and "slow heart rate" rather than "myocardial infarction" and "bradycardia" in his COVID-19 op-ed.

Keep most of the sentences, as well as the words, uncomplicated. "A lot of physicians for some reason like to use really long sentences with multiple clauses, and we'll put in commas and semicolons," noted Dr. Lew, who recommended making at least some of your sentences short.

Next in the op-ed, you might want to pre-empt any likely counterarguments. "One thing that makes our job a little more difficult than the misinformationists of the world is that we have to provide context and nuance," he said. "They can say things like, 'Hey, you know, the vaccines will kill you.'" A physician writing a pro-vaccination op-ed, on the other hand, might need to acknowledge that the COVID-19 vaccines are related to cases of myocarditis but then compare that risk to those of an infection.

The final op-ed section includes the conclusion and the ask. "Bring it home. Synthesize your arguments," said Dr. Lew. "Now you want to get people to do something." In some cases, the ask or solution is direct, like getting vaccinated, in other cases, less so.

"Sometimes the solutions are more indirect and require forces bigger than individual action. It could be things like, 'Have this problem in mind when you vote. Pressure the changemakers. Make some noise,'" he said. "I took that latter approach in my gun violence piece."

Either way, the ask should be specific, realistic, and ideally, optimistic. "Leave your audience with one more memorable thought," said Dr. Lew. "You can often reference back to that memorable experience or whatever you wrote as the hook." Don't be afraid to use strong language, like "need," "demand," or "push," he advised. "If you're angry, say you're angry."

Once the op-ed is written, the next challenge is to get it published. "The process is not as hard as getting into, say, the New England Journal of Medicine, but it still can be pretty competitive," Dr. Lew said. "I do encourage people to explore national outlets, the big ones, New York Times, LA Times, USA Today, but also take a look at the local and online outlets. Local newspapers are a great place to start. They're always looking for pieces, and they always really appreciate someone from their own community writing."

Local TV news stations may also accept op-eds for publication on their websites or as the basis for an interview, Dr. Lew said. For more advice on where to submit, consult your hospital's communications department, he recommended. "They have the connections, they know how to get your piece to the right people, and they want that publicity, too."

Publications list their submission guidelines on their websites and generally take submissions by email, which means you need a catchy email subject line. "Don't say something like 'potential op-ed' or 'written piece for your consideration,'" he said. "I like to use things like 'doctor's view on …'"

The text of the email should explain your credentials and why the op-ed is relevant and topical. Keep in mind that sometimes you may need to move fast when submitting an op-ed that responds to a news event, he noted.

If your piece is accepted, be ready to provide citations (to help with fact-checking) and a professional-looking headshot. "Things move pretty quickly. Once they accept, they usually want to publish soon and they want to publish your picture next to it," said Dr. Lew.

One other important rule of submitting an op-ed is to send it to one outlet at a time, rather than many at once. "If you don't hear from them for a long time, which often happens, you will want to send an email to withdraw that submission," he said. Then it's OK to submit it to another publication.

If and when your op-ed is published, it's time to publicize it on social media. "I always advise having a professional profile on X or Twitter, and you can keep your nonprofessional social media separate," said Dr. Lew. A hospital communications team can also help with publicity, he added.

Finally, it's good to prepare yourself for online backlash. "There's a lot of trolls out there. And aside from trolls, there's just a lot of people that are going to disagree with what you're writing," he said. "If everyone agrees with what you're writing, and it's not controversial, it may not be worth writing about."

Dr. Lew showed the audience an array of the nasty comments he's received in response to his writing. "Someone called me a fascist piece of garbage, and then there are the ones that are truly hurtful," he said. "You may ask, 'Why do it? Why put yourself out there?'"

One answer is that in Dr. Lew's experience, the negative feedback is outweighed by the positive, which includes letters and emails about how his writing made a difference. "They were able to take my newspaper article, literally clipped it out, and then showed their grandma, 'Look, there's a Stanford doctor that's saying this vaccine is good.'"

Publishing an op-ed also offers professional benefits. "Getting your name out there will raise your profile and will help create opportunities and invitations. People will see you as a content expert and want to collaborate with you. When I was writing a lot about COVID, I got a lot of invitations to comment on different treatments that were coming out."

Finally, there are the potential psychological benefits. "We see all this misinformation and all this news that's just not true," Dr. Lew said. "Writing against it and writing actual data-driven pieces can be therapeutic and make you feel better."