The “rip and tear” days
Back in the 1980s, when owning a personal computer was still mostly the domain of nerds and techies, most physicians depended on printed medical journals. Since it was impractial and unnecessarily expensive to subscribe to them all, it was not unusual to mainly get the official journal of medical societies delivered to the office. The rest were available at the hospital library, of course. Some doctors would rip and tear out key articles from their personal subscriptions, and file them in the office file cabinet for handy reference. As a resident and subspecialty fellow, I would often be handed these to copy and read.
In the early days, physicians would often request that the hospital librarian do a literature search for them, and send back a list of suggested articles. Then the physician would select a few articles for the librarian to retrieve, and then the article would get back to the physician in a day or two, depending on how long it took to locate another library that carried the publication. When personal computers became more mainstream, the more computer-savvy physicians would learn the PUBMED syntax and try their hands at doing medical literature searches themselves. One still had to ask the medical librarian to retrieve the articles, however. Supplemental education would take place at medical conferences and evening meetings that pharmaceutical companies would sponsor. I remember being told by one of my instructors that he didn’t need to attend conferences because he was able to read everything he needed to know in the journals her subscribed to. Good times…
The Information Boom
In my own subspecialty field, which is hematology and medical oncology, there’s a lot to have to keep up with. The specialty of hematology covers diseases of the blood, such as iron metabolism, coagulation (both excessive clotting problems and inadequate clotting leading to excessive bleeding and bruising), hematopoiesis (which basically covers growth of red blood cells, platelets, each subtype of white blood cell), and malignancies of the blood system (such as leukemia). Medical oncology covers cancers of solid organs, like those of the lung, pancreas and colon, etc). Although surgical oncology and radiation oncology are separate disciplines, the medical oncologist has to keep up enough to know how advances in those disciplines will affect the medical management of cancer. We need to stay current with the latest medical therapy, such as the indications of all the newly approved drugs, as well as their pharmacology. What has made this more challenging are the advances in genetics and molecular and cell biology, which has relevance to diagnosis and disease classification, but also has impacted therapy. Advances in computational technology has accelerated progress incredibly in the past few decades, and this had made my field incredibly interesting and rewarding, as so much progress has been made in understanding cancer and hematopoiesis.
I’ve sensed that the amount of information that a competent hematologist/oncologist has to absorb and master has increased since the rip-and-tear era, and my instincts were confirmed. Using the number of articles registered in PubMed in the National Library of Medicine, it is clear that there are more articles published since the 1970s.
And look at how much the cancer literature has increased in the past few decades:
This is especially notable if one focuses just on the literature dealing with the cancer at the level of genetics, protein (genomics, proteomics, metagenomics, etc — now just lumped together as “omics”)
How is the modern physician expected to stay reasonably up to date with all of this? We’ll continue this discussion in my next posting.