Pronouns - Grammar

AMA Manual of Style - Stacy L. Christiansen, Cheryl Iverson 2020

Pronouns
Grammar

Pronouns replace nouns. In this replacement, the antecedent must be clear, and the pronoun must agree with the antecedent in number and gender.

Avoid:

The authors unravel the process of gathering information about diethylstilbestrol and disseminating it. [Antecedent unclear; does it refer to information or to diethylstilbestrol?]

Better:

The authors unravel the process of gathering and disseminating information about diethylstilbestrol.

Avoid:

A questionnaire was given to each medical student and their spouses. [Disagreement of pronoun with referent in number; the referent is each medical student (singular), but the pronoun used is plural (their spouses).]

Better:

A questionnaire was given to the medical students and their spouses. or A questionnaire was given to each medical student and his or her spouse.

Note: The possessive pronoun its should not be confused with the contraction it’s (short for it is) (see 8.7.2, Apostrophe, Possessive Pronouns).

Possessive:

The journal published its first issue last year.

Contraction:

It’s not advised to take the medications together.

Note: Contractions are typically avoided in scientific writing.

7.2.1 Personal Pronouns.

Use the correct case of personal pronouns: subjective case (the pronoun is the subject of the phrase or clause) or objective case (the pronoun is the object of the phrase or clause).

She was assigned to the active intervention group. (She is the subject.)

Collect all the samples and give them to her. (Her is the object.)

Your decision affects him and me. (Both him and me are objects.)

Do not substitute a reflexive pronoun, ending in -self or -selves, for a simple personal pronoun.

Avoid:

George, Patricia, and myself attended the lecture. The author replied to the editor, illustrator, and myself.

Better:

George, Patricia, and I attended the lecture. The author replied to the editor, illustrator, and me.

7.2.1.1 We: Royal, Editorial, and First-Person Plural.

The pronoun we has several permutations, several of which are noted here. It is important that we not be ambiguous within a manuscript; for example, it should not be used to refer both to the authors of the paper and then to a larger group (such as all health care professionals) unless the distinction is clear.

The royal we is largely attributed to use by monarchs who used it to mean “God and I,” and thus the ruler by divine right, or as the ruler and the ruled (the body politic).

We are not amused. [attributed to Queen Victoria]

We is sometimes used when one is speaking for a group. This is called the editorial we.2

We welcome submissions reporting original research as well as insightful opinion pieces.

The editorial we is also used by writers in an attempt to make the reader feel included.

It is critical that we take an active and ongoing role in helping to optimize patients in this phase of survivorship.

We need to determine the best way to encourage patients to modify their lifestyle.

In scientific writing, however, we should be reserved for the first-person plural subject, which is appropriate when writers are describing their work or their observations. Rewriting to exclude this form of we would promote the passive voice construction, which is less direct (see 7.4.1, Voice).

Beginning in September 2010, we recruited serodifferent couples from 75 clinical sites in 14 European countries.

We used the Breslow-Day test to examine differences in aspirin effect by site.

We conducted a single-center randomized clinical trial of patients admitted to the intensive care unit for ARDS who required noninvasive ventilation.

7.2.2 Relative Pronouns.

Relative pronouns (who, whom, whose, that, and which) introduce a qualifying clause.

7.2.2.1 Who vs Whom.

Who is used as a subject and whom as an object. The examples below illustrate correct usage.

Give the award to whomever you prefer. [Objective case: whomever is the object of the verb prefer.]

Give the award to whoever will benefit most. [Subjective case: whoever is the subject of will benefit.]

Whom did you consult? [Objective case: whom is the object of consult.]

Who was the consultant on this case? [Subjective case: who is the subject of the sentence.]

He is one of the patients whom Dr Rundle is treating. [Objective case: whom is the object of is treating.]

He is one of the patients who are receiving the placebo. [Subjective case: who is the subject of are receiving.]

7.2.2.2 That vs Which.

Relative pronouns may be used in subordinate clauses to refer to previous nouns. The word that introduces a restrictive clause, one that is essential to the meaning of the noun it describes. The word which introduces a nonrestrictive clause, one that adds more information but is not essential to the meaning. Clauses that begin with which are preceded by commas. Two examples of correct usage follow.

A study on immune responses to insulin in children at risk for diabetes was published in the 2015 JAMA theme issue on child health, which contains articles on a range of similar topics. [Nonrestrictive; there was only one JAMA theme issue on child health in 2015.]

The issue of JAMA that contained the article on immune responses to insulin in children at risk for diabetes was the 2015 child health theme issue. [Restrictive; there are thousands of issues of JAMA.]

Following are examples of ambiguous or incorrect usage that highlight this grammatical problem.

Incorrect:

The high prevalence of antibodies to the 3 Bartonella species, which were examined in the present study, indicates that health care workers should be alert to possible infection with any of these organisms when treating intravenous drug users. [There are more than 3 species of Bartonella. Hence, the correct form here should be “ . . . the 3 Bartonella species that were examined. . . .”]

Ambiguous:

Many reports have been based on series of patients from urology practices that may not fully reflect the entire spectrum of illness. [Do the patients or the practices not fully reflect the entire spectrum of illness? Also, do the reports involve all or only some urology practices?]

Reworded:

Many reports have been based on patients in urology practices, which may not fully reflect the entire spectrum of illness. [Urology practices in general do not capture the range of the disease.] or Many reports have been based on data from urology practices that may not fully reflect the entire spectrum of illness. [Some particular urology practices do not capture the range of the disease, but others might.]

Note: The omission of that to introduce a clause may cause difficulty in comprehension.

Avoid:

This morning he revealed evidence that calls the study’s integrity into question has been verified.

Better:

This morning he revealed that evidence that calls the study’s integrity into question has been verified.

The addition of that after revealed frees the reader from backtracking to uncover the meaning of the sentence above. The use of that to introduce a clause is particularly helpful when the second verb appears long after the first has been introduced (above, the interval between revealed and has been verified).

7.2.3 Indefinite Pronouns.

Indefinite pronouns refer to nonspecific persons or things. Most indefinite pronouns express the idea of quantity and share properties of collective nouns (see 7.5.5, Collective Nouns).

7.2.3.1 Pronoun-Verb Agreement.

Some indefinite pronouns (eg, any, each, either, neither, one, no one, everyone, someone, anybody, nobody, somebody) always take singular verbs; some (eg, several, few, both, many) always take plural verbs; and some (eg, some, any, none, all, most) may take either the singular or the plural, depending on the referents. In the last case, usually the best choice is to use the singular verb when the pronoun refers to a singular word and the plural verb when the pronoun refers to a plural word, even when the noun is omitted.

Singular referent:

Some of her improvement is attributable to the increase in dosage.

Plural referent:

Some of his calculations are difficult to follow.

Singular referent:

Most of the manuscript was typed with a justified right-hand margin.

Plural referent:

Most of the manuscripts are edited electronically.

Singular referent:

Some of the manuscripts had merit, but none was of the caliber of last year’s award winner.

Plural referent:

None of the demographic variables examined were found to be significant risk factors.

7.2.3.2 Pronoun-Pronoun Agreement.

The use of an indefinite pronoun as the antecedent of another pronoun can create confusion. (“Everyone should cite his sources”—whose sources are being cited?) Some writers may try to avoid gender bias by using distracting constructions, such as s/he, by consistently applying the same pronoun throughout (eg, she), or by using the formal-sounding one (“Everyone should cite one’s sources”).

There are several ways to deal with this potential problem. The examples below will not work in every situation; use judgment when writing or editing so as not to change the meaning of the sentence or overuse any device that could distract the reader.2

■Replace with a more concrete noun: Authors should cite their sources.

■Replace the second pronoun with an article: Everyone should cite the sources used.

■Change the verb to the imperative mood: Cite sources used or Cite your sources.

■Rewrite the sentence: All sources used should be cited.

■If permissible, use the “singular they”: Everyone should cite their sources.

Like The Chicago Manual of Style and AP Stylebook, the AMA Manual of Style now permits the use of they as a singular pronoun when rewriting the sentence as plural would be awkward or unclear.2,3 In addition, this construction can be useful in medical articles in which patient identifiability is a concern (eg, removal of gender-specific pronouns) (see 11.12.1, Inclusive Language, Sex/Gender).