Saturday, January 21, 2012


My resident approached me the other day asking for advice on how to write up a case report. It was somewhat timely as my sister had seeked a similar advice recently. I can't claim to be an expert in publishing materials as at my alma mater, the real experts had over 300 first-author papers each, though I've had my hand in this several times. This is what I told him:
  • Use a cover letter. Even if the author instructions lists this as optional. Take the trouble to find out who the Editor-in-Chief for the journal is, and address it to him/her appropriately. Make it succinct, but explain in one or two lines what your manuscript adds to medical knowledge, or why the case/study is special. Otherwise, a manuscript simply entitled "Chordoid glioma of the third ventricle" gives the reviewers little insight and makes it easy to disregard. Thank the Editor for considering your paper.
  • Identify potential journals. Not all journals take all types of manuscripts; not all journals take case reports, or medical images, or unsolicited review papers. Do your homework
  • Know the format. Once you identify your target journals, use the appropriate format. Double-spacing is a given, but know how they like their references cited, or tables and diagrams labelled. If they lists a word-limit, do not exceed it.
  • Use the proper lingo. Obviously, don't mess up the English. That being said, there is a certain type of lingo that is expected in a scientific publication. Informal language should not be used. No DON'Ts, CAN'Ts, WON'Ts, HE'S. My style is to follow reinforcing statements with INDEED, THUS, FURTHERMORE, rather than SO, OF COURSE.
  • Don't over-abbreviate. While abbreviations can be used, always start with the full syndrome names and follow this with abbreviations. But do not overdo it. Ie. A 50-yo man with DM 2 presented with SOBOE and ACS...
  • Do it now! It's true, the passion and motivation for any case or study will fizzle. So, if you are enthusiastic about writing up something and submitting it, do it now! Because if you don't the weeks become months, and then years. Though I'm pretty satisfied with what I've done, I do have manuscripts that ended up in my dusty to-do folder that will never see the light of day. Including that (sigh) 20-page (double-spaced mar)/80-reference review of thyroid nodules that is now 5 years old and is stale and no longer up-to-date. And I'm too lazy to update this. So, do it while you are keen. Otherwise life gets busy and you make excuses.
  • Use reference formatting software. Do not manually type out your references! That is a lot of work, and you need to modify it to the journal you submit it to. And, if you manually type things out, but decide to add a new reference between Number 3 and 4, you're left with manually relabelling references 4-20! There are numerous programs out there that do the formatting for you. I used Endnote back in my day. It was neat, as from Medline or Pubmed you could directly save the citation (even the .pdf) and keep it in a folder, and then just label it when you work on your Word document.
  • Don't give up. About two-thirds of my manuscripts were rejected initially. Sometimes it's just a matter of shopping for the right target journal, whose reviewers feel your paper is well-suited to their readership. So, if one journal rejects your paper, look for another. Start with more ambitious ones, the ones with a higher impact factor, and then work down. A mentor once told me, "All manuscripts can be published, if you look long enough for the right journal". (Almost true, though I had one manuscript that in retrospect sucked bad enough that I probably shouldn't have bothered even trying! Ah, that was when I was still a publication virgin).

It's a lot of work. My most hard-earned papers spanned 2 years of my personal work (and 5 years of data). But to get that email, "Congratulations Dr. Vagus, your manuscript entitled X has been accepted for publication...", and then to see your paper in print, is a very rewarding feeling. So, if you are inclined to do research and write papers, it's well worth the effort.


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