Guidance for BMJ patient reviewers

Patient peer review at The BMJ

If you're a patient living with disease or have experienced a significant illness or medical condition, a carer of a patient, a patient advocate acting on behalf of a patient group, or you play a leading part in advocating for patient participation and partnership in healthcare we'd like to invite you to take part in a unique initiative. The BMJ has committed to improving the relevance and patient centredness of its research, education, analysis, and editorial articles by asking patients to comment on them. We need your help to make these changes.

If you already review for The BMJ as a researcher or clinician, but you are also interested in reviewing as a patient, carer, or patient advocate, you can do this too.

Patient review is a new initiative for The BMJ. We are taking the lead here, and we hope other publishers will follow. We apologise in advance if our systems seem impersonal or are not yet ideally tailored for patient reviewers. If you have suggestions for how we could do this better, please do let us know.

The peer review process

When medical researchers or clinicians complete their study they write a paper presenting their methods, findings, and conclusions and send it to a scientific journal (like The BMJ) to be considered for publication. If the journal's editors think that a paper might be suitable for publication they send the paper out to other scientists and specialist experts who research, practise, and publish in the same area, asking them to comment on whether the research is done well and if it provides an important contribution to scientific knowledge. For more information about what we ask them to do, see our guidance for traditional peer reviewers. The scientists assessing the papers are called reviewers, and the whole process is called peer review. The aim of peer review is to reject poor quality articles and unoriginal studies, promote good ones, and offer feedback and constructive criticism to researchers, so they can improve the clarity and impact of their paper.

Through The BMJ's commitment to improving the relevance and patient centredness of its research, we now invite patients and carers to review articles alongside other peer reviewers.

Patient reviewers do not need medical or scientific training, because what we need from you are answers to a slightly different set of questions than those posed to traditional peer reviewers. If you're a patient reviewer we will want your views on the following:

• Are the study's aims and the issue and questions that the paper addresses relevant and important to you as a patient? Do you think it would be relevant to other patients like you? What about carers?
• Are there any areas that you find relevant as a patient or carer that are missing or should be highlighted?
• From your perspective as a patient, would the treatment, intervention studied, or guidance given actually work in practice? Is it feasible? What challenges might patients face that should be considered?
• Are the outcomes that are being measured in the study or described in the paper the same as the outcomes that are important to you as a patient? Are there others that should have been considered?
• Do you have any suggestions that might help the author(s) strengthen their paper to make it more useful for doctors to share and discuss with patients?
• The level of patient involvement in the research described, and if and how it could have been improved. Authors are now required to state if and how they involved patients in setting the research agenda and the design and implementation of the study and include this information in a box within the manuscript. If there was no patient involvement we would welcome your ideas on how this could have been done. We hope this will help authors think of the best ways to include patients in their future research and further progressive patient involvement in the research enterprise.

Reviewers of all kinds sometimes worry whether they have something useful to contribute to an academic article. This is what one of our patient reviewers told us:
"I recently reviewed a paper for The BMJ and as a non-academic I was terrified of saying what I actually thought of it – I agonised over the words.... I wanted to be constructive, challenging, and polite, but the bottom line was that I felt that the authors of the paper were in an academic bubble and very divorced from what I experience, read, and talk about in real life. A huge relief then to see the other reviewer felt the same way! It was a steep learning curve and a big leap to have faith in my own views and not be afraid to share these with the authors and The BMJ's editorial team."

How to register as a patient reviewer for The BMJ

As we are a large journal, all our peer reviewing is conducted using an online database ( This database was designed before we started patient review and is rather inflexible. Patients reported that setting up an account was confusing, so we will now register an account on your behalf. To do this we need you to complete a short form by clicking on the link below.
The form asks you to list any medical conditions you have, or have had, or that you have experience of through your role as a carer or for which you are a patient advocate (for example, cancer, heart disease, or stroke). Editors will use this information to match appropriate papers to your experience.

Many of our registered patient reviewers live with chronic long term conditions but as a general medical journal we receive lots of papers about general medical issues and also acute conditions. These broad based papers might be about patient and carers’ experience of accessing and using services, their involvement in decisions about how services are designed and delivered, priority setting in health care, and ethical debates. If you are willing to review papers on general subjects, such as these, as well as those directly related to the conditions you have, please indicate this in the relevant question on the patient reviewer registration form. It is likely that we would then be able to call on your help a little more often than we currently do or are likely to do. That said, requests to review can always be turned down if they are not relevant to you or you are unable to review at the time.

Once the above form has been submitted, we will upload the key information you provided to our online database and set up an account for you. You will then receive an automated email to confirm that the account is set up notifying you of your user ID. To complete the account registration you will need to click on the link in the email to log you into our database and set your own password.

What happens if you are selected to do a patient review?

If we select you to do a patient review, we will send you an invitation by email. You will see the title of the paper, the names of the authors, and a short summary of its contents. You will have the opportunity to accept or decline the invitation to review either by email or by clicking a link in the email. If you are unable to review please do let us know, and if you are able to suggest an alternative reviewer that would be most helpful.

All unpublished manuscripts are confidential documents. If we invite you to review an article, please do not discuss it with anyone. All reviewers are asked to provide their opinion within two weeks of being sent a paper by using our online manuscript tracking system. Most medical reviewers provide opinions of 500-1000 words, but it is quality, not quantity, that counts, and we are seeking an informed independent viewpoint presented in a clear and constructive way.

We ask our reviewers to declare all conflicts of interest. A conflict of interest exists when judgment concerning a primary interest (such as whether a paper is accepted) might be influenced by a secondary interest (for example, the researcher is your doctor, or you've been paid to be a patient advocate by the sponsor of the study). Read more on competing interests here.

Why review for us?

By reviewing you will be giving the editors your perspective on the patient focused aspects of selected manuscripts, drawing on your experience of a particular topic, condition, or intervention. It's your opportunity to have a real voice in shaping the way researchers design and report research and clinicians practise medicine, and to further their understanding on what is most important, and of benefit, to patients. To say thank you, all reviewers get a year's free online subscription to The BMJ. We also name and thank all peer reviewers on our website every year.

What happens to your review?

We do not ask any of our reviewers to comment on whether they think the paper should be published. Your comments, alongside those from the traditional peer reviewers, will be used to guide editors' views about the paper under consideration, but the decision to accept or reject a paper is made by the editors. It is not unusual for reviewers to disagree on the importance and relevance of the paper, and it is the editors' job to weigh up the various comments and use their collective judgment to reach a decision. As such, it is extremely important that all reviewers provide reasons for their views. Once a final decision has been made (and this can take several months), all reviewers are copied into the detailed decision letter sent to the authors, and they can then see the other reviewers' comments. Unfortunately, because of the volume of reviews received, we are unable to give you personal feedback about your review. You should be aware that research papers, in particular, have a very high rejection rate at The BMJ.

The BMJ asks reviewers to sign their reports, so that authors know who has reviewed their work. This includes patient reviewers, and we have now adopted a policy of publishing all reviewers' signed reviews on our website| alongside the paper, so that all readers can see them. We appreciate that there may be circumstances when that will prove difficult for some patient reviewers and are willing to discuss this with individual patients (please contact

Are there any reasons why I should decline to review this article?

The BMJ takes conflicts of interest seriously to maintain the independence of the peer and patient review process.We therefore suggest that you decline to review the paper if you
(a) are or have been a patient of one of the authors
(b) are working with the authors on another project; or have worked closely with them in the past
(c) where your relationship with the authors is such that you do not feel at liberty to express your true impressions of their work.

If you remain uncertain about whether you should review a paper that has been sent to you please email the editor who sent you the invitation and explain your concerns.

Whom should I contact if I need help?

If you run into any problems or have any questions that haven't been answered here, please email the editor who sent you the paper to review and copy the email to our patient partnership editor, Amy Price at If you have any problems logging on to our online database please email Sue Minns at

Frequently asked questions

Where can I find out more information about peer review in general?
Some additional resources:
Wikipedia article on peer review
Reviewer guidelines—Elsevier
"How to review a paper"—Benos et al 2003
Top 10 tips for peer reviewers—Guardian
A graduate student guide to peer review—American Psychological Association
How to be a peer reviewer—Political Science

With whom will you share my data?

After you have registered, we will set up an account for you on our manuscript tracking system and will enter keywords to try to reflect the information you provided us with on registration. This database is accessed by The BMJ's editors and editorial staff and very occasionally by researchers working on specific projects under contract. We will not share your data with other parts of our business without your prior permission. We will not share your data with third parties.

How will you keep my account up to date?

We will routinely write to all patient reviewers annually to ask you if you still want to be a reviewer for us and have your data held on our secure database. It is quite possible that you haven’t received an invitation to review yet, but this does not mean that your account is inactive or that we won’t invite you soon. You are free to withdraw from being a patient reviewer at any point without giving a reason.

What happens if I want to stop reviewing once I've signed up?
If you have registered to be a patient reviewer but have changed your mind, you can email at any time and ask for your account to be closed.

What happens if I am unable to review an article?
If we send you an invitation to review a paper, but you are unable to review it for any reason, you can simply decline the invitation in the email we send you. To avoid delays for authors, it is helpful if you decline an invitation to review quickly. If you don't decline or accept the invitation to review, you may receive an automated reminder. If you do decline an invitation to review, your account will still be active on our database, and we will still invite you to review in future if we receive a suitable paper.

Why haven't I received an automated email to let me know that my account has been set up?
There will be a short delay between your completing the online form above and your receiving confirmation that we have set up an account for you. This is a manual process and will periodically be done in batches. Please do email us at if you want us to speed up your registration.

What happens if I forget my user ID?
We will set your user ID as the email address you gave us in the form above on registering for this initiative. You can change this by following the guidance below.

What happens if I forget my password?
If you forget your password, go to and enter your email address where it says "Password Help." You will then receive an email reminding you of your password.

How do I change my password or user ID?
To change your password or user ID first log into the database at with your current user ID and password. Then click on the red arrow, next to where your name is displayed on the top menu bar, and select "User ID & Password" from the dropdown menu. Then click on the link that says "Change Password" in the first box and follow the instructions. To change your user ID, just enter a new user ID in the relevant box. Please note, your user ID or password cannot contain any spaces, and your password must be at least 8 characters in length.

I have an account registered on your database, so why haven't I been invited to do a review yet?
Because some conditions are more common than others, you might not get asked to do any reviews for quite a while after volunteering. This is quite normal, even a reviewer in a highly active area, such as diabetes or cancer, might be asked to review only a few papers a year.

How many papers does The BMJ receive and publish?
We receive around 3500 research papers a year, but about 80% of these are rejected by editors without any external review. For example, they might be too specialist for a general medical journal or lack originality. About 20% are sent for external peer review and are thus eligible for patient review. We eventually accept less than 5% of all our research submissions. This means that many patient reviewers find that they are asked to comment on papers that end up being rejected by The BMJ. Some patient reviewers have been disappointed by this, and a few have expressed concern that it might be because of their feedback. This is not the case, however, for while feedback from reviewers, critical or otherwise, is an essential part of The BMJ’s processes, the decision about whether to publish a paper rests with the editors and not the reviewers.

How many reviews will I be expected to review?
This depends on your area of expertise and the content of the papers we receive. If we don't receive any papers that match your experience then we will not contact you. We do keep track of reviewer activity and would try to send you only a couple of reviews a year.

Why is the box where I write my review on the database so small?
This box expands as you write your review, so although it may appear small it should be sufficient. You might find it easier to write your review in MS Word and copy and paste it into this box.

Should I offer an opinion as to whether I think the paper should be published or not?
We do not ask any of our reviewers to comment on the paper's suitability for publication as this is an editorial decision.

What happens if reviewers do not agree with each other?
It's not unusual for reviewers to offer conflicting advice. We will consider the opinions in all the reviews we receive and weigh them up alongside the views of other editors.

Can I discuss the contents of a paper with other patients?
No, papers are submitted to us in confidence, and we need you to respect this until the paper is published.

Can I see some sample patient reviews?

Here are some links to several patient reviews of published papers. We have selected reviews on different topics with different styles. You should bear in mind that every paper and reviewer is different so these are examples, not set guides on style and format.

Patient review 1
Patient review 2
Patient review 3
Patient review 4
Patient review 5
Patient review 6

Can I be a patient reviewer if I already review for The BMJ as a researcher or clinician?
If you are already a peer reviewer for The BMJ, but would like to also register as a patient reviewer, we may need you to have two accounts on our database. This is because the database is restricted in the number of keywords we can use to match your expertise and patient experience to relevant papers. Having two accounts will avoid us confusing your role as researcher/clinician with your role as a patient. We suggest that you use a personal email address for your patient reviewer account and your work/professional email address for your traditional peer reviewing. If you have any questions then please email

Why was I sent an email saying my review was no longer needed after I agreed to review an article?
We are committed to making fast decisions on articles submitted to us so that authors are not delayed. As such, there might be an occasion where you are invited to do a review, but we then withdraw the request so that the paper can be pushed on to the next stage. This is not an indication that we do not value your opinion, merely a reflection of our commitment to expedite the peer review process.

Do I need to comment on spelling mistakes and grammatical errors?
We do not need you to point out spelling mistakes or grammatical errors as we have a team of editors who correct this when they are preparing the final manuscript for publication.