First, let’s consider the factors required for good communication. It is probably evident that clear and logical presentation of information is important, and that your text should have correct spelling and grammar. So why is this hard to achieve? One reason is that people who are good doctors or researchers are not necessarily good writers. Cultural and environmental factors are important too, but tend to be overlooked in most of the published advice about scientific writing, so we are going to concentrate on their impact here.
1) Medical culture/environment
What does this mean? A large part of communication is based on having a shared set of assumptions. These assumptions can be tied to your language and culture or can be related to your work environment, etc. For example, Japanese authors sometimes mention the National Health Scheme that operates in Japan. This is easy for doctors in the UK or Europe (or Australia) to understand because similar schemes exist in those countries, but the USA does not have one and American doctors may need an explanation of things that you think are obvious.
Another example is that relatively long hospital admission times are common in Japan, but need to be explained to doctors in most other developed countries because their medical systems are different. These are examples of assumptions based on the medical culture/environment in Japan, which are relatively easy to identify and handle in your manuscript if you stop and think “I am writing for a foreign audience”.
2) National culture
Every country has its own culture and this comes with a set of assumptions that influence communication. In the graphic above, culture is positioned as the factor with the ultimate influence on communication. Because we are so used to our own culture’s assumptions (our cultural mindset), we will overlook their influence unless we make an effortFor example, my name in English is ‘David McQuire’ (first name/family name), but it is ‘McQuire David’ (family name/first name) in Japanese. If I write an address in English, it goes like ‘25 South Street, Bentleigh, Victoria’ (house number/ street/ city/ state), while a Japanese address goes in reverse order. You would know about these differences already, but have you thought about why they occur?
English speakers tend to think from the individual to the group, from specific to general, or from smaller to larger when classifying the world, which is why a person’s own name goes before the family name or why the house number is listed first in an address.
Based on the examples given above and a survey of Japanese speakers (on a small scale, so it may be inaccurate), it seems that Japanese tend to do the opposite. In other words, you may tend to think of larger categories before smaller ones, groups before individuals, etc. when classifying the world.
This could lead to misunderstanding when writing an English manuscript because your audience will have the opposite mindset.
3) Linguistic culture
This is the biggest problem for Japanese researchers writing in English because the two languages are organized differently. Let’s take a simple example: “I eat lunch at Kappa Sushi every day.” This is organized as subject (I), verb (eat), object (lunch), and modifiers (at Kappa Sushi every day). But in Japanese, the same sentence is “Watashi wa Kappa Sushi de mainichi hiru gohan o tabemasu.” This is organized as subject, modifiers, object, and verb (If I translate it literally to English: “I Kappa Sushi at every day lunch eat”). Unfortunately, the two are quite different. Of course, you all know this from learning English at school, but that still doesn’t stop Japanese authors from writing fractured English because the influence of their linguistic instincts is too strong.