Thursday, 8 September 2016


s a junior resident in Surgery I was always tutored by my teachers to document the operation notes accurately, in great details and always with an accompanying diagram. When I rose the ladder of seniority in the residentship programme, I was coaxed, bribed, harassed, tormented and threatened with dire consequences to   publish my clinical and research data, and I often wondered what is all this fuss about? When I became the Editor of Indian Journal of Plastic Surgery when I went through the submissions to our journal I at once realized who all were fortunate enough to be tortured in their formative years and who all are trying to torture themselves today! But it is never late to start publishing!  

So why should we publish? We publish to communicate with a wider audience, to secure recognition of our peers, to promote the work of our team, to document our research data and get it reviewed by our peers, to advance our career and to satisfy our own self. The importance of the immortality of the published work can not be over-emphasized.

Fear of writing or ‘Blank screen syndrome’ is dreadful. It is caused by
  • fear of failure
  • waiting for an  inspiration - that never comes
  • sub-optimal information gathering
  • laziness and lack of discipline
  • desire to write it all in one go
  • the dreaded ‘Perfect Draft Syndrome’.
Stephan King had very correctly said that the scariest moment is just before you start writing. After that things can only get better!

There are various ways of getting over the initial hesitation - 5 tips that I can offer are
  • set a ridiculously easy targets
  • bribe yourself for finishing small bits
  • challenge yourself for completing parts of the paper
  • spin a web of ideas in your mind
  • when tired or exhausted give yourself a break

The paper need not be written from start to finish in the order it will appear, one should start from the part one knows best, the study plan or the Material & Method perhaps. Tape recording the paper instead of writing it may be an easier option.  One should not fall into the trap of ‘Laundry List Phenomenon’ i.e. cut-paste from 10 papers! This is plagiarism and there are softwares to pick it up even if the reviewers miss it, which itself is highly unlikely.

The ‘Pre Research Stage’ of writing is vital and sites like Google Scholar, Pubmed, SCOPUS all help us with what is current. Instead of accepting all printed text one should question it….. can we do it better?. Recording all performed work as one goes along – data, graphics, videos etc. and discussing with seniors and colleagues helps one to develop and research the thought and eventually formulate a hypothesis. Hypothesis is a testable assumption and every research should have a hypothesis. It is best to write it down – it is key to the research project. Then one should test it and critique it to destruction……..ask “so what?” and “who cares?” and finally one should answer honestly “is it worth publishing?”

Good data speaks for itself – generally we can eyeball a good data. If we need statistics to prove our point we are putting the cart before the horse. Statistics should prove what is obvious, but statistical fishing expedition to somehow prove our erroneous hypothesis is wrong. Statistics should not disguise the hypothesis.

Choice of ‘Title’ is vital as the latter is the critical identifier of the contents of the research we intend to publish. Title only comes up on search and so should be short, catchy and representative of the hypothesis. Abstracts and Conclusions are most read parts of a paper and should entice the reader to read the whole paper. Abstract is what comes up on Pubmed search and is the calling card of the research project. It is like a well decorated display window in a departmental store, if it is attractive then shoppers come inside the store and otherwise they move on to the next store! An abstract should entice the browser to read the complete paper and so is absolutely vital.

The style of writing should be simple with short paragraphs conveying a single idea with a sub-heading. Sub-titles / Sub-headings are important as they are critical to readability, critical for IMRAD structure, they introduce a new subject / idea and the reader is not lost in a long discussion, thus making the paper more readable. Judicious use of images, graphics and tables, properly placed in the text again helps the reader to understand the hypothesis. Printing space is at premium and so one should avoid excesses - excess data does not add intellectual worth and such data overload only baffles the mind; excessive tabulation and statistical wizardry should be avoided and excess colour is an irritant. The look of the page is important and brevity is vital – there is very little useful you can offer beyond 3000 words. Watson & Creeks’ landmark paper on ‘Structure of Nucleic Acid’ was written in 2 pages of ‘Nature’. Lastly one should submit the manuscript when it is ‘good enough’ and not wait for it to be ‘perfect’

Choosing our audience and journal according to our message is also of vital importance. What is the core message? Who needs to hear it? Is the message for local or regional or international dissemination? What is the best format? – Editorial, Review Article, Original Article, Letter to the Editor, Case Report, Ideas & Innovations? Which journal has audience for our message? This can be judged by reading the target journal’s aims, scopes instructions and guidelines and its past issues. Aiming for a high prestige journals is good as it has sound criticism and peer review and that improves the quality of the efferent article. But these journals have low acceptance rates.

Tackling reviewer is a very taxing and tactful part of paper writing. One should be patient and receptive. They are usually experts – been there done that too, they have spent valuable time to read our manuscript and they are trying to help. Good referees act like proxy guides and one should address their queries point-wise and make the alterations in the text in a different coloured font

Lastly claiming what is not true is immoral and can easily be picked up by experts and systems. Other author’s work / diagrams have to be acknowledged and permission obtained for reproducing in any form text can not be reproduced verbatim from a previous publication. Use of pronouns ‘I’, ‘my’ and ‘mine’ has no place in a surgical paper as surgery is a team game and by using plurals ‘we’, ‘us’ and ‘ours’ we are acknowledging the contribution of our team of doctors, nurses, therapists etc. even if the paper has a single author. Language and grammar are non-negotiable factors and help from others should be sought whenever one feels challenged.

We are today not teaching our residents to document properly and this is not only a reason of concern but a matter of shame. How long are we going to keep our heads buried in the sand and stay convinced that nothing is going wrong? To all  Karmyogi Surgeons who are of the opinion that their job is to do the surgery and writing papers is the job of some nerd, sitting in a cold country with no patient-load, I have a news: they may be the Shehenshahs, Badshahs, Emperrors and Kings of their own world of fiction, but the real world does not recognize them, does not know about them and will never come to know about their exploits lest they publish their work. Their vast clinical wealth will be lost in oblivion and posterity will refuse to accept their existence! And this exploitation of our clinical wealth and paying back nothing intellectually in return is a crime on posterity!

Publications are our footprints on the sand of time. While our surgical exploits can fetch us local fame our publications are our calling cards to the world. You have a choice to be in the elite league of Berni O’Brien, Joseph McCarthy, Converse, Graham Lister, Wayne Morrison and Ravin Thatte or you in far bigger and unknown team of Mr. Nobodies. The choice is yours!