08 January 2011

Medical Reading

Now that I am out of medical school and residency, keeping up with my reading and study has become a major goal for me. I usually keep a weekly log of articles and book chapters that I have completed. For instance, I have been reviewing the medical treatment of esophageal disorders today. In addition to my last evening's read of the appropriate chapter in the latest edition of Sabiston's, I tend to keep my medical reading as up to date as I can. While Sabiston's is a great general surgery resource, I do find that reading in Harrison's Principles of Internal Medicine provides an in-depth review of physiology and pharmacology. I also tend to read from 20 to 30 journal weekly in addition to my textbook reading. The question would be, "Why do all of this work now that I am out of school?"

As a professor, I need to keep ahead of the textbooks on many topics. Human beings are incredibly complex entities that regularly present their physicians with diagnostic dilemmas. I have found over the years, that my diagnostic skills have greatly improved with both experience and reading. I find myself looking forward to my time with the "pulps of medicine" as being able to constantly learn and assimilate information is crucial to me in navigating those diagnostic dilemmas. There is always some new theory or different way of looking at a disease entity that I find interesting. Since medical school, I could never get enough of New England Journal of Medicine or Nature Medicine as a student. One of my internal medicine professors encouraged us to read journal (as much as we could between coursework study) in order to develop an early grasp of the language of medicine. It turns out that old habits die slowly for me which is a good thing in terms of journal reading.

Most weeks I will have an undergraduate student or two drop by my office to discuss entry into medical school. One of the first things that I encourage for these folks (not New England Journal of Medicine or Nature Medicine; these are better utilized in medical school) but just to read a variety of types of literature (scientific and non-scientific) from a scholarly perspective. Regular critical reading encourages regular critical thinking which is integral to the practice of good medicine. There will be plenty of opportunities to read medical journals in medical schools (great libraries online and on site) but training your mind to handle different types of writing is a good skill to have as an undergraduate. Most undergraduate college libraries have a wealth of well-written scholarly journals that are great to keep up with.

In addition to reading the scholarly journals, pick up a couple of newspapers (New York Times, Richmond Times-Dispatch, Wall Street Journal) and read the editorial pages. Most editorials are short and very well-written in the three newspapers that I have listed in the last sentence. The New York Times and Richmond Times-Dispatch are both published online for easy access. In addition to the editorials, compare how major front-page news stories are handled. Do both papers have the same stories "above the fold" on the front page? Look at your local newspaper, even if are from a smaller locale such as the Falls Church News-Press or the Marin Independent Journal to see how your local events are covered and discussed. The Marin Independent Journal is one of my favorite reads along with the San Francisco Chronicle as both newspapers provide a welcome change for my brain as I move through my weekly medical journal reading.

Being able to read efficiently and comprehensively is a habit that can be honed by regular practice. Just as walking/jogging on the treadmill or listening to my favorite recording artist is welcome change from my daily work routine, my journal and newspaper reading are welcome habits that I enjoy. It's great to utilize the social media such as tweeting and blogging but the best reads are still those that explore a subject (medical or otherwise) from a comprehensive standpoint. You won't get a comprehensive view of a topic from Twitter but you will get great opinions from that website. Blogs are also great for both opinion and information but force yourself to think creatively and comprehensively even when you are reading your scholarly journals.

Many people will say that they just don't have the time to do much reading outside of work. I generally find that I can make use of my "down time" when I am waiting for a patient or something else. I always have an article or two in my lab coat pocket for those stray minutes. I do find that I have to "mark my progress" so that I am not reading the same sections over and over. I have a list of my regular journals and then I have the journals that I scan sporadically for a change of pace. Most of the time, if a subject is getting loads of press in one journal, it's getting mention is many journals. Knowing what's "hot" is just one of the great aspects of regular journal reading. I also find that when the Nobel Prize winners are announced, I generally have some knowledge of their work from my journal reading.

If one keeps in mind that it takes approximately 2 to 5 years for something to become established enough in the journals to become published in a textbook, then the utility of regular medical journal reading for the physician becomes important. While I make my yearly read of Sabiston's, Cameron and Greenfield, I find that my journal reading enriches those topics that I encounter in the text. Regular reading when I was a resident, made study for the "in-service" exams much easier than some of my colleagues would find. Residency is the ultimate learning experience because one is learning both from a practical standpoint and from a scholarly standpoint which is the only time in training that you will have both types of learning so intimately connected. Journal reading during residency is an integral part of the process.

If you hang around me for any length of time, you will find that I have a journal article or book chapter in my hand/pocket most of the time. Over the holidays when I was traveling thorough some of the wonderful airports of New York and Chicago, I was able to get my journal and textbook reading off to a good start. Since there is so much waiting involved with air travel, having a good read is a necessity. I keep my Amazon Kindle jammed with .pdf copies of articles and chapters for airplane reading in addition to my paper copies of one or two things (they tell you to turn off all electronics until 10,000 feet). In short, I always have something to read.

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