BMJ No 7123 Volume 315
Education and debate Saturday 20/27 December Christmas 1997 issue
The BMJ and the 77 specialties of medicine
Richard Smith
The editor explains how the BMJ and different medical specialties can help each other
"The BMJ never publishes anything
useful to leechologists. You haven't got a single leechologist on your
editorial board. Once in a blue moon you publish a leechology paper,
and it's always bloody awful. I don't know who you get to review
them. What you don't seem to understand is that leechology is one of
the most important specialties in medicine. There aren't enough of us,
we're overworked, and general practitioners don't seem to know even
the basics. E Sadly, I hear this message regularly from representatives of the 77
different medical specialties. Some of the failures are inevitable. The
BMJ is not intended to teach plastic surgery to plastic
surgeons: if it did, we would lose contact with the 99.5% of our
readers who are not plastic surgeons while we did so. Rather the
BMJ attempts to concentrate on what matters to all
doctors. Interestingly, medical educators are discovering that the
knowledge and skills needed by doctors in different specialties are
more similar than dissimilar.
When I meet with disgruntled specialists - as I do often - we usually
have an enjoyable meeting and discover that there are many ways in
which we can help each other. As it might take me a long time to work
through 77 specialties in 122 countries, I thought I should write down
answers to some of the questions that come up commonly.
How can we get our messages across?
(1) Be clear about what your messages are "Every year 250 000 people in Britain die of leech related diseases.
Yet these patients must be cared for by only 127 fully qualified
leechologists. General practitioners do not understand leechology, and
it is hardly mentioned in undergraduate education. Recruitment to the
specialty is a problem. The Medical Research Council has no
leechologist on its committees and spends less than 1% of its budget
on leech related diseases. The NHS Executive has failed to recognise
the workload of the specialty. And the World Health Organisation has
closed down its leechology unit in Turkestan."
(2) Decide on the main audience for your messages
(3) Prepare a long term strategy for your messages
If, for example, general practitioners are your main target then, as
well as trying to get something into the BMJ, you should
try medical magazines such as Pulse, General
Practitioner, and Doctor. BMJ
space is under enormous pressure, whereas some of the medical
newspapers have trouble at times keeping the advertisements apart. They
can also publish large colour pictures, and if your message is dramatic
enough they will probably send a journalist to write it for you. And
some of these newspapers reach more general practitioners than the
BMJ because they are sent free to all of them, whereas
the BMJ in the United Kingdom is sent only to members of
the BMA. You might also consider approaching the doctors who organise
vocational training and postgraduate courses for general practitioners.
The key thing is to plan long term and get your message repeated
through many different media.
Why don't you accept our papers? We want papers that are scientifically sound and relevant to a broad
audience. We don't want papers that describe a great idea but include
no proper evaluation. Good ideas are easy. Evaluation is hard.
Where can we get published in the BMJ? You need to fit your message to the forms available in the
BMJ. We are reluctant to invent new forms, although we
might. Readers need to know what to expect. You could send us something
that's completed, or you could write suggesting a topic for an
editorial, telling us why it is important and suggesting who might
write it. We are particularly interested in authors from outside
Britain.
Will you consider uncommissioned editorials?
How can we get a letter published?
How can we teach ordinary doctors the basics?
Why don't you cover our meetings? If the meeting is really exciting we will send somebody. Alternatively,
you could send us the list of those attending and we might identify
somebody to write for us. Or we might be interested to take a version
of one of the keynote speeches.
How can we get into News?
If we have an important report, will you cover it?
How can we get through to politicians?
How can we help you?
Will it all end in tears? BMJ,
Richard Smith,
Important and not so important politicians read the
BMJ. Readers are warned that two of these pictures are fakes.
This is usually the main question that specialists ask me, and I
might tell them to employ a public relations specialist. Increasingly,
medical specialties do, but they are expensive and I can give you the
basics for free.
If your primary interest is to promote your specialty rather than
put across a message that has health importance, then life will be
difficult. The BMJ is very interested in clinical
messages that are important to a broad audience. We are much less
interested in the t
If the messages are intended for all doctors, medical
students, politicians, and senior health managers then the
BMJ is the right place. If the message is intended
primarily for a particular group of specialists there may be other
places where publication is easier to achieve.
Specialists sometimes imagine that their problems will be solved
by a Lesson of the Week (or "cock up of the week," as we call it)
describing three examples of the mistake they see most commonly. They
won't. Education is a never ending process that needs messages to be
delivered in different forms, in different media, time and time again.
It's tough to get a paper published in the BMJ. We
reject 85% of papers, and so if you are an average researcher you will
get only one out of seven published. Simple statistics mean that you
have a high chance of having 10 in a row rejected. There is thus lots
of room for becoming paranoid and imagining that we have it in for you
or your specialty. We don't.
Anywhere, but think hard about the best form. If your message is
educational, then a paper is probably not the best form. Many more
people read editorials and educational articles than read original
papers. If it is about improving the whole management of oral cancer
then it will need to be at least a Fortnightly review, perhaps even an
ABC. If it is a concentrated message on the need for tibial fractures
to be managed by a multidisciplinary team then an editorial might be
best. But you'll need evidence, not just assertion, and the editorial
should not read as though it has been written by a committee of people
so important that none of them ever sees a patient. If it is just a
feeling, try a Personal View. Something very short and sweet might be a
Minerva paragraph - a great way to get through to a lot of doctors.
Yes. We peer review them. Keep them short and snappy and make them
evidence based.
By writing a clear, unpompous, evidence based letter of not more
than 400 words that says something interesting. Don't just whinge. Be
positive.
By concentrating on what ordinary doctors really need to know
about your specialty and not getting carried away. An ABC can be a good
route - but they are easy to read and so tough to write. Of every 10
people who offer us an ABC, only one delivers.
We can't possibly get to all meetings, and meeting reports can be
desperately dull: "The chairman, Professor Sir Windbag, reminded
everybody of the importance of the subject. Professor West said that.
Professor East said this. The lunch was excellent. Everybody agreed it
had been an excellent meeting and looked forward to next year."
Do or say something newsworthy.
Probably, but we would like a copy before publication so that we
can write about it as it appears. And we don't want you writing about
your report. That's too much like people reviewing their own books. We
will find somebody, but we welcome suggestions.
With difficulty, but the BMJ is one good route.
Politicians read the BMJ.
I thought you'd never ask. This is the way to peoples' hearts.
We need you. Without input by doctors of all shapes and sizes the
BMJ is nothing. Keep sending us material and forgive us
our occasional incivilities and inefficiencies.
Sometimes but not usually. The more general and the more hard
pressed the publication - whether it's the New York
Times or Nature - the more likely you are to have
something rejected and feel misunderstood. But please come back.
London
WC1H 9JR
editor
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