[Δημοσιεύθηκε στο περιοδικό BMJ Careers 2005]
You can usually tell by the size of the envelope: if it is bulky enough to contain two of the three (or three of the four) copies you submitted, you can safely bet that the covering letter will contain a phrase such as “regret to have to disappoint you,” along with a soothing statement that “we have to reject a large number of quality manuscripts.” Having also received several positive responses, I can attest that they come in much more lightweight parcels.
From anger to acceptance
After receiving such an envelope you may experience certain well defined reactions analogous to the Kübler-Ross responses to a diagnosis of cancer. Initial anger makes you feel like depositing the unopened package in the nearest wastebasket, forcefully and without delay. You may even bounce it off a desk surface or the furthest wall, for better effect. Then comes denial: it cannot be happening to you again. You have to see—maybe there is something else. You pluck up enough courage to tear the flap of the envelope. Your doubts last until you cast your eye on the last sentence of the editor’s reply. A second wave of anger ensues, during which the idea of the wastebasket again seems very attractive. But then you have to see the “Path report”: it may offer a glimpse of hope. So you turn to the reviewers’ comments: “Neatly written, might be interesting, but not original enough to deserve publication.” In plain English: no.
To fight or not to fight?
If you are a fighter, you get your second (or third or fourth) wind and switch on the word processor again. If you aren’t you move into rationalisation. Who wants to have something published by that journal anyway? You try to convince yourself that you are a good clinical doctor (your success in postgraduate exams shows that), that you enjoy your work, and that you get on well with your patients. You are not really a writer. If you were to have your way, you would never submit for publication anything more than an occasional letter to an Editor. It’s actually that vacuum under the publications section in your curriculum vitae that begs for some substance. With this final thought you turn to the section providing information to authors of the next periodical.
Dispute comes next and may last for many days. Some of the comments raise fundamental questions. “The case would be received with interest by the readers of XYZ journal, but is not sufficiently rare to merit publication.” What is the threshold prevalence for publication? One in a hundred million? One in a billion? One in recorded history? If so, unique cases are destined to remain unique until somebody changes the rules. How do you reconcile the description of the patient as “unusual” with the comment that the problem in question would have been more interesting if it had occurred in a more “ordinary” person? Why were the reviewers not excited by the fact that you diagnosed and treated the patient even though you had never encountered his condition before? How come they did not share your enthusiasm and that of your seniors, who encouraged you to write the case up in the first place? Why is clinical interest not synonymous with “editor’s choice” these days?
Inevitably you speculate on the reviewers’ age when they refer to bygone good times or use medical terms abandoned long ago. You even have a moment of malicious joy when you pick up spelling mistakes in their comments, even though these could possibly be secretarial in origin. You fume when they ask for the results of this, that, and the other investigation, knowing full well that these were not done because they were considered irrelevant, because it was Friday night or Christmas Eve, because the patient was too ill to have them or getting so much better that they were unnecessary, or (you must finally admit it) because you never thought of them in the first place. Then again, how could your report be shorter and still contain even more results (positive and pertinent negative) or refer adequately to each and everybody’s pet disease or syndrome?
Having vented your spleen at the reviewers, the associate editor, the chief editor, the editor emeritus, your coauthors and the patient, you decide that it is worth another try. This is easier said than done. Retyping the paper, even though the skeleton is there and you only have to rearrange the flesh, takes hours, and this is inevitably time off your sleep. The returned copies are useless: they will have to be revamped. You still need a third (or fourth) set of illustrations. And what about the statement signed by all authors that the paper has not been submitted elsewhere etc.? You wish they’d send that one back, so you would not have to chase colleagues all over the country for their repeat signatures. Surely the journal does not need this declaration for a work it is not going to publish.
A groundbreaking idea?
My experience with rejection has given me an idea. What we need is a beginners’—or beggars—medical journal (Beg Med J), a sort of nursery for authors of nought to five papers, that will not accept submissions from established writers. Contributions will be welcome as long as they are truthful, well written, and interesting. The papers will be peer reviewed, and the reviewers’ comments will be published along with the papers, thus helping others to avoid similar pitfalls in their writing. Contributors will have the double benefit of publishing papers and getting official constructive criticism. After the nursery period they can then try their hand in the mainstream journals. There is only one problem: I am a clinician and not a medical editor. However, if anybody wants to take up such a venture, I hereby register my claim to the paternity of the idea.
Even such an original suggestion might be rejected; however, now one is prepared. It has happened to countless others before, and acceptance of this fact leads to consolation. And hope for the future. ■