Since the earliest days of medical school, I learned fast to bring my computer wherever I went. Not only did my laptop function as my personal entertainment center through the dullest parts of lectures, but it also proved to be a source of instantaneous and infinite medical knowledge via the click of a mouse. Four years later and here I am, one hand on the shoulder of patients whilst listening to their afflictions with the other hand already reaching for my iPhone, ready to pull up necessary gaps of my medical knowledge.
Is this a proper way to train as a physician? Surely I'm not the only doctor to sneak out of the patient room like a cheating lover to softly glance at a guideline on UpToDate® or straight up ogle a dosing regimen on Epocrates®. Yet, this is how many of us Gen Y physicians survived medical school and how many of us will continue to claw our way through residency and beyond.
It's a fact: Your doctors today do not know everything about your health. But we sure as hell have perfected the art of finding out exactly what we need to provide the right kind of care for you. So the question remains: Are the new physicians of the world the adventurers of medical knowledge, paving paths through the vast and ever-widening available online literature? Or are we the lazy college grads living in our mothers' basements, completely functional yet totally okay with someone else doing all the housework?
To Infinity and Beyond
Every time I am on the phone talking shop with the real Dr. Secemsky (my father), he never hesitates to counter my complaints about residency with unsolicited anecdotes of what it was like during his training. Back in those days (years? decades?) the only websites around were in unswept cellars and children's books about Charlotte. (And yes, they had to walk three miles in the snow to work!) In all honesty, medical training back then sounded awful, not only because of the long hours, but also because of the lack of available medical resources to rely on during their daily grind. In the 1970s and 80s, students and physicians alike had to trek to the nearest library between patient visits in order to find a relevant journal article or dig up treatment guidelines for uncommon conditions. Now that there are more computers in hospitals than there are patients, all one needs to do is take a few steps to the nearest terminal and, through a variety of popular medical search engines, find answers to most any clinical questions.
PubMed®, created in 1996, was one of the first big players in the field of online medical resources. It functions as a subscription medical database that provides full access to most life sciences and biomedical journal articles dating back more than two decades. Thankfully, the creation of this trove of online knowledge obliterated the painful activity of searching through countless paperback journals for the right issue and specific study. Another behemoth, UpToDate®, took things a step farther by becoming the largest online evidence-based medical textbook. Written by physicians and covering almost every angle of clinical medicine, it quickly replaced the 30-pound textbooks that even I (gasp) had to lug around the hospital like a baby in a sling. Can't wait to tell my kids about that one.
Not only has medical literature become ever more accessible to physicians today, but it is also becoming much more individually tailored to their specific needs. Take Docphin® for example: Created last year by a resident from UPenn, it functions as a free online platform for physicians to share and discuss research from hundreds of specialty-specific journals.
Losing the Physician's Brain
So what's the problem, the reader might ask? In today's world, where the efficiency of a physician is more important than ever (think of the estimated 30 million more insured Americans flooding clinics and hospitals around the country in the next few years), one might say that online medical resources are the silver lining to our otherwise stormy health care system. However, critics of such large and readily-available online databases are right to question the effects that these sources of medical knowledge are having on physicians' ability to critically think on their own.
One of the first phrases that I've readily picked up as a new resident is "forgetting your intern brain." This essentially involves an intern misplacing his notes in a nursing station, only to become completely useless as a physician until said notes were recovered. I can't tell you how many times I've lost my intern brain, only that it's a shock that I still have the capacity to write this opinion piece. In a similar vein, one might rightfully question if newly-trained doctors are as dependent on online resources.
What if the Internet shuts down in our hospitals? Are physicians today prepared to calculate the fractional excretion of sodium without their medical calculator app or recall the recommendations of landmark articles without stepping out to do a quick online search? In fear of respecting my father in public, his generation of physicians was certainly more readily-equipped to do such mental math. This is simply due to the fact that medical resources were scarcer and less efficient back then, prompting a greater need to commit such knowledge to long-term memory. Thus, it is more than probable that physicians today, not excluding myself, may be too dependent on online medical resources, to the point where it hinders our potential to become more autonomously knowledgeable as practitioners. It just might be that this generation of new doctors has permanently lost our physician brains.
Take Home Point
Online medical resources are certainly not the next fad in health care. They are likely to become a permanent fixture in the way we as doctors practice medicine. Therefore, it is the responsibility of practicing physicians in every generation to not only learn how to navigate these online tools but also to spend enough time absorbing as much of this vast medical knowledge as possible in order to be able to critically think on their own. Although easier said than done, it's better for the patient to have their doctor's brain inside the exam room than left at the computer.
Disclosure: Dr. Secemsky is a member of the Docphin ambassador network.
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The value of Docphin seems to be that it gets younger doctors in the habit of reading; at my hospital, I've partnered with a faculty physician to create a periodic newsletter that we send to all internal medicine residents. This is in contrast to their Journal Club program, which also promotes reading but with an emphasis on critical analysis, including statistical analysis. Our residents really seem to love the newsletter, and I've realized that it's the opposite of the high-tech approach -- it's a high-touch approach!
Lastly, I would just point out that PubMed is a free service of the National Library of Medicine, funded by U.S. taxpayers -- your tax dollars at work for the benefit of the online medical community worldwide!
-Lydia W. in Philadelphia
Some nuances to add to my earlier comment:
Our newsletter is both high-touch AND high-tech; each issue is born digital (I use Dreamweaver software), full of hyperlinks, delivered by e-mail, and archived on our intranet. Readers might print things out on their end, but it's pretty high-tech until then.
For commonly-seen ailments, it's most efficient for you to have memorized the latest dosages/guidelines/&c; for less commonly-seen things, you'll probably have do a little sleuthing. As a patient, I don't care whether my doctor consults with her colleague (old-fashioned style) or looks it up in DynaMed or UpToDate (although I'd prefer she used DynaMed!) -- the important thing is that I end up with the most current, evidence-based treatment possible. The problem with her print PDR is that it's not as current as her smartest colleague's knowledge or the digital resource, both of which could've been updated yesterday with a new FDA black box warning.
Use the best resources available to you, just as your predecessors did (or, the best of them did), but keep in mind that in low-tech settings -- or during disasters in high-tech settings -- the best available resource may be what's inside your cranium. Luckily for your patients, you seem well on your way to developing a fine "doctor's brain".
-Lydia