Paivi Hietanen on being a stranger at the BMJ

Paivi HietanenObservations by the editor of the Finnish Medical Journal (FMJ)

When leaving Helsinki I had ambiguous feelings. Two books from my childhood came to mind, The Bear Who Always Said “No” and Turre, The Ship Dog. The bear was thrown out of his home and his subsequent lonely journey through foreign villages inhabited by unfriendly strangers reflected my separation anxiety. Turre, in contrast, was adventurous and autonomous. He sailed alone happily to far-away destinations and always emerged from considerable dangers with happy outcomes. During my stay at the BMJ, the bear-feeling has turned into the dog-feeling.  It is reassuring to see that the ethical principles of medical journalism are the same for a small national journal as for a high-impact international one. Trustworthiness, independence, and transparency are values on which a successful journal, big or small, has to build its future.
The largest difference between the two journals is in monetary and intellectual resources. The high quality of submissions, the enviable amount of original research, and the global pool of excellent reviewers make the BMJ a prestigious global journal.  The FMJ has to focus more on continuing medical education, on nationally important research and health news, and use of the Finnish language in medicine (that’s what the patients speak!).  It is easier for doctors to improve their general medical knowledge in the mother tongue, though many look for new research in English. 

The process of scientific publication is impressively transparent at BMJ.  The ~30% of submitted articles which survive to be discussed at the weekly manuscript meeting are reviewed in detail by global experts – sometimes after several corrections. “Does this help doctor’s decision making?” is the key question in article selection, and I will now put more emphasis on that at FMJ. The decisions are tough, but occasionally one person can rescue an article that is on the verge of rejection. All reviewers can make mistakes and have biases, so that decisions are in the end subjective; it is impressive and unusual that BMJ encourages appeals.

BMJ has taken a leading role in informing doctors about the health consequences of climate change. A striking difference in comparison to my home office is that at the BMJ several people work from home many days a week, and some even work from distant countries. Once, I sat alone in the conference room – all the other participants were connected via the phone. I was delighted to see that these approaches to communication are becoming useful and effective. However, it remains difficult to substitute for human presence, as non-verbal messages are important in human communication. We need each others’ smiles, looks, grimaces, and everyday discussions stimulated by random thoughts. The development of technical devices has some distance to travel: a blurred voice without a picture is a substantial challenge even to native speakers.

The mixture of the modern and the traditional is a fascinating characteristic of both BMJ’s office and British society.  The BMJ has shown no fear in risk-taking when experimenting with new communicative approaches such as the social forum doc2doc and BMJ Open. The combination of traditional science alongside hectic everyday news reporting makes the office a vivid place for an outsider to observe, even if the journalists might believe there are too many doctors while the doctors believe there are too many journalists in the mix; I have observed this in Nordic journal offices as well.   

I have many fresh ideas from BMJ to take home. I have learned something possibly even more important.  I am a very privileged foreigner and had the good fortune to live by the wonderful Regent’s Park during my stay; the apartment belongs to a generous friend, who invented the Teletubbies, and each morning as I looked over the colourful trees of Regents Park I was grateful for the success of Tinky Winky. However, I recognise the feelings of uncertainty with less fortunate foreigners, some of who would stop and ask me directions on my morning walk. I identified with their limited communication skills, and I so envy and admire the eloquent and positive way English people express themselves. The feeling of stupidity when asking a third time before understanding what the salesman is telling me in a shop is a source of shame which I share with others. Overcoming one’s anxiety and sailing on foreign waters is a learning experience in many ways.