Consider a physician at the point of interaction with a patient. After taking the history and performing the physical examination, and ordering the necessary lab tests and imaging studies, the physician might be ready to recommend treatment. There are many factors that go into his/her decision-making, and although I will discuss more of these later, for this discussion I will focus on how the physician feels confident in recommending the optimal therapy, based not only on individual factors pertinent to the patient, but drawing upon the knowledge base built up after many hours of learning the basics and dedicated inculcation of new advances. These are part of the decision-making that goes into formulating a treatment plan.
How physicians stay updated on latest developments is likely personal style. Those involved in research or who are narrowly specialized generally keep abreast of the latest developments by reading specialty journals in a focused manner. Specialists also often serve as a referee for specialty journals, reviewing submitted manuscripts for publication (since they often review and summarize the field of concern). They also attend focused research meetings, which offer the opportunity to interact with peers, and sometimes learn the scuttlebutt of what successes have been seen in some researcher’s lab, which
For the general clinician, absorbed in patient care, journal reading is the best way of learning of latest developments. This is, of course, easier said than done. With a busy clinic schedule, with time taken up by navigating through the electronic record system (which, at least in the system I used, was plagued with updates which mainly served to re-arrange the interface that one grew familiar with, forcing the physician to develop new workflows and keystroke patterns until the next update). Then there’s family time, and time to just rest and recharge. Trying to find dedicated time to “enter the zone” and study journals is very challenging.
There have been some efforts to lower the barrier to resistance to this effort, such as to email physicians the table of contents of a journal, in order to make it easy to click and browse articles. However, not all journals provide this service, and I’ve found that locating all of the the desired emails when it’s time to study is not always easy.
My journal newspaper
I have found it easier to browse a “newspaper” instead. In my field of hematology and medical oncology, I have compiled a newspaper containing assembled links from all the journals that I typically browse to stay abreast. It has been much easier to read all the latest articles this way. You can check it out at
Using a reference manager is key
Being able to peruse the journal contents is only half the task. One needs to be able to store these in a retrievable manner, akin to the file cabinets that were used in bygone times. It is vital to have a system that allows for organized and quick retrieval of reference material. Some have maintained a system of PDF files in a folder, but this requires finding the link to the PDF, downloading the file, and storing it in the appropriate folder. To save time and accomplish this task more efficiently, I have recommended to residents the use of a good reference manager. I have found Zotero system to be easy to use and conveninent. One can install a browser extension that when clicked, can download the article and save it in the appropriate folder for later retrieval. This system does require a reasonably affordable cost in storage, however, but it is definitely worth the investment.
But having a digital file cabinet of references does not alone guarantee that a patient is going to get the latest and proper treatment from his/her physician. I will discuss more of this in my next posting.