The term peer review is well known to every member of this community, and might be loosely defined as the scrutiny of a piece of academic work by people not involved in its creation, yet considered knowledgeable about the subject. Thousands of biomedical journals use peer review in some shape or form to help editors decide what to publish, or what not to publish. As most journals receive many more submissions than they can possibly publish, peer review is a valid way of sifting through the mire in order to identify those papers that might be considered of greatest relevance and interest to their readers, and which will possibly have an important affect on clinical practice. Peer review can be brutal. General medical journals, such as The New England Journal of Medicine, can reject up to 90% of submissions, not simply due to the fact that the submitted research might be considered unsound, or in some way unethical.

Audience interest is most often the key. What is interesting today will not necessarily be interesting tomorrow. It is not very scientific to say that your paper might well be published because you have been lucky and have timed your submission correctly. After all, the customer is always right.

When you have submitted your paper to your target journal you have to arm yourself with patience and hope for the best. You are, so to speak, at the mercy of the reviewers. Reviewers come in all shapes and sizes, and some are good while others are not so good. The big journals will have a reviewer database, which lists each collaborator’s field of expertise. This database expands with the editor’s personal contacts, together with the never-ending flow of authors that submit their own work to the journal for publication, and who might also be considered reviewer material. Cited authors are also a good source to draw upon. A good reviewer will be knowledgeable, thorough, courteous and timely. Indeed, time is of the essence. If you do not receive an answer from your target journal several months after your submission check the standard response times in the instructions for authors, or contact the journal office and ask what is going on. The reviewers might be to blame. Reviewers that are superficial, abusive (masking can also have its bad points), or constantly miss deadlines will inevitably be removed from the journal’s list or database.

Of course, reviewers can sometimes misunderstand a manuscript, or maybe overlook its crucial feature. Indeed, authors sometimes risk writing a rebuttal letter to point this out to the editor, but it is generally a waste of time, especially when the editor is of the idea that the work is not suited to the journal and will not be of particular interest to its reading population.

However, authors can avoid a mammoth waste of time by taking the following basic points into consideration before submitting a manuscript to a journal.

• Choose the right journal: focus on relevance and audience interest, and do not simply go for the journal with the highest impact factor;
• Consult the target journal’s instructions to authors regarding length, format and style and stick to them 100%;
• Pay attention to detail and take NOTHING for granted;
• A grammatically/syntactically correct manuscript that follows the instructions to authors to the letter will have a far greater chance of publication than one which is superficially written and full of mistakes;
• Be sure of the correct abstract format (single-paragraph or structured), do not exceed the permitted number of keywords, make certain the title is concise and informative and supply a running head if requested, use double spacing throughout, number the pages as requested, thank everyone that needs thanking in the acknowledgements, declare any eventual conflicts of interest, specify ethics committee approval if required;
• Prepare a magnificently clear, concise, and pertinent cover letter.

When you have checked and double-checked (triple checking is even better) everything, submit your manuscript and cross your fingers. Good luck!