If the NHS is truly moving to a networked electronic record there are many issues to be addressed and discussed by doctors. Many are technical. At the moment they may seem arcane to the majority, but the current NHS information strategy requires for example, all GPs to address network security and privacy issues for their own practice. This will require substantial amounts of education and training, and the BMJ has a role to play in this.
The BMJ set up its information in practice section of the journal to foster discussion on these issues, and to promote high quality research and evaluation in clinical informatics. The BMJ's traditional values are represented in its guidelines, published here. This is all useful information if you have a scientific study that is best represented in the IMRAD structure.
But we are also aware that accounts of many potential articles sit uneasily with traditional evaluations to the highest academic standards. The BMJ struggles with the many expectations that its readership places upon it: it is a newsgathering and amplifying organ, a place of repose for the scientific record, a weekly entertainment for embattled NHS professionals, the house journal of a trades union, a forum for debate on the broader issues of healthcare. It is a general journal, with all of the problems that generalism brings. At the same time, journals are prisoners of their history. A paper that looks like a BMJ paper is more likely to easily fit into the editorial system: which can be conceptualised as a steeplechase, with a series of hurdles designed to trip up all but the most scientifically fit.
In fact, of course, the decisions we take are culturally bound. While we grope for a more scientific understanding of our processes (and I believe that a sociologist is in negotiation for access rights to the office with our alpha male) we realise that we may need to establish some sub-cultures that allow current minority interests to flourish. Gardens with only one kind of flower are boring. To this end the paper has editorial committees not only for Papers, but for General Practice, Education and Debate, and most recently, Information in Practice.
To continue the gardening metaphor, editors surveying the fixed plots of their pages know that growing something new means growing less of an established variety. Experiments continue, but there seems to be a developing consensus in the BMJ office that it is appropriate in a general paper journal to have more papers that are shorter, and that serve as flags for the more detailed information needed for thorough peer review, which is published on the web
At the same time, we also recognise that in the new era of electronic health records, doctors who have not plunged into the uncertainties of the information maelstrom, now require an understanding of often complex issues presented in educational rather than research formats. It is interesting for example, that the most popular BMJ products--by far--are the ABCs--short, authoritative, illustrated, didactic accounts of commonly met clinical subject areas. In the first instance, strive for readability, clarity, purpose, brevity.
Producing material that satisfies all of these standards, yet that is also timely and relevant is a challenge of the highest order, yet we ask authors to do it for little or no pay--if we ring you the sum of money offered for an article at the end of the conversation is likely to be of the order of 100-200 pounds, which in no way reflects a good hourly rate for the work involved. Broadly, the balance is paid in professional prestige, in adding strength to a departmental research rating by impact factor, and a place, however small, in the record for posterity. (Note: Articles published in Information in Practice are cited in all of the major databases e.g. Medline, unlike the Career Focus articles in the classified supplement for which I am also responsible)
A new era requires new rules and structures, and that authors contributing to new sections need to be nurtured and encouraged, not flatly rejected. Papers are submitted for peer review not to fell them but to assist with their improvement, and the editorial committee that considers them is committed to the subject area, even if the papers cannot appear in the BMJ. Because although we want to be constructive the reality is that authors in this area have to compete for space and editorial attention with many other concerns. Do telephone or email for advice at any stage of the process, including suggestions for articles that might be commissioned.
Comments to Douglas Carnall
12 October 1999