BMJ Quality Department, London and
1 City Hospital, Department of Rheumatology, Nottingham, UK
SIR, I have just thrown my laptop out of my office window. Shame the window was closed at the time. It just adds to the bill.
My day had started so well. I had set aside some time to write up a case report, and for once in my busy clinical life it looked like I might get an hour or two without any interruption.
I had a fascinating patient with a very rare variant of Sjögren's syndrome. It was unilateral. My lady had a dry left eye, and wet right one. Furthermore, she had a positive lip biopsy on the left, but not the right (and a rather swollen lip after the double procedure). I was disappointed to find that blood taken from her left arm was just as anti-Ro and La positive as blood from the right, but I thought this made an interesting discussion point.
Of course unilateral Sjögren's syndrome had been described three times before. The last report had been in the Review of Rheumatological Rarities, an occasional periodical found in the darkest depths of departmental library book shelves, and one of the few journals with a negative citation index, because researchers positively avoid referring to it.
All three previous case reports had been on right-sided unilateral Sjögren's, whereas my lady was left-sided, making her absolutely unique in the world of literature. I knew that my colleagues would be literally salivating in anticipation of my report, but hopefully in a bilateral and symmetrical distribution, unlike my patient.
And so I told my secretary to hold all calls. This was the first time I had tried to submit a paper online, and the Internet has always made me a bit nervous. Anything over which I feel no control always induces anxiety, the National Health Service being another example.
So I visited the new BSR website to find the link for submission. It asked for my password, which I had naturally forgotten. Was it Billybremner or Normanhunter (older Leeds United supporters will understand)? So I tried the first, and of course it was the second, but no major problems or delays so far.
The Main Menu has a button called Author Centre which I clicked on, then Submit First Draft of a New Manuscript. Then it asked for Manuscript Type, and on the drop down menu I chose Letter to Editor (Case Report). Piece of cake so farwhat was I worried about?
I needed a running header, so I chose the succinct Left-sided unilateral dry eye and dry mouth with bilateral seropositivity for anti-Ro and anti-La. But it would only take 45 characters or less, so I cut it to the even more succinct Unilateral Sjögren's syndrome. I was then told that I needed to print out the Copyright form and post it, but I needed some sort of Acrobat to do this, and I did not seem to have any type of gymnastic programs on my computer at all, so after a while messing about I decided to leave this until later.
The next page asked for the Institutions of the authors, but it seemed a bit strange asking for the institutions before I had put any of the authors in. The boxes provided seemed very small for my long-winded National Health Service Trust, but I coped (just). On the Authors page I wanted my Specialist Registrar as first author (as she has done most of the work, and I was just typing it up because she is on a protected study dayagain), but I wanted me as the corresponding author. The program just did not seem to accept this complicated arrangement at all, and in the end I put me as first author, and the Specialist Registrar would just have to lump it, especially as I was putting more time into the submitting of the paper than she had done in writing it.
On the next page, the title went well, especially as I could put up to a thousand characters in, which gave me a chance to think of something encyclopaedic but informative, until I realized my title is as long as the case report, so I trimmed it right down. Also I wanted to demonstrate that I know that the o in Sjögren's has a funny little double dotty thing over it, so I visited the Character palate to show how clever I am, but found that there is not a funny little double dotty thing in there, so I forgot it, and decided to show my cleverness in other ways.
It then asked me for an abstract, but I did not really want to write one, as it was only a brief case report. But it would not allow me to progress until finally I gave in and typed I don't want a bloody abstract! which seemed to work like a magic spell, and I proceeded. Eat your heart out, Harry Potter.
At this point the computer froze up totally, so after a few minutes of low level swearing, I went for my famous Ctrl-Alt-Del complex simultaneous finger manoeuvre (perhaps this is the Acrobat it was referring to?). I was then cut off in my prime, and I started again, which I find difficult to tolerate.
Now it was only on the fourth occasion of doing this that I realized that there is a Partially Submitted option so that I did not need to start the manuscript all over again, but by then I had three other versions of the same paper all at different points in their frustrating WWW journey, and now probably on record in cyberspace as testimony to my ineptitude.
Okay. Keep calm. Now it wanted Key Words. So I typed in Sjögren's, which then appeared in the box with the funny little double dotty thing over the o, which only sent me into apoplexy, because why the hell would it not let me do that before? Then Unilateral seemed a key word in my fascinating report, but it would not accept that, no matter how many times I typed it in. Strangely it would not accept What a complete waste of time as a key word either, so I left it at Sjögren's' with the double dotty thing, and moved on.
Now it wanted reviewers. Well I could not think off hand of anybody who is interested in Sjögren's syndrome, but I felt I must put someone in otherwise it may not let me proceed, just like the abstract box that I spent so long over. Then I remembered a nice chap called Simon Something from Birmingham who I met at a BSR dinner, but I had a mental blank over his surname. Then I remembered that I might have imbibed a bit too much wine that night, and might have said something controversial about Birmingham, so I decided that even if I could remember his surname I did not want him as a reviewer. It was therefore a sense of relief when I realized I did not need to allocate reviewers, and I could move on. It then asked me for Excluded Reviewers, and I still could not remember Simon Thingy's surname, so once again I moved on.
I then got to a bewildering page called the File Manager for file uploading. It offered me all sorts of unfathomable types of submissions, so I had a stab at one. I then thanked God that I was not submitting any figures or pictures, as this would probably only have complicated matters further. I did not seem to be getting any manuscript number returned to me, until I realized that hidden away in the right-hand corner is a Save and Continue button. I clicked on it with so much vigour that my mouse squeaked in anguish.
The final page wanted me to preview the paper before it went to reviewers, but it then had the audacity to tell me I needed the gymnastic program again.
At this point I lost any remaining shreds of self-control, and the laptop created a new ventilation point in my office window. Hearing the sound of breaking glass, my secretary came running in to see if I was all right, looked at my face, and just walked out again.
And so I am afraid you will never see my fascinating Unilateral Sjogren's (without the double dotty thing) syndrome in the pages of Rheumatology, and your lives will be less rich as a consequence of this. I will be sending it to the Review of Rheumatological Rarities, which still accepts good old-fashioned paper manuscripts. Few of you will read it, and those who do will positively deny having done so in order for the Review to maintain its proud tradition of a negative citation index.
Top tips for online submissions that do not result in new office air conditioning:
Notes
Correspondence to: N. Atherton
Accepted 5 August 2002