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Devil in the detail: citation accuracy

Zalcberg, Dave; Ben-Menachem, Erez

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European Journal of Anaesthesiology: March 2013 - Volume 30 - Issue 3 - p 129
doi: 10.1097/EJA.0b013e32835aa527


We read with great interest the recent review by Rama-Maceiras et al.1 entitled ‘Job satisfaction, stress and burnout in anaesthesia: relevant topics for anaesthesiologists and healthcare managers’ and the accompanying editorial by Pirjo Lindfors.2 The review article was both insightful and informative, addressing the important issue of occupational stress and burnout, and the subsequent implications on the healthcare system. The authors highlight the negative individual and organisational effects of job dissatisfaction and burnout and offer strategies that may improve outcomes.

However, we noticed that when discussing burnout, it was stated ‘There is an associated trend to quit or decrease work activity…’ and the authors choose to cite ‘Burnout and the relative value of dopamine’ by Cassella3 as their reference for this statement. Although, in itself, this is a well written article, it is a creative writing piece. The preamble to this article states, ‘…these pages will be set aside to share reflections from the artistic perspective, Mind-to-Mind is a place where researched footnotes matter less than emotional footprints and personal values matter more than statistical P values.’

We believe this highlights a wider issue with regard to the accuracy of referencing, and referencing within the context of the original source. There have been many articles written about the potential deleterious effects of inaccurate referencing with research articles and grant proposals, and Steven Greenberg4 eloquently demonstrated how citation distortions can result in subsequent bias, amplification and invention and that ultimately ‘…citation can be used to generate information cascades resulting in unfounded authority of claims.’

In an editorial discussing Greenberg's work, Fergusson5 claims that, ‘Improper citation is not a benign practice; adequate and accurate citation is a necessity of scientifically and methodologically sound research. Rather than treating citation errors in a particular journal article as isolated incidents, we must appreciate that such errors can be replicated in further articles and, therefore, cause considerable damage over time.’

Although we are sure the authors did not intentionally cite a creative writing piece as evidence, or in any way that could cause confusion to the readership, we do believe that inappropriate referencing has the potential to detract from the importance of the content of this or any other article. We believe all authors need to be mindful of accurately referencing literature in its correct context. Similarly, readers should not only critically appraise the content and claims made within the academic literature, but also those references used to support such claims. We still congratulate Rama-Maceiras et al. on raising awareness of stress and burnout in the anaesthesia workforce.


Assistance with the letter: none declared.

Financial support and sponsorship: none declared.

Conflicts of interest: none declared.


1. Rama-Maceiras P, Parente S, Kranke P. Job satisfaction, stress and burnout in anaesthesia: relevant topics for anaesthesiologists and healthcare managers? Eur J Anaesthesiol 2012; 29:311–319.
2. Lindfors P. Reducing stress and enhancing well being at work: are we looking at the right indicators? Eur J Anaesthesiol 2012; 29:309–310.
3. Cassella CW. Burnout and the relative value of dopamine. Anesthesiology 2011; 114:213–217.
4. Greenberg SA. How citation distortions create unfounded authority: analysis of a citation network. BMJ 2009; 339:b2680.
5. Fergusson D. Inappropriate referencing in research. BMJ 2009; 339:b2049.
© 2013 European Society of Anaesthesiology