1.Philosophy. The editor of a journal, in conjunction with the publisher, chooses the philosophical direction of the publication. For example, in my capacity as editor of AJM, I must decide whether issues will contain only clinical material or whether basic science articles are to be published as well. Moreover, how many of the articles in AJM will be didactic and how many will be original research communications?
2.Screening. The most common task that I face each day as editor of AJM is the screening of manuscripts submitted for possible publication. Some are rejected without further review because of redundancy with recent material in AJM, and some are turned down because their quality is not sufficient to merit further attention. Sometimes, rejection of a manuscript is the result of the nature of the article, that is, it is deemed too specialized for AJM readership.
3.Final decisions. Once peer review has been completed by associate editors or peer reviewers, I have to determine whether their decisions to accept, reject, or revise a prospective manuscript are correct. I usually, but not universally, concur with their conclusions. If I disagree, then I communicate with the associate editor responsible for the recommendation so that we can arrive at a final unified decision.
4.Responses. Author complaints, suggestions for material to be published in AJM, and questions concerning the way AJM functions require a reply from me. I may agree with criticisms or favor recommended submission topics for review articles or didactic material. If I disagree with a complaint or suggestion, I try to explain to the correspondent why a particular decision was made by the editorial board of AJM or why the proposed topic is not likely to get a high priority for publication in AJM.
5.Ethical policies. On occasion, the editor is asked to make policy decisions concerning ethical issues. Possible plagiarism, multiple submission of the same material to other journals, or disagreements related to various aspects of authorship would be relevant examples.
6.Administrative duties. AJM, like all publications, is a business. As such, the editor is required to perform a range of administrative functions, such as financial assessments, hiring and termination, rental of space and equipment, and management of insurance issues. I often prefer to make these decisions in conjunction with the managing editor of AJM, Pamela J. Powers, and when necessary, with the help of our executive publisher in New York City, Pamela Poppalardo.
7.Technical features. The editor participates in numerous procedures essential to publication of a medical journal. Primary among these are the makeup and layout of each issue of AJM. Factors that must be considered in this area include the quality and size of figures and tables, the color schemes for AJM cover and inserts, and the proofreading and approval of summaries associated with each clinical investigation article.
8.Strategic planning. Journal publishing is a competitive enterprise; editors and publishers are anxious to have their journals recognized for their excellence. Many times during the year, the executive publisher and I discuss ways to improve AJM and ensure an ever-increasing readership. Every second year, the associate editors, the subspecialty editors, and the executive publishers gather for a 2-day retreat to discuss past successes and failures and to plan future directions for AJM. Several years ago, Pam Powers and I initiated a blog for AJM. This continues to be a popular site for communication concerning material that we publish in AJM.
9.Rendering of opinions. Frequently, the publisher seeks my expert opinion on an assortment of medical subjects. These usually entail specific elements of medical professionalism. I also handle questions that Elsevier, the publisher and owner of AJM, might have regarding the best professional approaches for AJM or broader issues pertaining to other journals that Elsevier already publishes or might acquire.
10.Communication. I believe that this is the most important component of my position as editor of AJM. I strive for effective, clear, and concise verbal and written communication with the staff, publisher, and readership of AJM. I make certain that each issue of AJM includes an editorial I have written—this current piece offers an example. Because the purpose of AJM is to successfully communicate with our readers, the ability to fulfill this duty is the most important skill required of an editor.
11.Lobbying. This facet of the job requires the editor to encourage prospective authors to submit excellent material for possible publication. Furthermore, the editor must motivate physicians to read, ponder, and implement the information provided in AJM. Physicians can benefit when they put what they have learned from the articles into practice, but so can other healthcare workers, patients, and health-policy makers. I constantly ask colleagues and associates to consider AJM when they are about to submit a manuscript for consideration.
The multiple responsibilities of a medical journal's editor only superficially resemble those of the original Roman editors who sponsored and planned spectacles for the Colosseum. The Roman editor, who was frequently the emperor, sought to entertain the populace and thereby curry favor. Editors of medical journals such as 
