Guide to Publishing Creative Reflective Essays in Medical Journals
Story, Voice, or Name
A very astute student who used to come to a writing group we host, pointed out that most pieces of written reflection seem to fit into one of four categories--a compelling story, a powerful writing style/voice, a timely topic, or who the author is.
Story: Some pieces tell a story that is in itself really compelling, moving, unique, or dramatic.
Voice: Other pieces tell a somewhat mundane or universal story but are told with a really compelling style of writing.
Timeliness: the topic of a piece is in the cultural zeitgeist at the moment, so is more likely to be published. There seems to be a relatively narrow window of time for this.
Name/Identity: Others are not great stories, blandly told, but if you google the author, you find out that they are some bigshot somewhere, who might have connections at the journal. More recently, it seems, editors have realized that it is important to publish stories from voices from groups that have typically been ignored, so the identity of the author may be helpful in getting pieces accepted.
Of course some pieces contain more than one of these.
What is your hook?
When you are considering publishing a piece of reflective writing, it is helpful to think about what makes (or what could make) your story stand out and be interesting to an editor (and later) an audience. Sometimes a story can be pretty universal (and therefore not novel) but you may be able to come up with a way of thinking about it–a narrative framework, an extended metaphor, or a perspective–that others might not have considered before. If so, you should really focus on this unique feature in the telling of the story.
Whose story are you telling?
As you are reflecting and thinking about trying to get a piece published, think about whose story it is that you’re telling. Sometimes, I’m so impacted by a patient’s story, that I feel compelled to write about it to help myself make sense of why it impacted me the way that it did. However, sometimes at the end of the process, I realize that I am only a side character and that the story really belongs to the patient and is not mine to tell. Writing these types of stories is still cathartic and personally beneficial as I process the experience, but I don’t allow myself to try to publish them. Sometimes it’s possible to center yourself in the story--make the story be more about your experience caring for that patient than be “a hey look at this crazy thing that happened to this person” kind of story. It also seems like more and more, editors are thinking about this as well, and fewer pieces are getting published that are more about the patient than the author.
Consent
Different journals have different policies about consent from patients/other people in the story. Some are okay as long as you assure them that you’ve done enough obfuscation so that the patient is not easily identifiable--you can change the person’s age, gender, diagnosis, etc. However, some journals (JAMA, for instance) want signed consent basically if you mention another person in the story, regardless of how innocuous the description. (One author I worked with mentioned that she took care of a newborn whose family also spoke Nepali and they asked for signed consent. I mentioned a tearful moment with my wife in a piece, and they asked for permission from her.) So as you’re considering writing about an experience and where you might want to publish, you should think about how comfortable you might be reaching out to anyone mentioned.
Start Strong and End Strong
As a genre, these types of pieces are too-often plagued by too much throat-clearing (providing a lot of detail or scene setting before the “action” of the piece starts) or by outstaying their welcome and adding on a paragraph or two of “this is what you should take away from this piece.” Often you’ll do better if you start with something more active and engaging and end the piece at the end of the story and let the audience come to their own conclusions with less hand-holding.
Length
Different journals have different word count allowances. Within those allowances, there seems to be a sweet spot for publication (at least for certain high-impact journals that I’ve looked at). For JAMA and Annals of Internal Medicine their allowance is higher (1600 for JAMA and 1500 for Annals, but the majority of pieces are around 1200 words. Very few that are published there are more than 1400 or less than 1000. NEJM’s allowance is 1200, and its average is around 1000. So keep the word count in mind as you are writing. (Longer pieces can still find a home in more literary sources--like Bellevue Literary Review, The Examined Life Journal, or the Intima, but some of these are very competitive since professional authors submit to them.) This spreadsheet can be helpful to show word counts allowed for various journals.
Formatting and Cover Letter
When you feel that your piece is ready to submit, you’ll create a cover letter and add a title page and format the piece. (Links are to examples. Note that journals typically want double spaced and indented rather than spaced paragraphs.)
Submission
Each journal has a slightly different submission process, but for all, there should be a “For Authors” or “Submission” link in the header of their website. This will lead you to a submission manager which should walk you through the steps of uploading, categorizing, and submitting the cover letter and the actual manuscript.
Don’t be discouraged if it takes multiple attempts to get it published. The number of these pieces that are submitted are growing rapidly. (One editor recently told us that they have >2000 submissions per year). But there are also more and more places to publish them, so if you are persistent, you’ll likely be able to get it published somewhere.