Editor’s Corner: Don’t Forget to KISS Your Audience!

Aristoteles Giagounidis, MD
Head of the Department of Oncology, Haematology, and Palliative Care, Marien Hospital, Düsseldorf, Germany

For hematologists around the world, a definite highlight of each year is the December American Society of Hematology (ASH) annual meeting, which now draws a crowd of 30,000 U.S. and international attendees. From October onward, whenever you meet an international colleague at a conference, you can bet your bottom dollar (or euro, peso, pound, yen, etc) that the last sentence of your conversation will be, “See you at ASH!”

Before departing for the ASH annual meeting, though, international attendees have to overcome certain obstacles, starting with applying for travel authorization via ESTA (Electronic System for Travel Authorization) or other visa waiver programs. The U.S. Department of Homeland Security has to ensure that you do not seek to engage in terrorist activities, espionage, sabotage, or genocide, and that you do not suffer from cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, or viral hemorrhagic fevers, including the Ebola, Lassa, Marburg, or Crimean-Congo viruses.

As a prospective U.S. visitor, you’d also better not have traveled to Iraq, Syria, Iran, Sudan, Libya, Somalia, or Yemen on or after March 1, 2011. If you have, you will need to get past a border control agent asking the notorious question, “What is the intent of your travel to the United States?” You may parry with “hematology conference,” but this will likely be countered by a right cross, “What’s hematology?” You may terminate the conversation with a nice uppercut by explaining, “The study of blood disease.” “So, you’re a doctor, eh?” “Yeah!” “Welcome to the United States.”

At each annual meeting, the first morning is prime time for industry-sponsored Friday Satellite Symposia, and some of us foreigners sitting in these symposia wish that the presenters knew how much we are struggling to follow their presentations. English has become the lingua franca of medicine, and many of us will have published an article or two in the language of Shakespeare, but writing and listening are two different things. When you write articles, you review everything several times and can work at your own pace. When you listen to a presentation, you have only one fleeting chance: You either get it, or you don’t. And, if you fail to pick up key information early on, you might not understand the rest of the talk.

Speakers would help their international audience by remembering a few key points. First, most of your audience was raised in a metric world. Inches, feet, and miles – let alone ounces, pounds, stone, or other measurements – are difficult for international audiences to follow, as they have to compute while you continue talking.

Also, please remember that most attendees are experiencing jet lag. In addition to the aftereffects of Customs & Immigration trauma, we’re often battling the physical effects of crossing many time zones. San Diego, the upcoming annual meeting destination for 2020, is torture for Europeans and Africans (9 hours’ time difference!), but at least we will travel westward. Any destination in the U.S. is hell for Asians!

Sleep deprivation has effects on the brain comparable to alcohol intoxication: A considerable portion of your audience may be operating at attention levels associated with blood alcohol concentrations of 0.05 to 0.1.1 So imagine that you’re giving a presentation in front of people coming from a cocktail party.

Your audience has an additional challenge: They are not native speakers and won’t necessarily understand peculiar terms or phrases. Therefore, when speaking to international audiences, the rule of paramount importance is to follow the KISS protocol: Keep It Straight and Simple. Use common, straightforward words whenever possible. An ASH talk is not a chance to show how elaborate and proficient you are in your language; instead, it is a chance to increase your audience’s scientific knowledge, and make a difference in the treatment of patients after the conference.

A good approach is to speak as you would to a bright, scientifically inclined 12- or 13-year-old who grew up in an English-speaking country. Sentences can convey complex scientific concepts but shouldn’t be too long. You don’t need to compute the Fog index of your talk (that [the average number of words in a sentence + the number of words with ≥3 syllables] × 0.4); just use this rule of thumb: Sentences with eight words or fewer are very easy, nine to 11 are easy, and 12 to 14 are fairly easy.2

Review every grammatical structure you use and ask yourself, “Is there an easier equivalent?” For example, instead of saying “with reference to,” you can say “about.” Instead of “to request,” you might just “ask.”

Native English speakers commonly use abbreviations that complicate the meaning of the message. Once, I sat through a talk where the presenter said “eye-ee” all the time and it took me a while to figure out he meant “i.e.” (which admittedly is an abbreviation for Latin, not English, but is made more difficult because in many European languages “i” is pronounced “ee” and “e” is pronounced “eh”). In general, try to skip Latin altogether: Bona fide myelodysplastic syndromes (MDS) should be “true” or “genuine” or “real” MDS. Other examples that may not be automatically understood by all listeners include Latin phrases like a priori or primum nihil nocere, and the indications of frequency for taking a drug (BID, TID, TIW, and so on).

Also, avoid idiomatic expressions like the plague! Most people will understand what you mean when you say that something is “not rocket science,” but you might as well say that it’s “not complicated.” When someone “hits the nail on the head,” consider instead telling him he “got things exactly right.” Avoid “elephants in the room” or “$64,000 questions.” Instead, tell people that there is “a big, obvious problem being ignored” or a “difficult question.”

Don’t forget that most foreigners at school have been trained to understand “Received Pronunciation” (RP) which has historically been standard BBC English, even though only 3 to 10% of Britons have been brought up with RP. It can be tricky for foreigners to understand a Scottish, Welsh, or Irish accent. American English is a little easier because of the broad international exposure to American television and films, but still, Americans too should remember to speak slowly. There are plenty of pronunciation differences, even in medical terms, that are cause for bewilderment. The Americans diagnose a tumor of the SAlivary gland, while Britons find it in the saLIvary gland. Americans deTERmine special goals, while Indian speakers usually DETTERmine them.

Furthermore, references to baseball, American football, and other sports aren’t very helpful. I realize that hundreds of baseball expressions have entered everyday language, and Britons use many references that come from cricket or rugby, but only a minority of the international audience follows those sports on a regular basis. Even if the outcome of last year’s American football Super Bowl was the most exciting event in your lifetime and immediately recalled by all of your friends at home, most of us will not understand your Super Bowl running back analogy, and, even for Catholics, a “hail Mary” might not evoke a long forward pass. A “home run” may be the only sports reference we’re familiar with.

Look at it from the other side: Every German knows a soccer player called Gerd Müller (a few Americans may, too, because he played with the Fort Lauderdale Strikers from 1979 to 1981). The guy was dubbed “Bomber der Nation,” because he scored in nearly every game, and a good shot in soccer was referred to as “bomb.” Imagine a German giving a talk at the ASH annual meeting and referring to “a Bomber der Nation event” … “The Germans are bombing whom? Are we under attack? Is this a NATO conference?!” You get the picture.

My final point is to be careful about joking. Talks in America and the U.K. often start with a joke, but this is not a universal rule. In Japan, you’d be better off starting with an apology than a joke. In Germany, where I live, joking can be OK in certain circumstances, but will usually be omitted. My heritage is Greek, and I note that Greeks take science seriously and will never joke at the beginning of a presentation. However, at the ASH annual meeting, I have attended presentations where speakers joked continuously for the first three minutes, bewildering their audience.

Jokes are often rooted in a culture. For example, Britons tend to joke in an understated way, often poking fun at themselves, which not everyone understands. American jokes are usually more straightforward, but it’s difficult to find a universally accepted twist that makes the entire crowd snort. Mikkael Sekeres, MD, MS, previous editor-in-chief of ASH Clinical News, started his 2019 educational session on MDS with an interesting American idiom that he explained right away. Then he joked about his mother. Everybody has a mother, so everybody got the humor. He then talked slowly and clearly. What a feast!

So, let me pull all this together: KISS your audience. Pronounce clearly, refrain from idioms, be cautious about jokes, and remember that your international audience might as well be drunk. There you go. I look forward to hearing you – and understanding you – in San Diego at next year’s annual meeting!


  1. Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med. 2000;57:649-655.
  2. Gunning R. The technique of clear writing. New York, NY: McGraw-Hill; 1952.