Authors face a variety of obstacles to publication after submitting their papers to scientific journals. The first of these derives from the meaning of the word 'fact' and the phrase 'clinical fact'. A second arises from the ambiguous nature of the analysing instrument used to accumulate clinical data. A third is a result of the different perspectives used by analysts to inform their observational instruments. The fourth impediment is a cognitive one: there are often serious lapses in logical operations involving predicate identifications and hasty generalisations. The fifth is a result of an awkward contemporary glossary, a glossary that extends ambiguities rather than relieves them. Finally, there is an obstacle that derives from style.