Converging paths

In the MJA’s Centenary Year, we investigate the career pathways of those doctors who choose to enter into the mysterious world of medical publishing

Medical editors tend to be a quiet group, at least in the workplace.

Usually they have their noses buried in manuscripts, statistics, other journals and texts.

If they do speak it is to the authors of the manuscripts they are supervising, or the reviewers who are recommending revisions or rejections, or the assistant editors who are the next link in the chain of the journal editing process.

They are focused, dedicated and have a streak of perfectionism.

Dr Ginny Barbour has been the medicine editorial director of PLOS Medicine since 2012 and previously worked at The Lancet. She studied natural sciences at the University of Cambridge, and then medicine at University College London and the Middlesex Hospital School of Medicine in London.

Her specialist clinical medical training was in haematology at the Royal Free Hospital, London. She was awarded a Doctor of Philosophy from Oxford University in 1997 for research into globin gene regulation. Her postdoctoral work was at St Jude Children’s Research Hospital in Memphis, Tennessee, in the United States.

Dr Barbour came to publishing almost by accident. Needing a job sooner rather than later on her return to London, she was told about a maternity leave contract as an editor that was available at The Lancet.

It didn’t take long for her to be hooked.

“Scientists tend to be completely devoted to a relatively small area of interest”, Dr Barbour tells the MJA.

“As an editor, I got to read anything that came through the door. I can clearly remember the first paper I accepted for publication — it was on the side effects of Chinese herbal medicines and I was totally excited about it.”

That excitement with the research and content is a common thread among doctors who become medical publishers.

Dr Ruth Armstrong, medical editor of MJA InSight, had been practising as a general practitioner in Newcastle for 7 years when she applied for a 12-month editorial fellowship at the MJA, before becoming a full-time editor.

“The joy of it is that you don’t have any idea what is going to come across your desk”, she tells the MJA.

“I’m good at catching other people’s vision, becoming absorbed in their ideas, and suddenly you get almost as passionate as the authors.”

Dr Armstrong’s grandmother was disappointed that she was no longer treating patients and asked why she was doing editing instead.

“I told her that even if my name wasn’t anywhere on the research, I could have a whole lot to do with getting big ideas out there.

“She didn’t think that sounded like much fun and said it was like building a stage for someone else to dance on.

“And I thought, yes, exactly, that’s what I really enjoy doing.”

A love of language is another common thread among medical editors.

Dr Astika Kappagoda, a medical editor with the MJA, combined medical studies and his passion for Ancient Greek through 7 years of a double degree at the University of Sydney, internship and residency at St Vincent’s in Sydney, a Masters in Indo-European linguistics at Cambridge, and a PhD from Macquarie University in the evolution of the language of ancient science and medicine.

From 2006 to 2011 he worked as a government research scientist in computational linguistics, dedicated to developing linguistic pattern recognition for use in the field of knowledge analysis and information extraction.

“When I finished my PhD I remember thinking that medical editing would bring together both my medical and linguistic skills”, Dr Kappagoda tells the MJA.

“I was interested in how the communication of research affects how people view that research and then how that research is subsequently advanced.

“It’s satisfying to see research which is important and then help the authors to communicate that research in a way that makes the importance shine through.”

Another MJA employee, Dr Kathryn Tuckwell, is a scientific proofreader.

She completed her MB BS at the University of Adelaide and did her internship at the Royal Adelaide Hospital before moving to Sydney and working at Sydney Hospital and Royal North Shore Hospital.

“I loved patients”, Dr Tuckwell says. “But I had this sense of dread and panic every time I worked a shift. I didn’t love it.

“It’s only since working at the MJA, and reading articles about medical education, that I’ve realised many people at my level were probably in a similar position.”

She knew, however, that she loved words and language. That led to her completing a BA(Hons) in linguistics, and teaching visual analysis and functional grammar before joining the MJA in 2011.

“I’m a bit of a perfectionist”, Dr Tuckwell says. “That makes me a good proofreader but it made me anxious as a doctor.”

Some medical editors experience backlash from friends, family and colleagues for eschewing clinical life for the world of manuscripts and revisions.

“Some colleagues thought I was crazy or wasting my medical degree, going down the path that I did”, says Dr Kappagoda.

Dr Tuckwell experienced the opposite. “My own GP told me to get out while I could”, she said. “The danger, he said, was waking up 10 years later with a mortgage and responsibilities and being unable to change track as easily.”

Dr Christine Gee, another medical editor at the MJA, said she did feel some guilt about not being a clinician.

“But I knew that if I wasn’t happy and not looking after myself then I wouldn’t be any good for my patients either”, she says.

“My family saw me more happy and relaxed and they understood. Some colleagues were a bit dismissive.”

Dr Gee’s path to publishing was via an MB BS from the University of New South Wales, internship and residency at Royal Prince Alfred Hospital, and jobs in the medical devices and then pharmaceutical industries.

“I felt like my job [as a clinician] was taking over my life”, she says. “It was all-consuming and I was worried that in 10 to 20 years I would have nothing to show for my life except my job and I wasn’t prepared to make that sacrifice.

“My perfectionist tendencies meant that my job as a doctor never felt finished — there was always another sick patient and I was completely exhausted.”

Dr Gee also wanted to stretch her creative side more than medicine allowed.

“In medicine you learn, memorise and apply what you’ve learned the same way every time”, she says.

“I wanted something more challenging, where I could tackle things in different ways.”

After 5 years working for a pharmaceutical company in both their marketing and medical divisions, Dr Gee was ready for a change.

“The thought of being a medical editor had intrigued me for a while but I had never pursued it”, she says. “I’d always loved reading but had never had the time or the energy; I loved English, and then I stumbled across the advertisement to work at the MJA.”

And like her colleagues, she’s hooked on the process.

“I’m learning new things again and it’s an opportunity to look at a very broad range of topics. It gives me the chance to have my finger on the pulse of the latest research and who’s who in medicine and health.

“It’s exciting and I have a lot of respect for the MJA. It’s a privilege to be a custodian of what it stands for.”

Professor Bruce Waxman, a former member of the editorial board of the ANZ Journal of Surgery (ANZJS), and a current member of its eminent advisory group, is the exception who proves the rule.

“I failed English in Year 12”, he tells the MJA.

A biology teacher took him under his wing and taught him how to write essays. But it was student politics that brought him to publishing, editing a student newspaper in his medical school days.

“It wasn’t so much a love of the language as it was a quest for knowledge”, Professor Waxman says.

In 1994 he was invited to join the editorial board of the ANZJS and began writing a regular column called “Medicine in small doses” for the journal.

One of the biggest drivers, he says, is the feedback he receives from readers.

“It makes you feel good and confident”, he says. “I always wanted to set a standard — if you’re going to write, write well.”

Writing and reviewing other people’s work makes him a better doctor, Professor Waxman says.

“It improves communication skills, teaches you how to explain things. What a patient wants is good bedside manner and empathy. Writing helps with that.”

One vital role medical publishing can play is the nurturing of the next generation of researchers and writers, he says.