First descriptions: Back to the future
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2010)

Every journal has its own publication policy, and there are many tens of thousands of medical journals. When an irate author accosts me about a landmark paper, whose importance I must have missed, standard JRSM practice is to review the original decision but only a small proportion of such appeals are successful. Decisions at medical journals are made for many reasons and the most frequent one should be a judgement by the journal editors about the interest of the paper to readers. Assuming, though, that a research paper is methodologically sound or a case report is plausible how do you decide what to publish?

For case reports, this question is particularly troublesome, simply because there are so many submitted for publication and generally so little to choose between them. The JRSM's current strategy is to publish two categories of case reports. A case report that is a useful reminder, or clinical lesson, for a broad range of JRSM readers is likely to attract the interest of JRSM editors. Nothing too rare and nothing too common, lessons should be helpful to clinicians in an author's specialty but also to clinicians in other specialties. Again, this is a difficult decision which is based on the information provided by the authors, the opinion of the peer reviewer, and the judgment of the editor.

The same triangulation decides on the second category of case reports that are published, which are first reports of adverse drug reactions. These are easier to determine as we use reviewers who are experts in drug safety, and establishing whether or not a case report is the first report of an adverse event is easier than judging the usefulness of a clinical lesson. In addition, authors are required to inform their national drug regulatory authority and the drug manufacturer, if they have not already done so. Written consent to publication from the patient, or the next of kin in the event of death, is required for all case reports published in JRSM. You can download a consent form from the journal's website.

We now introduce a third category of case report inspired by a new book that delves into the JRSM archive, Doctoring Medicine, from which we will serialise a selection of chapters over the coming months. The Royal Society of Medicine has a grand tradition of reporting first clinical descriptions. The great names of medicine, including Edward Jenner and James Parkinson, have published first descriptions in previous incarnations of the JRSM. The new category of case report, also to be published in the Grand Round section of JRSM, will feature first clinical descriptions.

We will make mistakes. Some first descriptions that we publish may transpire not to be first descriptions at all. We know journal peer review is fallible. Some readers will debate the usefulness of some first descriptions. We know journal decision-making is fallible. But we will attempt to reconnect with the essence of the Society in the hope that we might publish reports from the future great names in medicine. At the very least, we hope to fascinate readers.