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Using the Literature


Mark A. Hurt MD

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I “grew up” in medicine from 1978 to 1982, graduating from the University of Missouri-Columbia. During my medical school years, learning consisted of long days of lectures followed by hours of study in the evening; it almost never consisted of using the literature directly. In my experience then, laboratories were also more-or-less “cooked”; it was a lot of work mentally, but it was composed of mostly lecture, demonstration, and textbook-based presentations not on using the literature directly.

My real introduction to the use of the literature occurred in my residency in pathology, from 1982 until 1987. The introduction was from one of my attendings, a man not much older than I, but who had a lot of savvy about solving problems associated with difficult cases.

Whenever we worked together on cases we constantly "dropped" everything and went to the medical library to copy physically countless articles to aid in dealing with the cases. Essentially, whenever a problem in diagnosis occurred that could not be solved by experience or books, we hit the library.

Finding articles occurred in three ways: someone remembered the reference (which was not very often), it was found in a textbook (a more common occurrence), or, finally, it was found by using by using physical books of literature summations. Even though the National Library of Medicine was in the midst of bringing the literature online, most of us then had no computer or did not know how to use one, or both.

We used the literature then, much as today, to provide guidance about cases. Articles served to help provide criteria for a diagnosis, to expand the differential diagnosis, and to provide historical context. I was amazed at how much primary information was available, how useful it was, but how time consuming it was to extract. Writing literature then was also much more difficult, as it was hand or type-written in physical media, and the review process was much slower.

Fast-forward 25 years.

Finding relevant literature today is a snap. Electronic tables of contents are available in one's e-mail in-box as free subscriptions. PDF's of preferred articles are easy to download and keep on one's computer or tablet or phone, and historical literature is coming online at an ever increasing rate.

Here are my suggestions about using literature today:[list]

[*]Subscribe to electronic tables of contents of journals of your interest. Keep them. Use them. You never know when the next case you see in practice might trigger a memory of a recent title. If so, you are 99% on your way to making a diagnosis you new nothing about last week.

[*]When you encounter cases in your practice that require literature support, create a special computer folder of articles that helped you solve a real world problem. I call this folder a “useful articles” folder, because it consists of articles that address specific questions that need answering; often these are articles that are in constant use because they address problems that arise frequently.

[*]Keep the PDF's you download and make sure you can find them in a logical manner. If you prepare lectures, primary literature is crucial today, as it is easy to fill PowerPoint presentations with relevant information from them in addition to your own source material. The audience loves to see the literature-based source-material, so don't make your work harder than it needs to be. If you write articles, PDF's allow for easy organization to develop the historical perspective.

[/list]
Happy literature hunting. After all, this is not the 1980's!
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Dr. Phillip McKee

Posted

An excellent blog. I have only two comments to make and that is[b][u] do not believe everything that you read in the literature.[/u][/b] So much rubbish seems to get published and it can sometimes be quite difficult sorting the wheat from the chaff. The other is never just read the abstract, always read the entire article.
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Mark A. Hurt MD

Posted

Great point, Phillip. It is critical to look at the data in these articles as well as the specific language in them.
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