November 15, 2004
Knowledge Is Me: Medicine And The Internet
M.J.McKeown, MD, FACOG, FACS
There are few professions where keeping up with current knowledge is as critically important as in the profession of medicine.
The initial learning cycles of college pre-med, medical school, internship and residency are intense and consuming. In those times of the medical professional's life learning is the job.
When the medical professional leaves this intense learning environment and enters into his or her pathway of using this knowledge as an occupation it is an entry into the real world where use of this hard earned knowledge is but part of their life.
Time passes and in the intense and rapidly changing knowledge world of medicine it passes with lightening speed. This passage of time must also include many other things for the medical professional. Life is not just relaxation and then a return into the intense learning of a medical student, intern or resident with a constant intellectual banter of things being learned. Rather new knowledge and experiences intrude into the limited hours of any day, week, month or year. The world of the business of medicine intrudes. The worlds of raising a family, traveling for relaxation, being involved in sports and hobbies, and planning for retirement intrude.
- However the greater problem is that as time passes the hard earned knowledge becomes outmoded. In a profession where an intense effort to learn and apply new knowledge is a large part it is a continuing effort to remain current in this knowledge. Too soon this initial knowledge base slips into being only a little amount in the newer universe of knowledge in the profession. It is then that the cautionary poem of Alexander Pope becomes relevant.
- A little knowledge is a dangerous thing
Drink deep or taste not the Pyrean spring
Outdated knowledge in the work of an auto mechanic may lead to a vehicle that does not run well. Outdated knowledge in the work of a medical care worker may lead to the death or severe impairment of a person. The medical professional is constantly faced with the need to keep up with new knowledge.
How best to fill this need in the physical limit of only 24 hours in a day? Entire, large libraries exist for medical knowledge. There are daily, weekly, monthly and yearly regular publications in all the diverse areas of medicine and its supporting basic sciences. When the usual day of the medical professional begins with an early morning rush to do something that is scheduled to begin early in the day and then continues with episodes of time scheduled to use professional knowledge until late in the day then the time to keep up with this deluge of new information is scarce. The few hours of the end of the day are filled with meals, family, entertainment and other non-medical events. Somewhere in this busy life time must be found for rest and relaxation, and time must be found for business and economic planning.
The usual result of these non professional intrusions into the time of the medical professional is that time to keep up slips and in the long run the vibrant, sharp edge of knowledge in the profession dulls. It is just not physically possible to devote several hours each day to the pursuit of this new knowledge. Therefore journals pile up until they are discarded and information pamphlets sit until discarded. Attempts are made to combine knowledge gathering with recreation by attending meetings or seminars in an area of the knowledge needed.
All of these efforts are an attempt to keep the necessary knowledge base current so the knowledge held does not become ...a dangerous thing. When faced with reading three or four monthly medical journals, reviewing information updates sent from the profession and following the uses and hazards of rapidly changing medications some sort of system is needed. Industries have arisen that add audio tapes and video tapes or CDs into the growing knowledge base. Tapes can be listened to while driving and videos can be watched while physically relaxing. However it is still an extremely difficult job to keep knowledge current.
- A new tool now exists to help in keeping up with this knowledge explosion. It is the Internet. I have used the Internet for several years to find information. There are two major ways to utilize this immense world library of information.
The first is to utilize searching to find the answer to a specific question. There are numerous searching programs or systems that one may use. This can be as simple as using the searching capabilities of the Internet Browser one uses or the use of common searching entities such as Google or Yahoo. One can use more specificity oriented search programs such as PubMed. There are some new search programs in the Medical Information field such as Cluster MedTM with the Vivisimo® clustering engine, or another of the clustering engine search services available for searching medical literature databases.
The second is to subscribe to a service that supplies updated information on topics of one's choice on a regular basis. Several of the medical specialty societies publish newsletters and practice guidelines. Some of the medical journals have online editions one can subscribe to. However the most useful technique in my experience is to join the American Public Health Association. This association has an online edition of its journal and more importantly it has a weekly abstracting service of much of the world's scientific literature. The user goes to the abstracting service and signs up and creates a profile of the search topics desired. The service has two major divisions into medical and nursing information. I have used this abstracting service for several years now and find it an excellent way to keep up. The service sends a weekly e-mail message that contains links to all the positive findings it has obtained for my profile criteria. One can change the profile as one wishes. I have an extensive profile and even so find that it takes at most 2 hours per week to go through the list and review the abstracts I find of most interest. In this fashion one can save the abstracts to a file on the computer using one of several programs available. I use Paperport Pro Office since it can capture part or all of a website and has a filing and indexing and retrieval capability.
There is a third function one can utilize on the Internet and that is taking advantage of many Continuing Medical Education courses that are available. Many of these are associated with specialty medical or nursing groups and have a credit system to keep track of needed CME credits for credentialing and licensing.
- These three functions of the Internet provide an incredible source of continuing new medical care information. These can be accessed from almost anywhere in the world. A medical group could have a portal for these functions in its local network. An individual with a WiFi enabled laptop could access information while enjoying a break at a Parisian café, or while relaxing on the beach at a resort.
The license to practice medicine or an allied health profession carries with it the great responsibility of keeping up with knowledge advances. I have spent years subscribing to many journals and having them bound as volumes. I had an extensive library in my home since I was a rural practitioner. Now all that can be done with digital filing and Internet access which is available 24 hours per day, 365 days per year. I still subscribe to some certain journals of greatest interest but as soon as any journal offers an Internet edition I take that option.
Remember medical information is a rapidly changing area. You must have a system of keeping up and then do it. Piled up, unread journals convey no information and Internet information does not come unless you log on and interact with your sources.
- If in the last few years you haven't discarded a major opinion or acquired a new one, check your pulse. You may be dead.