Learning, Teaching, Publishing: Write to Cure, Share to Grow

“Publish or Perish!”

This imperative phrase seems to govern the current mode of communication and dissemination of scientific knowledge. While it conveys an undeniable truth, the necessity of sharing advancements for science to thrive, interpreting it as an unyielding obligation can lead to counterproductive consequences (1). What should be a natural extension of medical practice—the transmission of knowledge, of achievements and failures, of certainties and doubts—often ends up feeling like a burdensome duty. A task that, due to arbitrary and decontextualized demands, is experienced as a heavy burden, sometimes even dismissed, undervalued, or vilified. Publishing should not be a bureaucratic obligation but rather an inherent expression of the medical spirit. Sharing what we have learned—including our mistakes—is part of the very soul of this discipline. To deny or ignore this is to amputate one of the essential pillars that sustain and drive human progress (2).

Regrettably, in the field of Medicine, scientific publishing has often devolved into a mere metric for evaluating promotions, dismissals, professional mobility, and career development. Universities, major hospitals, and prestigious research institutes have elevated the act, seemingly simple yet profoundly significant, of transmitting knowledge to the status of a gold standard upon which they build their institutional reputation and even their survival. Metrics like number of publications as a first or leading author, impact factor, h-index, i10-index, or total citation counts, originally conceived as objective measurement tools, have become perverse mechanisms for many vocational physicians. Instead of fostering critical thinking, rigorous work, and a passion for knowledge, they have pushed many professionals into a race against time to publish—sometimes at any cost (3). The pendulum has swung so violently that it seems to have lost its axis: the act of publishing, or even attempting to publish, now provokes suspicion, disdain, or outright rejection, even among those most committed to the essence of Medicine.

Though scientific publication remains a crucial channel of communication in medicine, many professionals forgo it or never even consider the attempt. On the one hand, the growing burden of clinical care forces any non-patient-related activities, such as research or scientific writing, into off-hours, weekends, or days off. This is compounded by the scant recognition clinical research typically receives, especially compared to basic research, contributing to a general sense of disinterest or demotivation among clinicians. On the other hand, medical publishing seems increasingly divorced from its core purpose as a forum for knowledge exchange. The widespread use of article processing charges (APCs), even in journals with modest impact, has created a significant financial barrier. Added to this are excessively long editorial response times, often due to the difficulty of finding reviewers willing to take on an unpaid, largely unrecognized task. The rise of predatory journals offering “guaranteed publication” for a fee further undermines trust and enthusiasm among those eager to share their work with the scientific community. Finally, the proliferation of open access publishing, while democratizing access and facilitating dissemination of a high-quality research content, comes with high costs that Thomas Edison’s famous formula for success “1% inspiration and 99% perspiration” has switched to “inspiration, perspiration but, above all, financiation”. Consequently, publishing opportunities are increasingly limited to work resulting from project funding (which is sometimes inaccessible to early-career researchers) or supported or directly financed by the pharmaceutical industry—whose priorities do not always align with those of the medical community at large. This significantly hampers the ability of many professionals, especially those lacking institutional or financial support, to share their results and ideas. The current landscape often resembles a marketplace of knowledge, where visibility is influenced by financial means, leaving others overlooked. This dynamic reinforces the notion that money drives influence, even in science, which ideally should remain impartial and guided by curiosity and the pursuit of truth.

In medical publishing, randomized controlled trials (RCTs) are seen as the gold standard but may be influenced by industry sponsorship, raising concerns about bias. In contrast, independent studies lacking this financial support, such as observational, qualitative, or case reports, often receive less recognition, despite their value, because they fall outside narrow definitions of high-quality evidence. In this context, it is all too often difficult to convince residents, junior colleagues, and even senior physicians of the importance of publishing—beyond the potential impact it may have on their careers and professional development. Everyone has something to contribute, regardless of how significant or modest their findings may seem. Every result, every observation, every well-reasoned reflection deserves to be shared: for the sake of science, for the benefit of patients, and for the growth of the medical community itself (4).

Though this portrayal may seem exaggerated, it closely mirrors the daily reality of countless physicians, especially younger ones, brimming with ambition and a desire to contribute. As a result, more and more voices are rising against what appears to have become a true editorial marketplace, where the dissemination of medical knowledge is contingent upon the ability to pay. A rational solution would be for academic institutions, many of which are affiliated with hospitals, to cover the APC costs for research and clinical work carried out by their staff. After all, the resulting knowledge, institutional prestige, and scientific visibility directly benefit them. At the same time, the growing number of open-access, no-cost repositories offer an attractive alternative. In these spaces, authors can share their manuscripts before formal journal acceptance—freely and openly for any interested reader. These repositories not only disseminate results but also promote critical reading that can correct errors, enrich the work, and open constructive dialogue between authors and readers (5-7). However, these articles frequently have little (or no) academic merit and lack the peer review procedure that impact factor journals have. One potential improvement would be to incorporate expert-reviewed certification systems within these repositories, granting preprints a level of scientific credibility akin to that of traditional journals. And would these reviewers accept to do so voluntarily, without compensation? Many of us already do so for conventional journals…

And yet, the reasons to persist in publishing remain strong and compelling. Teaching and learning are the twin pillars upon which the art of Medicine has turned since its inception: learning from those who came before us, and teaching those who will come after. All too often, we forget that publishing our data, experiences, and results goes far beyond merely transmitting knowledge. It is much more than that: it is the wind that propels others forward, that awakens the desire to know more, to investigate, to confirm or challenge the status quo, to pose new hypotheses and question prevailing paradigms. Sharing what we’ve learned, with all its triumphs and mistakes, also provides solace and perspective in times of failure or disappointment. It reminds us that Medicine cannot solve everything, that we are not infallible, and that a vast landscape of knowledge remains unexplored. Publishing is, at its core, an act of intellectual generosity and a driving force of collective progress. It also connects us to our origins (8,9). We are who we are, and do what we do, because others came before us and did the same. Because we learned from their experiences, their successes, but also, and perhaps especially, from their failures. Because those who preceded us had the courage, the patience, and sometimes even the audacity, to write, to share, to ensure their knowledge transcended their time. Thanks to them, we know more today. We do things better. We care better for our patients. Because someone, once, chose to publish. And just as we benefit from that legacy, we too have a responsibility to leave one behind. Publishing is an act of gratitude and commitment: to those who came before, and to those who will come after. Being able to awaken curiosity in those who follow in our footsteps, by questioning ourselves in our endless process of learning and sharing with them the need to reflect on how to improve what we are doing, is a necessary exercise in humility, highly beneficial for everyone, especially for our patients. As physicians, we must view publishing as key to our identity. But journal editors also have the vital role of ensuring publication integrity by rejecting flawed research and differentiating rigorous work from manipulated studies, particularly under the pressure to publish that may sometimes compromise scientific truth. Moreover, publishing is a way of continuing to learn. Physicians have a duty, not only to others, but to themselves, to remain in constant learning, to resist complacency, to keep searching, understanding, and questioning. The very act of writing, of recording one’s results, of comparing them with those of others, of seeking similarities, differences, and explanations, demands deeper study and understanding. This is one of the great, and often underestimated, benefits of publishing: the learning that occurs throughout the entire process, from facing the blank page to seeing the work in print. Reaching the Ithaca of publication should not make us forget, as the poet wrote, that the important thing is that “the journey be long, full of adventures, full of experiences.” For it is in that journey that the true pleasure of study and learning lies.

We should not publish solely to honor those who came before us, those from whom we learned the art of Medicine, nor just to pass on current knowledge, including both successes and mistakes, to future generations. We must also publish to set an example for those we are training. The role of a mentor is, above all, to inspire by example: to encourage young physicians to engage in the act of publishing, to awaken in them a curiosity for the past, and to help them build the future through their own experiences. Mentors must guide them to learn, and to become capable of teaching others, by sharing their knowledge and efforts through publication.

This duality, teaching while learning, is rooted in the very origins of Medicine, embedded in its foundations, the source of its principles, and the guarantee of its progress since the dawn of history. Publishing, sharing, teaching—these are not ancillary tasks, but essential responsibilities that define the medical profession from its birth. In the earliest versions of the Hippocratic Oath, which we proudly once recited, the duty to transmit knowledge was already enshrined: “To my own sons, the sons of him who has instructed me, and to disciples bound by covenant and oath according to the medical law, I will teach this art. But to no others.” This same idea, transformed yet enduring, appears in the most recent version of the Physician’s Promise, the 2017 Declaration of Geneva: “I will share my medical knowledge for the benefit of the patient and the advancement of healthcare” (10). Because for the physician, the drive to learn more, to understand better, to continue growing intellectually is not an egotistical ambition. It is an essential part of their identity. “Once you stop learning, you start dying,” said Albert Einstein. Nothing conveys this better than the moving Prayer of the Physician by Moses ben Maimon, Maimonides: “Grant me the strength, the joy, and the ambition to learn more every day. For the art is endless, and the human mind can always grow” (11).

Now that access to knowledge is easier than ever, it is paradoxical that discouragement grows among those with the capacity, and the responsibility, to share it. In an age when artificial intelligence offers fast and seemingly accurate answers to any question, though often no more than superficially convincing displays, the very need to publish is being questioned. And precisely for that reason, now more than ever, we must reclaim the true value of scientific publication. Publishing is not only a way to share rigorous, verified knowledge; it is also an expression of our ethical commitment to our profession and to future generations.

Abbreviations

APCs – article processing charges

RCTs – randomized controlled trials

Statements

Conflict of interest: The authors declare no conflicts of interest regarding any aspect of this manuscript
Funding: The authors declare no source of funding for this manuscript

References

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