Embracing the future of medical journals

Euan Lawson

doi:10.3399/bjgp13X670723

Medical journals are far from perfect. A former editor of the BMJ, Richard Smith, wrote a whole book setting out the problems.1 Bias of various hues has plagued the literature. Conflicts of interest abound, authorship has been controversial, and the pharmaceutical industry and commercial pressures have influenced content. There is the ongoing challenge of the peer review process that stubbornly refuses to be superseded by anything better. All the flaws have been highlighted and debated.

Journals have already moved a long way in less than a generation. Britpop was in full swing, Blur versus Oasis, when I was at medical school handsearching the Index Medicus. Medical journals were roughly on a par with telephone directories when it came to readability and it required physical stamina to complete the briefest of literature reviews. The only way to access academic papers was to trawl around the university library dragging the heavy volumes to the photocopier. I’d lean on the spines trying to flatten the middle sections of the tightly bound volumes while praying the copier wouldn’t jam again. It is a scarcely imaginable process to those raised with the internet.

While online medical journals have improved accessibility, many of us will have experienced the frustration of finding the perfect review article only to discover it’s sitting behind a paywall. Paper-short, web-long articles are the norm at the BJGP and open access is being embraced. The internet extends the reach of journals in ways that are only just being explored. Most of us will own socks that are older than Twitter and Facebook yet they already seem to have become ingrained in our culture. There are plans to continue to develop the online presence for the Journal. It also opens up a channel for post-publication review that we should all welcome.

Academics may feel they know exactly where they stand with medical journals. The role of the front section of the BJGP is relatively clear. The BJGP is an international primary care medical journal striving to publish primary care research of the highest standard and to add to the scientific record. Some of the research will have immediate and obvious implications for practice. However, research is more commonly about the slow accumulation of knowledge, inching towards consensus. That is an essential function of any medical journal.

GPs going about the daily business of seeing patients may be less sure about the BJGP. We all know that the research in the medical journals informs the guidelines, which in turn translate into clinical practice. For many, the BJGP is their most tangible contact with the College. The section at the back of the BJGP (Out of Hours) has taken a wider view of the world of general practice. Those pages have, under the expert guidance of the outgoing Deputy Editor, Alec Logan, provided stimulation and opened up reflection and discussion on the nature of general practice. That also seems to me an essential function of a medical journal.

These competing functions get to the heart of the role of a medical journal. They have always given me a sense of everything medicine should aspire to be in the modern world of health care. They are deeply rooted in a scientific evidence-based approach; yet there is still scope for that essential debate and exploration of all the grey areas that adds humanity to clinical practice.

The flaws in medical journals highlighted by Richard Smith are being addressed but in tackling them it is erroneous to create a false distinction between GPs and academics. Many will be both but even at the ends of the spectrum clinicians will take a scholarly approach to their practice and academics are motivated to improve patient care. More than anything I believe that an international academic journal publishing high-calibre research can offer engaging content that fulfils the needs of both academics and coalface clinicians; they are not mutually exclusive. Journals offer a unique opportunity to help patients come to better decisions alongside well-informed healthcare teams. I would value your feedback because now, more than ever, the future of medical journals truly involves the readers.