Perspectives on Communications in Medicine, 1978 [Unfinished; noted as a draft of a speech for Africa]
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perspectives on communications in medicine martin m cummings m.d the first director of the national library of medicine dr john shaw billings in an address given before the international medical congress in london in 1881 pointed out that the medical literature which is the common property of the educated physicians of the world forms the international bond of the medical profession of all civilized countries through this literature physicians from all parts of the world meet not as strangers but as friends having common interests medical education research and practice depend upon communications for transfer or diffusion of information a wide variety of techniques are employed in these processes ranging from speech and writing to modern audiovisual and computer programs the professional competence of physicians and other health care personnel depends on their willingness to seek and utilize infor mation available in many forms and formats the rich abundance of medical knowledge which is available through academic health centers professional societies libraries and meetings and conferences often overwhelms rather than enlightens the practitioner he wants readily available facts directly applicable to problem solving knowledge and information sources however frequently provide unnecessary theoretical and conceptual background along with practical information 1 billings j.s our medical literature in selected papers of j.s billings medical library association baltimore waverly press 1965 p 116

Page  2 2 the complete physician learns and continues to keep abreast of advances in medicine by maintaining contact with those who create medical knowledge he uses selectively all of the modalities of information available to him however few physicians in fact have the time or energy to sustain such relationships broadly and they develop idiosyncratic patterns of seeking information a few regrettably make no serious effort to upgrade their knowledge and practice obsolescent medicine others choose to acquire information from the salesmen and advertising of the pharmaceutical industry still others depend on the opinions and pronouncements of their colleagues and consultants some attempt to review the content of a few journals while others attend meetings and conferences or postgraduate courses to gather new information the scholarly physician uses the library as an additional resource for medical information in depth most physicians use some mix of these information resources and this is probably all that we can expect from busy hard-pressed practitioners as in billings time it is still true that periodicals and journals contain the most recent and original contributions of the medical profession little has changed except the volume of this literature which has increased twenty-fold during the past century for each journal which has ceased publication three new ones have appeared bringing the total in print today to more than 20,000 titles sixty-nine percent of the active current periodicals were established in the last 25 years index medicus has increased in

Page  3 3 size from some 20000 articles indexed in 1879 to more than 250000 last year also during this century the proportion of articles published in english increased from 42 percent to 66 percent thus english has become the principal language of medical publications the current biomedical literature is contained in 20000 journal titles of which 6000 are considered to be important that is to contain original substantive reports medical experts who review these products for the national library of medicine judge that 2500 journals and 50 to 100 new books contain most of the original scientific and clinical information directly relevant to the progress of medicine it is clear that no physician can be expected to review and keep abreast of the information contained in this large corpus of literature it is doubtful that anyone could read all of these publications even if he did nothing else 24 hours a day 7 days a week how then can we be certain that a physician at least knows that such information is available when it is needed selected pertinent portions of the literature can be identified and accessed through the use of indexing and abstracting services because most significant articles published in major medical journals have been reviewed and indexed or classified by subject and author one can search for information which relates to the interest of the inquirer this can be done through printed indexes and catalogs such as index medicus and current catalog or

Page  4 4 through the use of on-line computer systems such as medline and catline access to these and many other data bases is now easily obtained through the active modern medical library the utilization of this information resource however still depends on the initiative of the physician the bewildering array of information sources referred to earlier requires not only bibliographic control for identification but also calls for continued technological advances for access and dissemination even in nations which have an abundance of medical libraries there remain problems of time distance and expense for users to acquire the materials for study and review new communications technologies may provide us with the means to transport the information to the user rather than requiring the user to travel to the information but we must also learn to make better use of existing technologies which are widely available one of the most successful programs which uses the telephone as a means of providing medical information to health professionals is a state-wide system operated by the university of alabama medical center called mist medical information service via telephone it allows any physician in alabama to dial a toll free number and be in immediate communication with a wide array of specialists during the seven years of its existence its use has grown tremendously a recent analysis of the cost benefits reveals that 37000 in travel expenses was saved in one month by providing information to primary care

Page  5 5 physicians thus reducing the number of patients moved to the university hospital moreover it is clear that the ultimate beneficiary is the patient who has access to a level of consultation which might not otherwise be possible or forthcoming recently dr william n hubbard defined the role of a medical library in broad conceptual terms the role of a medical library is to improve the utilization of health-related scientific knowledge the role of the medical library is realized as it acts as translator and communicator between those who produce and those who utilize scientific knowledge the variety and magnitude of the possible mechanisms by which a library can serve its role transmutes that function itself into a question of the logic of choices of possible mechanisms of action one extreme interpretation of that role asserts that in any health-related matter there should be a single point of entry into the total store of human knowledge that would conveniently and immediately make available to the inquirer all the information useful to him and none that is redundant it is now within the technical capacity of medical libraries to respond to such a concept but any such response should be made with the realization that the pattern of organizational and financial structures that support health-related activities does not naturally support such a coordinate function dollar m.d and klapper m.s the economic benefits of mist a preliminary analysis ala j med sci 14 103-107 no.1 1977 3 w n hubbard jr the role of a medical library in epilogue essays at the bicentennial of medicine in the united states bethesda md dhew publication no nih 77-1176 1976 p 9

Page  6 6 dr hubbard went on to say that the medical library of the future will be similar to a university without walls this concept is based upon the high value placed on individualization of information transfer the pattern of accessibility and response made possible by new information transfer systems that are designed to deal with real problems in real time the pressures generated by the threat of peer review relicensure and recertification examinations malpractice suits and congressional inquiries are now forcing practitioners in the united states to reexamine their continuing education acitivites self-evaluation tests and professional society reviews have been developed as mechanisms through which the physician can determine what he needs to learn arrangements to fill these knowledge deficits however still depend upon the physicians own initiative some seek to learn where to find information when it is needed while others resort to the exercise of attempting to memorize new information as it becomes available in my view the former approach is more reasonable and practicable since information memorized today may be obsolescent tomorrow i recognize of course that every successful practitioner of any art must always have a great deal of specialized information or skills at his command without having to look it up finally i wish to comment on the importance of modern computer based information services which if used properly support medical education research and practice access to these systems may serve as an alerting service it may also be useful in the selection of key articles or reviews of subjects of special interest or importance to the physician