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WBR: Start as Close to the End as Possible

I have huge news for you.

Info you can't wait to hear. A new idea that will change your life. A way to solve your biggest problem. Action steps to take right now to improve everything.

First though, let's go through a comprehensive history lesson. Then I'll give you a few pages of technical details. It should only take about an hour. Then we'll get to the good stuff.

We made it!

Wait... why am I going to do that? Why would anyone do that? Why would anyone put off the good stuff to detour through complex history and arcane technicalities?


Welcome to our reports.

Roughly 99% of reports I read put the most important info at the end. You might call it the "Summary", or "Impressions Section", or "Diagnostic Profile" or "Conclusions." But whatever title you use, you mean the same thing: The good stuff.

You put the good stuff at the end. Well, almost the end. Most reports actually bury it near the end, preceded by many pages of history and test results, and followed by a few pages of tables or appendices. So, you put the good stuff 80% of the way through. Where your reader can't even easily flip to find it.

Why on earth do we do this?

Mostly we do this because we've always done it. You learned to write that way because your supervisor wrote that way. She learned it from her supervisor. He read it in a book somewhere. Five other books on report-writing said to do it that way too, because that's "how it's done."

But why did we as a field start doing it this way?

There are 3 main reasons:

1. It's how we write journal articles.

Most people who write child assessment reports trained as psychologists or allied professionals. That training involved reading hundreds of journal articles. Maybe even writing a few. Even if you're thrilled your days of reading journal articles are long gone, the format journal articles use is still burned into your brain.

That structure is called IMRaD, for Introduction, Methods, Results, and Discussion. This structure has been essentially required in the hard sciences since the mid-20th century. It's been increasingly more common in social sciences over the last several decades. The APA style manual formally recommended this structure starting in 2010.

I'm going to leave the description of IMRaD to the Nobel Laureate Peter Medawar (1915-1987). Medawar is the Brazilian-born British immunologist known as "father of transplantation" and the "wittiest of all science writers."

Medawar described the structure of papers as:

Peter Medawar, who did not receive a Ph.D. because he could not afford the 25 pound fee. Famous Quote: "I cannot give any scientist of any age better advice than this: the intensity of a conviction that a hypothesis is true has no bearing over whether it is true or not."

"First, there is the section called the 'Introduction,' in which you merely describe the general field in which your scientific talents are going to be exercised, followed by a section called 'Previous Work' in which you concede, more or less graciously, that others have dimly groped towards the fundamental truths that you are now about to expound. Then a section on 'Methods '-that is OK. Then comes a section called 'Results.'

The section called 'Results ' consists of a stream of factual information in which it is considered extremely bad form to discuss the significance of the results you are getting. You have to pretend that your mind is, so to speak, a virgin receptacle, an empty vessel, for information, which floods into it from the external world for no reason which you yourself have revealed. You reserve all appraisal of this scientific evidence until the 'Discussion' section, and in the 'Discussion' you adopt the ludicrous pretense of asking yourself if the information you have collected actually means anything."

Medawar included this description in a BBC radio talk in 1964 that was also reprinted in The Saturday Review (it's a great 3-page read).

The parallels between IMRaD and the standard psychological evaluation report format are obvious. A general background, including dim previous attempts to answer the referral question. A list of our test methods. A test results section in which we do our best to refrain from saying why we're running this test or reaching any sort of conclusions about the significance of the results. And at long last, a summary where we briefly review everything before concluding it all had some meaning.

I don't know whether our predecessors borrowed this format because it was familiar to them. Or, if they felt it would lend a gloss of "scientific respectability" to our reports. I am certain no one picked this format because they considered all the other options and chose this one. No one thought this format was the best way to convey evaluation results.

Of course, one of the few advantages of the IMRaD format is its familiarity. This is likely the main reason it is so pervasive. Once you've read a few journal articles, you internalize the structure. You know how to approach every journal article. You can immediately hone in on what's important to you. I sometimes hear this as a reason for keeping the structure of psychological reports the same. It's familiar. Everyone knows the structure.

Keep in mind though that the readers of our reports are not scientists. They are parents. And teachers. Grandparents. Therapists. Para-educators. People who may have no experience with journal articles. People who may have never read a single evaluation report before yours. The IMRaD structure does not help most non-scientists and non-psychologists. It's just confusing to them.

One reason the IMRaD format confuses parents is because it doesn't fit how you would talk to a person about their child. It probably doesn't even match how you talk to parents during feedback. In real life, you wouldn't waste time giving all the esoteric details first. Like Churchill, you'd start with the most important info: What Is the Problem and What Do We Do About It? You'd fill in anything else as needed, like if the parents want to know how the problem developed.

As a little thought experiment, imagine you go to the doctor because your stomach hurts. The doctor reviews your symptoms and history, does an exam, runs some tests, and now has your test results. She holds them in front of her, and...

She proceeds to tell you all the history you just gave her, including how much you weighed when you were born. She reminds you what you were like during testing, including how much pain you just said you were in. She describes the tests she gave at length, complete with confidence intervals. She describes tests that sound scary, like screening for cancer. Your blood rushes to your ears and you can barely hear her. She doesn't stop to tell you how those results relate to your actual diagnosis, which she still hasn't told you. You don't understand why she won't just tell you what's going on.

Many moons later, she gets to the good stuff: You have indigestion, and should take an antacid. Or, you have cancer, and need chemotherapy.

Whether the news is good, bad, or in between, telling it this way is uncomfortable. It's formal. It's a structure that is not familiar to patients. It wastes their time. It reviews things they already know. It introduces room for jargon to creep in. It leaves less time for questions at the end. It fatigues the listener or reader.

It also lays out the doctor's entire thought process, which makes the patient wonder if she really understands what she's talking about. Can she really know what she's about if she had to lay out this persuasive essay? I mean, who is she working so hard to convince, and why is she trying so hard?

Which brings us to the second reason the IMRaD report format has stuck around for so long:

2. It's easiest for our supervisors.

Unless you’d been specifically trained to do so, you wouldn’t naturally talk to someone about a problem in IMRaD format. You wouldn’t tell them things they already know while deliberately delaying telling them the new info you have. You might briefly reflect or summarize their history with empathy, but not for 8 to 12 pages.

The only person you’d communicate with in IMRaD format is a skeptical, highly-trained person whom you’re trying to convince. For scientists, that’s their peers reading their papers. For psychologists, that’s our supervisors.

For a supervisor, the fact that the IMRaD format lays out the entire thought process is a feature, not a bug. The background gives you the initial data your trainee had. You can easily see what he chose to emphasize. You can see if there’s info he failed to obtain or doesn’t seem to be attending to. With the background info, you can also check if your trainee’s methods (test selection) made sense. You easily navigate through results because you’ve read a thousand reports. As you read your trainee’s write ups of the tests and results, you can mentally check how well he understands the tests and what they measure. You know if he is accurately and comprehensively testing hypotheses. You can watch him start to circle around a case conceptualization. Then you can then read his summary to see how well it matches the data. And you can do this without ever meeting the patient, if needed.

What a timesaver! For the supervisor, that is. It’s a long journey for the trainee. And it’s a strange, uncomfortable journey for the parent reading the report.

And it’s a pity we still write reports for our supervisors long after we no longer need supervision. We may even write reports for our supervisors once we start to supervise our own trainees.

Sometimes, we even convince ourselves we’re doing it for a “good reason”:

3. “It Tells A Story.”

The “good reason” I hear most often for the IMRaD format is that by building up from the details to the big picture, a report “tells a story” about a child. I hear people use the report-as-a-story metaphor frequently. To be honest, I used to use it myself.

I waxed poetic about how I framed the background info into a “coherent narrative” that would “lead the reader towards my conclusions.” I talked about how my behavior observations and discussions of strengths and interests “brought the report to life.” (Pro tip: If you need a technique to bring your writing to life, what you’re writing is already dead.) I convinced myself I wrote up my test results so well that “parents could ‘see’ their child doing the test.” They could “envision” how that test related to real life and the “child as a whole.”

Excuse me for a minute while I cringe at my past self’s vanity. Yikes.

You know what I want if my stomach hurts? I want to know What Is the Problem and What Do We Do About It. I don’t want your story about my stomach. I don’t need you to shape my pain into a "coherent narrative." Your story is weird anyway - you're quoting some things I said and not others, and I don't know why.

In fact, honestly... please don’t bring my stomach problem to life at all. Don’t force anyone to "envision" me getting an endoscopy, or even sitting meekly in the waiting room waiting for my test. It’s okay if you bring my “whole self” into the exam room, but can you at least wait until after I’ve taken the antacid?

"Are you ready to hear 'The Epic Story of Your Abdomen' yet???"

The Problem

The problem with putting the good stuff at the end is that it is bad communication.

It's a format unthinkingly borrowed from a completely different type of writing. One with completely different aims. (And one that not everyone would agree is a good idea even in that context. Our favorite immunologist Peter Medawar wrote "The inductive format of the scientific paper should be discarded. The discussion which in the traditional scientific paper goes last should surely come at the beginning.")

It's also confusing and potentially alienating for our readers, no matter how much we congratulate ourselves on our clarity and storytelling skills.

It also wastes your reader's precious time. That's irritating under the best of circumstances. But when your reader is in pain or in need, wasting their time seems particularly egregious.

Let me appeal to someone who knew way more about the art of good writing than almost anyone else: Kurt Vonnegut (1922 - 2007). Vonnegut had 8 suggestions for aspiring writers. You can find all 8 here. For now, I'm only going to list 4 of them:

"That is my principal objection to life, I think: It’s too easy, when alive, to make perfectly horrible mistakes." -- From the book Deadeye Dick
  1. Use the time of a total stranger in such a way that he or she will not feel the time was wasted.

  2. Every sentence must do one of two things — reveal character or advance the action.

  3. Start as close to the end as possible.

  4. Give your readers as much information as possible as soon as possible. To hell with suspense. Readers should have such complete understanding of what is going on, where and why, that they could finish the story themselves, should cockroaches eat the last few pages.

So four out of Vonnegut's 8 rules boil down to the same thing:

Don't waste your reader's time. He felt this was so important he said it four times.

So next week, we'll talk about some ways to not waste your reader's time. We'll go through at least 7 options for how to start as close to the end as possible. And don't worry - I'll jump right in and try not to waste your time.

Note: This post is written at the 6th grade level. There are 189 sentences (average of 12.3 words per sentence). 21 of the sentences are hard to read. 11 of the sentences are very hard to read. There are 6 uses of the passive voice and an alarming number of adverbs. This post "technically" came out on a Monday.

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