BACKGROUND

Over the last 30 years, electronic mail, “e-mail,” has emerged as a primary vehicle for communicating in the business setting, replacing the time-honored office memorandum and to a lesser extent the phone call.¹ And sometimes, regrettably, it has replaced the face-to-face interaction. 

The office memorandum required composing by hand, converting to a typed format, proofreading, correcting, re-proofreading, photocopying, and manually distributing. The process could take less than an hour, if urgent, or it could take days. The phone call was frequently unsuccessful and provoked the familiar office game of “phone tag.” 

Creating an e-mail is usually a solitary affair—a person and a computer or a person and a smart phone. Often, within minutes, the message is composed and proofread, with electronic assistance, and is distributed to one or more recipients instantaneously. The e-mail’s astounding power is camouflaged by its familiarity. 

E-mails have created or destroyed businesses, reputations, or relationships.² They have been
submitted as evidence in courts.³ Given the magnitude of its impact, e-mail must be respected.

E-mail has permeated health care systems, hospitals, and pharmacy departments. Its widespread use has created new challenges for pharmacists. Recognizing that success in pharmacy practice goes beyond the technical and clinical aspects of the job, practitioners can benefit by applying elements of composition to the discipline of e-mail. 

Similar to most disciplines, composing e-mails is an art and a science. This primer explores the fundamental elements that promote effectiveness and efficiency.

PURPOSE OF E-MAIL

Creative writing and business writing are different disciplines with common elements. Creative writing is complex, varied, and multipurposed. The intent of a creative work is to provoke laughter, emotion, thought, or action; to entertain; to educate; or to create images. On the other hand, business writing, especially e-mail, is more straightforward and uniform. 

E-mail has a primary purpose, which is to convey a message; therefore, a successful e-mail is one in which the message received equals the message intended. The equation “Message Intended = Message Received” is a sound scientifically stated representation of the purpose.

According to most business communication experts, a primary factor that contributes to conveying the message effectively is clarity. If the intent and content of the message are clear and if the writing is clear, then the message received likely will equal the message intended. The equal sign in the equation is the scientific representation of clarity. 

Any action by the writer that is opaque, diverting, confusing, disturbing, pompous, incomprehensible, or irrelevant is distracting and erodes clarity. Injecting an element of creative writing, such as sarcasm, into a professional communication is inappropriate. For example, “That’s just what we need!” is distracting, if not jarring. Antithetically, any action that is straightforward, simple, understandable, comforting, or relevant promotes clarity.

Clarity of thought must precede clarity of expression. In Hemingway’svernacular, one must find “what is true.”⁴ Most experts advise e-mail writers to reflect on and crystallize the intent and content before proceeding. For complex efforts, it helps to transfer the mental outline to a physical outline. 

Before proceeding to the body of this primer, we must dispel the myth that writing talent is required. Innate ability in any form or measure is not required to achieve a basic mastery of business writing.
Herbert and Jill Meyer advise, “You want to begin thinking about writing not as a mystical art form that depends utterly on born talent or inspiration, but rather as a series of discussions, steps, and techniques that you can master and whose final result will be the clear, successful product you want.”^5(p11)

For simplicity of explanation and understanding, we will divide the quest for clarity into 3 approaches. First, as stated above, focus on the purpose of business writing, that is, strive for clarity and resist the temptation to superimpose purposes more closely associated with creative writing. 

Second, master the basics of punctuation and grammar. The rules of standard and proper punctuation and grammar are not meaningless and fanatical requirements of grammarians. In some cases, an aberration, such as a misplaced punctuation mark, does not alter meaning, but the misplacement could be distracting to the reader. 

In many cases, errors in conventional and proper punctuation and grammar change the meaning, producing a disconnect between the message intended and the message received. Lynne Truss tells the tale of the panda and the mispunctuated wildlife manual to explain the title of her book, Eats, Shoots & Leaves: The Zero Tolerance Approach to Punctuation.^{6(back cover)}

A panda walks into a cafe. He orders a sandwich, eats it, then draws a gun and fires two shots in the air.

“Why?” asks the confused waiter, as the panda makes towards the exit. The panda produces a badly punctuated wildlife annual and tosses it over his shoulder.

“I’m a panda,” he says, at the door. “Look it up.” 

The waiter turns to the relevant entry and, sure enough, finds an explanation.

Panda. Large black-and-white bear-like mammal, native to China. Eats, shoots and leaves.

Third, master the elements of style – the way ideas are expressed – that contribute to clarity. Most grammarians propose a standard set of practices that promote clarity. A select number of these, especially those that are relevant to the e-mail format, will be reviewed. Some of these practices promote clarity by reducing clutter, that is, by reducing or eliminating anything that clouds understanding or distracts in any way from the message intended. Other practices render the e-mail easier to read and absorb. A few practices enhance clarity by identifying the relative importance of certain words, phrases, or sentences or by strengthening the impact of the overall message.  

We would be remiss not to discuss the oft-debated connection between image and success. Whether justified or not, people make judgments based on appearance and actions—how you dress, the state of your office or workplace, or your attention to punctuation and grammar. In their book, Sleeping Dogs Don’t Lay, Richard Lederer and Richard Dowis state, “Using bad grammar can mark a person as one who is careless of language and who may be, by extension, careless of other things.”^7(p2)

The same approaches to punctuation and grammar and to style apply to e-mail responses. Replies should be as short as possible and relate only to those segments or issues in which a reply is requested or one is needed. It is advisable to insert the reply proximal to the relevant text in the original as long as font or color distinguish the replies from the original text.

PUNCTUATION AND GRAMMAR 

Although a complete review of punctuation and grammar is beyond the scope of this primer, a short list of reputable references is included.^8-11 One of the most heralded is The Elements of Style by William Strunk, Jr, and E.B. White, which can be accessed free online (http://www.bartelby.com/141 or http://faculty.
washington.edu/heagerty/Courses/b572/public
/StrunkWhite.pdf). Also, 5 Web sites devoted to punctuation and grammar are referenced.^12-16 Tidewater Community College’s Writing Center publishes a Grammar Hotline Directory, which is a list of centers that answer questions via e-mail or phone.¹⁷

Several punctuation-related and grammar-related elements are discussed below, particularly those that might affect clarity or are frequently applied
incorrectly.

1. Place a comma before a coordinating conjunction joining 2 independent clauses.

I dispensed Mr. Smith’s prescription and Alec dispensed Mrs. Smith’s. (Incorrect)

I dispensed Mr. Smith’s prescription, and Alec dispensed Mrs. Smith’s. (Correct)

2. Separate 3 or more items presented in a series from one another with commas. Items in a series may be single words, phrases, or clauses. The comma between the next-to-last element and the last element (called the serial or Oxford comma) is frequently omitted in creative writing. 

We recently hired a pharmacy manager, two pharmacists and three technicians. (Incorrect)

We recently hired a pharmacy manager, two pharmacists, and three technicians. (Correct)

3. Avoid misplaced and dangling modifiers.

Misplaced modifiers:Keep related words together and in the order that conveys the intended meaning.

We almost lost all the medications in the refrigerator. 

We lost almost all the medications in the refrigerator.

Dangling modifiers: A modifier “dangles” when what it modifies is missing or misplaced in the sentence.

Hidden in the back of the refrigerator, John finally found the suppositories. (Incorrect) 

(The modifier, “Hidden in the back of the refrigerator,” is misplaced.) 

John finally found the suppositories, which were hidden in the back of the refrigerator. (Correct)

4. Set off the year from the rest of a sentence with a pair of commas, even if the year is not a component of an introductory phrase. 

July 1, 2015 will represent a critical date in our department’s evolution. (Incorrect)

July 1, 2015, will represent a critical date in our department’s evolution. (Correct)

5. Set off academic degrees and titles that follow a name with commas. 

Cora Summers, PharmD is collaborating with Sam Stern, MD. (Incorrect)

Cora Summers, PharmD, is collaborating with Sam Stern, MD. (Correct)

6. Place commas and periods inside the quotation marks (for American English). 

Exclamation points and question marks are handled more logically. Consult a cited reference.

Meg related, “I got the job in Charleston”. “I am still waiting for my offer”, Anna replied. (Incorrect)

Meg related, “I got the job in Charleston.” “I am still waiting for my offer,” Anna replied. (Correct)

7. Use the semicolon to join independent clauses that share a close relationship. 

Note: The conjunction must be omitted.

David is excited about attending the annual meeting in Las Vegas; and Joe is ambivalent. (Incorrect)
David is excited about attending the annual meeting in Las Vegas; Joe is ambivalent. (Correct)

8. Make the subject and pronoun agree in number (singular or plural). The subject is referred to as the pronoun’s antecedent.

Each technician gave their opinion. (Incorrect)

Each technician gave his or her opinion. (Correct) or

The technicians gave their opinions. (Correct)

9. Use standard rules when forming possessives. Generally, form possessives of singular nouns not ending in an “s” by adding an apostrophe and an “s.”  

John’s license is mounted in the hallway.

Form possessives of singular nouns ending in an “s” by adding an apostrophe and an “s.”

Chris’s knowledge of the drug helped him identify the mistake in Ms. Jones’s prescription. 

Note: most grammarians advise to add only an apostrophe to create the possessive form of multisyllabic proper nouns, for example, “Dickens’ novels,” “Achilles’
heel,” “Sophocles’ plays.” If the extra syllable is clearly pronounced, as in “Columbus’s voyages,” the apostrophe with the “s” is acceptable.

Form possessives of plural nouns ending in an “s” by adding an apostrophe alone: 

The doctors’ lounge was converted to residents’ offices a year ago.

10. Express parallel thoughts in grammatically parallel terms.

Unparallel: The applicant was both qualified and we found him interesting.

Parallel: The applicant was qualified and interesting.

11. Omit the apostrophe in the plural of an abbreviation that does not contain periods.

MDs; FTEs; IVs; TPNs

12. Spell-out numbers from one to nine; indicate numbers 10 and over as integers (expressions of time and measurements are exceptions, eg, 3 mL, 5 days). 

Publications may have different style rules as to the treatment of numbers, but be consistent within a document or communication.

The main office has five employees. 

The main office has 11 employees.

13. Be aware of commonly misspelled words.

accidentally; accommodate; ancillary; auxiliary; commitment; allotment; consistent; definitely; harass; harassment; liaison; mnemonic; occurrence; ophthalmology; privilege; separate 

Proofread all e-mails for proper grammar and punctuation, including spelling and capitalization. Use electronic grammar and spelling checking programs as a safety net.

STYLE

Focus on clarity.

1. Use a standard format and format elements. 

A. Always send an e-mail with a subject.¹⁸ Use a compelling subject line. According to the www.mailchimp.com, “The best email subject lines are short, descriptive and provide the reader with a reason to explore your message further.”¹⁹ A Google search of “best practices for subject line in email” unveils a body of literature. 

B. Get to the point quickly and support it with a standard approach. Unless the message is direct and simple, such as, “I’ll meet you in the lobby at 7 a.m.,” a common approach is to include 3 sections: introduction, body, and summary. The adage, “Tell them what you will tell them; tell them; tell them what you told them” applies. 

I am writing to request that we open the ambulatory care pharmacy at 7 a.m. rather than 8 a.m. (Introduction)

We commonly have five to six patients waiting at the door at 8 a.m. Opening at 7 a.m. will improve patient satisfaction. Also, some patients do not wait and go elsewhere. We can make this change without additional staff. (Body)

In summary, opening an hour earlier will improve care and increase business without incurring more cost. (Summary)

Other variations of the introduction could be “I am writing to explain . . .” or “I am writing to ‘relate,’ ‘review,’ or ‘list’….”

C. Use plenty of white space. Leave a blank line between paragraphs.²⁰ 

D. Highlight key ideas with asterisks, parentheses, and bullets. Use different fonts. Use the bold feature. A balance must be reached; overuse of these elements can be distracting. Avoid using red font, which may inadvertently imply urgency or anger, and refrain from capitalizing all letters in a word or sentence, which may be interpreted as shouting or anger.²¹

E. Use the cc (carbon copy) and bcc (blind carbon copy) functions appropriately. Add a recipient to the cc function only if he or she has a need to know.¹⁸  Avoid using the bcc function unless there is a need for that recipient to have the information without the knowledge of the cc recipients. Routine use of the cc function is forthright and creates transparency.

F. Use a standard signature. E-mails should end with the writer’s contact information, including name, title, business affiliation, address, phone number, and fax number.²² Do not clutter the signature block with symbols, quotations, or other elements that distract from the message.

G. Note attachments. Although most e-mail providers use conventions to indicate attachments, adding a comment such as “see attached” proximal to the relevant text highlights the presence of the attachment and
connects the attachment to that text. 

2. Apply appropriate tone, language, and content. The language, tone, and content should match the environment and the message. If the environment and the message are professional, the language, tone, and content should be as well.

A. Choose an appropriate tone.

Wanna get something to eat? (Casual)

Do you feel like getting a sandwich? (Conversational)

Will you accompany me to the dining room? (Formal) ²³

B. Emotions. Emotions, especially volatile, negative emotions should be avoided. Criticism is best handled face-to-face. Emotions such as sadness, sympathy, anger, and remorse are difficult to convey successfully via e-mail and should be expressed in person. Responses to nonprofessional (inappropriate, attacking, impolite) e-mails should be handled in person as well.

However, congratulations and joy can be transmitted successfully. A “thank you” is acceptable for simple exchanges, such as thanking someone for lunch or providing information. Most e-mail etiquette writers warn against using e-mail to replace traditional thank-you cards for gifts or sympathy cards for condolences.

Emoticons should be used seldom, if at all.²⁴ Sentiments appropriate for e-mail should be embedded in the words. If an exclamation point is appropriate, only one should be used.²¹

3. Eliminate clutter.

A. Eliminate words, phrases, clauses, and sentences that do not directly contribute to the essence of the message. “The secret of good writing is to strip every sentence to its cleanest components.”^25(p7)

Compare a hypothetical first draft of Hamlet’s soliloquy, “Basically, to be or not to be. That is the really big question for sure,” to the immortal, “To be or not to be. That is the question.” ²⁶

B. Avoid “ing” words that are components of the future progressive tense, such as “will be working,” “will be deciding,” “will be trying.” Instead, use the direct verb form (“work,” “decide,” or “try”).

John will be responsible for managing the IV Admixture Room. (Poor)

John will manage the IV Admixture Room. (Better)

C. Use simpler words, phrases, and sentences. Do not make the reader work to determine your meaning. 

Substitute small words for big words.
implement (do); sufficient (enough); attempt (try); utilize (use); additional (more); purchase (buy) 

We will attempt to utilize the equipment we just purchased. (Poor)

We will try to use the equipment we just bought. (Better)

Avoid cumbersome phrases. Substitute the word in parenthesis for the stated phrase:

ahead of schedule (early); a large portion of (many); was of the opinion that (believed); concerning the matter (about); we request that you send us (please send us); is capable of (can); prior to (before); in all cases (always); in the event that (if); due to the fact that (because)

We will endeavor to minimize problems where feasible, but we have come to the realization that we will have to effect modifications in our procedures. (Poor)

We’ll try to reduce problems where we can, but we realize we’ll have to change our
methods. (Better)

Eliminate redundancies. 

regular routine (routine); small in size (small); for a period of 10 days (for 10 days); completely surrounded (surrounded); wide variety (variety); final decision (decision); 10:00 a.m. Friday morning (10:00 a.m. Friday); my personal opinion (my opinion); ask the question (ask)

The water from the leak at 10 a.m. Friday morning completely surrounded our dispensing island, disrupting our regular routine for a period of 3 days. (Poor)
The water from the leak at 10 a.m. Friday surrounded our dispensing island, disrupting our routine for 3 days. (Better)

Cut out duplicate words.

Thank you for supporting this innovative and progressive program. (Poor)

Thank you for supporting this innovative program. (Better).

4. Use the right word. Know the difference between the following words: it’s and its; insure, ensure, and assure; regardless and irregardless; comprise and compose; she feels bad and she feels badly; less and fewer; infers and implies; affect and effect.

5. Use an appropriate sentence length—the shorter, the better. An average sentence should be no more than 15 to 20 words. 

6. Avoid sexist language. 

Upon approaching the patient, each nurse must introduce herself. (Incorrect)

Upon approaching the patient, each nurse must introduce himself or herself. (Correct)

Upon approaching the patients, the nurses must introduce themselves. (Correct)

7. Put variety into your sentences. The same message can be conveyed by altering clause, phrase, and word selection and sequence to avoid a monotonous tone or cadence. The same idea can be conveyed in diffent ways:

Our director said, during an informal meeting, that the Acme brand is better. or

During an informal meeting, the director said that the Acme brand is better. or

Speaking informally, the director said that the Acme brand is better. or

It was during an informal meeting that the director said that the Acme brand is better. or

As he spoke during the informal meeting, the director said that the Acme brand is better. or

The director, during an informal meeting, said the Acme brand is better. 

8. Focus on strong, colorful verbs, then nouns, and only then, the adjectives.

Sentence that emphasizes nouns: The growth, development, and fortification of the body against viruses can be regulated by careful selection of foods and their vitamin content. (Poor)

Sentence that emphasizes verbs: You can help your body develop and grow while you fortify it against viruses. Select your foods and vitamins carefully. (Better)

9. Use the active rather than the passive voice. In the active voice, the subject performs the action. In the passive voice, the subject receives the action.

Mary was counseled by John. (passive voice) (Poor)

John counseled Mary. (active voice) (Better)

You are loved by me. (passive voice) (Poor) 

I love you. (active voice) (Better)

10. Avoid strings of prepositional phrases. Restructure sentences to eliminate prepositions; this will produce a more fluid, understandable sentence. 

I went to a hospital in a town in Maryland in the middle of a flood in June, which is during Maryland’s rainy season, and in a matter of minutes found myself in knee-deep water. (Poor)

Last June, I visited a small Maryland town during the rainy season. When I went into a flooded hospital, I quickly found myself knee-deep in water. (Better)

11. Avoid weak intensifiers and qualifiers. Avoid undue enthusiasm. Words like “very,” “quite,” “completely,” “truly,” “virtually,” and “definitely” can usually be removed without a loss in meaning. 

We are extremely pleased to offer you a position on our staff of exceptionally skilled and highly educated employees. The work offers -extraordinary challenges and a very large salary. (Poor)

We are pleased to offer you a position on our staff of skilled and educated employees. The work offers challenges and a large salary. (Better)

12. Rely on your ear for what sounds right. Does the word, phrase, or sentence convey the desired intent, content, and tone? Minor adjustments can transform the forgettable to the memorable, although the reason might be imperceptible.

Compare the eternal “These are the times that try men’s souls” with unremarkable alternatives: “Times like these try men’s souls.” “How trying it is to live in these times!” These are trying time for men’s souls.” Soul-wise, these are trying times.”^25(pp38-39)

CAUTION 

After you compose and proofread your e-mail message, pause to ensure the appropriateness of intent, content, and tone. Ask yourself if you will regret sending this e-mail. If so, stop and place the e-mail in the drafts folder. You can modify the e-mail later after you have had time to think about it. Rarely will this period of reflection compromise the timeliness of the message.

SUMMARY

The first step in composing effective e-mails efficiently is commitment. Second is a maniacal focus on clarity, which can be achieved by applying the suggested approaches and elements. The third is practice. Following these steps will lead to distinctive, more effective e-mails that are created with less effort and time.

REFERENCES

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^*Area Vice President, McKesson Pharmacy Optimization, Bel Air, Maryland; †Assistant Professor, University of Maryland Baltimore School of Pharmacy, Baltimore. Corresponding author: Marc R. Summerfield, MS, 1333 South Dahlia Road, Bel Air, MD 21015; e-mail: summsum@verizon.net