In defense of the passive voice in medical writing

Few medical journals specifically instruct authors to use the active voice and avoid the passive voice, but advice to that effect is common in the large number of stylebooks and blogs aimed at medical and scientific writers. Such advice typically revolves around arguments that the passive voice is less clear, less direct, and less concise than the active voice, that it conceals the identity of the person(s) performing the action(s) described, that it obscures meaning, that it is pompous, and that the high rate of passive-voice usage in scientific writing is a result of conformity to an established and old-fashioned style of writing. Some of these arguments are valid with respect to specific examples of passive-voice misuse by some medical (and other) writers, but as arguments for avoiding passive-voice use in general, they are seriously flawed. In addition, many of the examples that stylebook writers give of inappropriate use are actually much more appropriate in certain contexts than the active-voice alternatives they provide. In this review, I examine the advice offered by anti-passive writers, along with some of their examples of "inappropriate" use, and argue that the key factor in voice selection is sentence word order as determined by the natural tendency in English for the topic of discourse ("old" information) to take subject position and for "new" information to come later. Authors who submit to this natural tendency will not have to worry much about voice selection, because it will usually be automatic.