The discussion section (2003)

As a medical author, I find the discussion sections of original scientific articles hard to write. Judging by the papers we receive at the BJOG, I am not alone. For most papers, the background and methods almost write themselves, and, although the results may be tough to get, they are usually fairly easy to write down. In contrast, the discussion requires original thought, a new literature search and often many revisions to make it useful. Perhaps, this is why many are overlong, badly organised and some barely intelligible. Some authors also appear to think that this is the place to repeat the results, put in material they could not find space for elsewhere and to deliver themselves of personal opinions unrelated to the topic of the paper. This editorial is for them. The discussion section is designed to help the reader see how the results fit in with previous work and to indicate the implications for future practice and research. It is not a place to try to ‘sell the paper’. Docherty and Smith1 recently suggested that discussion sections should be structured in the same sort of way as abstracts, arguing that this would impose discipline on authors and reduce speculation. The BJOG editors think using Docherty and Smith's subheadings in the final paper is going too far, but we do encourage authors to follow their general structure (Table 1). Experienced authors usually do this already. A good technique for beginners is to use the five headings while writing the first few drafts and remove them before the final revision. The discussion should open with a statement of the principal findings. This should not be a restatement of the results, but rather should simply say in words what has been found. For example ‘We have shown that the abc allele causes xyz disease’. If there are weaknesses in the paper this opening phrase may be qualified. For example, ‘…the abc allele appears to cause xyz disease’ or even ‘…the abc allele appears to be associated with xyz disease’. The key requirement of this opening sentence is that it should be an accurate statement of the main findings. A factual description of the strengths and weakness of the study should follow. This is the point to remind readers if the study is original or not and to tell them of a strong study design, large sample size, strict diagnostic criteria or superior laboratory methods. It is also the place to come clean and admit the study's weaknesses. If the design was weak, the sample size smaller than planned, patients did not comply well with treatment or a laboratory assay was done in a suboptimal way, an honest description of this strengthens the paper. The next section should compare the present findings with those of previous related studies. If they are similar, explain why the confirmation is worth reporting and if they differ, speculate why the differences may have occurred. This is also the point to compare the strengths and weakness of the present study with earlier ones. When all these qualifications have been got out of the way, it is time to describe the implications of the study for intended readers, whether scientists, clinicians, policymakers or patients. For most clinical articles in BJOG, the intended readers will be clinicians and clinical researchers, but for some scientific articles, they will be basic scientists in the same discipline. The discussion should end by reminding readers what unanswered questions remain and what further research is needed. It is much more useful to give a specific statement of what you think should be done, than to make a platitudinous call for unspecified further research. If the results indicate that further studies are impossible or unnecessary, say so and shut up. Following Docherty and Smith's headings will make writing the discussion section easier and increase the impact of your paper for readers. It will also please the editors, which may increase its chance of acceptance.