The primary purpose of peer review should be to improve manuscripts and facilitate the dissemination of accurate and valid knowledge for the ultimate benefit of patients. The fundamental purpose must be consistent with that of medicine itself, to cure sometimes, to relieve often, to comfort always. Editors can poll their readership to determine whether journals are meeting the readers' goals, a survey of one group of clients. Other clients are the authors whose work is subjected to scrutiny by a process that is under intense examination. Authors must be served by the process, and editors must learn whether they are meeting the authors' needs.
Several conclusions derive from the survey.
The administrative and editorial assistance of the journal staff were highly regarded, by authors of both rejected and accepted manuscripts. Reviewers' guidelines that the review is a means of improving the manuscript and more than just a grading effort may need additional emphasis. Editors have expressed concern that this approach may limit comments, resulting in a narrow and focused review. In our survey, widely divergent opinions in a review were most dissatisfying to authors, although some editors prefer such critiques so that all aspects of the manuscript are considered. Aspects of the process may be viewed differently by authors than by reviewers or editors.