Introduction
It is unknown when the first clinical research paper was published. One of the early
scientific journals was the Philosophical Transactions of the Royal Society of London, which dates back to 1665 and is credited to Henry Oldenberg.[1]
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Clinicians, especially those in low resource settings, primary care settings, and
nonacademic settings, do not consider publishing scientific manuscripts as a priority
or a necessity. There are several reasons why a clinician should publish. The quality
of clinical care rests on a foundation of knowledge that we now call evidence. It
is important to understand that knowledge is more than just evidence. It includes
the generation, understanding, analysis, interpretation, and assimilation of evidence
in the right context. It is inevitable that current standards of knowledge are continuously
evaluated if clinical care has to progress. The knowledge that exists and generated
needs to be compared, critiqued, and assimilated appropriately to improve clinical
care. Improvements may mean discarding certain bits of existing practices or processes
that are not useful, continuing with existing practices that are useful, or improving
upon existing practices. Refuting existing evidence is not uncommon in the health
care realm.[3]
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[6] Controversies regarding the quality of evidence, research methods, and utility of
research are also not uncommon.[7]
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Diseases and well-being are a result of an interplay of several factors including
the individual, their environment, and genes, all of which are in a constant state
of evolution. Diseases and their definitions, therefore, are also evolving. Scientific
research is in a race with disease to keep pace with its ever-changing nature. If
such scientific knowledge constantly evolves, how do we manage to keep ourselves in
sync with it?
Medical knowledge, within the medical community and the public at large, can only
be updated through regular communications. Within the medical field, communication
occurs primarily through conferences, meetings, and a network of medical journals.
It may also happen on social media discussion forums like Facebook, WhatsApp, and
other similar media. These do have their own limitations. Conferences and meetings
are not regular, maybe held in different distant locations, could be expensive to
attend, and packed with busy schedules taxing one's attention such that one tends
to forget one presentation when the next one starts.
Discussions are rare at conferences due to time constraints. Social media forums offer
the scope for unlimited discussion but are usually informal, unstructured, and not
necessarily backed by the appropriate use or levels of evidence. Discussion in social
forums too is time consuming with plenty of viewpoints to filter.
Journals too have some limitations. Access that is restricted by high subscription
fees is an issue that is increasingly resolved by the proliferation of open access
journals. The quality of articles and the representation of different levels of health
care may be an issue. However, one has to consider that journals can only choose from
what is offered to them.
Journals, however, have several major advantages compared with conferences and discussion
forums. Journals, either in print or as digital archives, provide a ready reference
for a clinician who faces a clinical dilemma. Clinicians, almost daily, face cases
where they have to establish a precise diagnosis and prognosis, identify the optimal
management strategy taking into account the context of the patient, and evaluate alternates.
The clinician has to rely on a dependable source of information that has undergone
stringent evaluation. Currently, the scientific journal is the source of such information.
One can argue that textbooks are a better source but one must consider that textbooks
rely on scientific journals for information, are dated, and, at best, are a summary
of the wealth of information available in journals. Journals also offer scope for
discussion through letters to the editors where readers can interact with the authors.
Open review is also increasingly recognized where readers can view peer reviewer comments
and models where every reader is a potential reviewer with a scope to post comments
and ask for clarifications online.
So, returning to the query of, why should a clinician publish, I argue that a clinician
who truly cares for their patients wants to provide the best possible care for the
best possible outcomes for the patient. This is possible only by constantly updating
one's knowledge through the reading of scientific communications and best practices,
which currently reside in scientific journals. If one makes use of such knowledge
shared by other peers, I argue that every clinician has a responsibility to share
their knowledge as well with their peers. This can help to improve care for other
patients at a much larger level. Additionally, sharing one's experience and knowledge
with other clinicians allows for a larger evaluation of the utility of processes and
is thus educative by itself.
Publishing a scientific article is a learning education process in itself. When well
done, the research study is a learning process where one updates knowledge and evaluates
certain aspects of that knowledge. Scientific manuscripts are peer-reviewed, which
means they are evaluated for content by external independent judges or reviewers.
The process of review is primarily meant to understand the science better, to understand
the relevance and appropriateness of the results, and to ensure that research communications
add value rather than noise to the existing knowledge. Good peer reviews are a constructive
educative process often done on an equivalent footing with the reviewer and the researcher
learning and educating each other. A manuscript that passes through this process lends
itself to communication with other clinicians worldwide.
A clinician who publishes contributes to the education of their peers while learning
at the same time and contributes to an improved clinical care worldwide. They are
the ones who ensure that clinical care progresses. There are several other reasons
to publish a manuscript which are important but of less relevance. These include the
feel-good factor of having published, meeting mandatory requirements of a certain
number of publications for career promotion, ego, reputation, and more such factors
that lead to several gains from publishing beyond medical and scientific realms. Other
reasons may include improved reputation as an expert leading to more referrals, intellectual
pleasure, addresses including policy matters leading to an improved social interaction,
more grants or funds and increased revenue, and the ability to attract high-quality
people to work or collaborate which also helps to keep one on their toes.
I often hear clinicians say “I see so many patients every day and have treated so
many of their illnesses. Why should I publish?” To them, I have only three questions:
“First, where is the evidence to say you have helped, and Second, were your results
independently evaluated, and Third, if you have helped so many, why are you not sharing
that knowledge and experience with a wider group so that more people can benefit?”
We also hear clinicians complain that they do not have the time to write scientific
papers. In the course of a busy clinical practice, clinicians from a nonacademic setting
may be hard-pressed to find time which may take away from personal and family life.
Pragmatically, it is not often possible to draw a clear line between personal and
professional time in many settings. However, if we document each care in detail, we
do not really need to take too much time to write up a manuscript. And needless to
say, documenting each case in detail is also a reflection of the quality of care we
provide and a measure of our transparency while providing that care.
One must admit that scientific manuscripts are often filled with technical jargon
especially on the statistical front and may seem overwhelming and make one shy away
from publishing. However, I feel that every manuscript does not need complex statistical
maneuvering. A set of basic statistics can help to present most findings. The lack
of statistical expertise should no longer be a reason to avoid publishing. Some scientific
journal publishing houses suggest resources that can help you with several aspects
of publishing.[13]
Another, understated worry, about publishing is the possibility of finding out that
one does not really know as much as one thought one knew about a subject during the
rejection of the article after peer review. Rejections and comments to improve are
a part of the game. One can look at that as bruising to the ego or as ways to improve.
Writing a scientific manuscript is just a natural way to complete the clinical care
process. As in clinical care, it involves meticulous planning, evaluation of alternates,
assessing and analyzing results, and documenting findings. If you look at it carefully,
every good clinician actually does research on every subject they manage. Good clinicians
maintain good medical records with meticulous details about what has happened with
each patient. A scientific manuscript can be seen as sharing these notes, in a slightly
different format, through a more uniform language that is understood worldwide.
Should every clinician then publish, you may ask. I say why not? Every clinician has
a clinical story to share that can help someone somewhere manage a patient better.
Why not share that knowledge?
The study of medicine and care is constant. A good practitioner has a responsibility
to be a learner as well as educator throughout their time in the field. The learner–educator
interface is interlinked, dynamic, and constantly evolving. Do not publish so that
you may not perish. Publish, so that you help your peers provide better care. Publish,
so that patients receive better care.
Disclosures
None.
