With noble intention, a tower of worthy journals rises in a corner of my office. The information they contain is doomed to forever be trapped within their plastic envelopes. Whenever the tower achieves neurosurgical height, like a guilty developer I demolish it in the dead of night, disposing of potential life-saving gems of heritage value.
Sound familiar? It has been estimated that if a more conscientious GP than myself read two journals a week, by the end of 12 months he or she would be eight years behind in their required reading.
It is common to feel overwhelmed by the waves of information flowing over us, and by the incessant demands on our time. This column each month will explore ways to claim back our time. After all, as Jeff Davidson says, money comes and goes, but time just goes, whether you?re having fun or not.
Fear not. There are ways to control the flow. The problem is not new, but is increasing.
Sir Arthur Conan Doyle, the creator of Sherlock Holmes, was himself a GP, and therefore familiar with the problem.
Dr Watson was surprised that Sherlock Holmes did not know that the earth went around the sun. On being told, Holmes decided to immediately forget the fact.
“Now the skilled workman is very careful indeed as to what he takes into his brain attic. He will have nothing but the tools which may help him in doing his work, but of these he has a large assortment and all in the most perfect order…”
“Depend upon it there comes a time when for every addition of knowledge you forgot something that you knew before. It is of the highest importance, therefore, not to have useless facts elbowing out the useful ones…”
A means of classifying the relevance and validity of the medical literature was proposed by Slawson and Shaughnessy and further defined as follows by Dr Mark Ebell.
The information that we need to know as GPs must be patient orientated, evidence based, and to matter – we need POEMS.
The term Poem refers to the kind of article that
- addresses a clinical problem that primary care physicians will encounter in their practice
- measures outcomes that we and our patients care about: symptoms, morbidity, quality of life, and mortality.
- has the potential to change our practice if the results are valid and applicable.
An example of a POEM is a randomized controlled trial that demonstrates that not patching corneal abrasions leads to less pain and faster healing than patching. It is a common problem, an outcome that is important to our patients (they get better quicker with less inconvenience), and is a change from our current practice.
On the other hand, there are DOES – disease orientated evidence, much beloved of pharmaceutical reps. These findings are often premature and incomplete – we need to know whether patients have less fractures, or their nocturia improves, or their quality of life is better – not if they have decreased urinary calcium excretion, or their urinary flow rate is better, or Californian rats show tumour slowing.
The bad news is that a survey of medical literature has shown that 97% of articles are DOES. The good news is therefore that we only have to read those 3% of articles that are scientifically valid, about conditions that we see in primary practice, with worthwhile outcomes, and would lead to a change in our current practice – the POEMS.
Receiving reams of irrelevant information is more than just inconvenient .It wastes our most precious resource (our time). It contributes to a feeling of being overwhelmed. It gives us a sense of guilt about the adequacy of our continuing medical education. It also dangerously distracts us from learning that which we have a duty to know.
So, what steps can we take to improve our information management.
1) whenever you receive a ?pseudo-journal? – pharmaceutical company material disguised as a journal, ask your secretary to fax or write a form letter to the editor requesting you be removed from their mailing list. If they persist, mark the envelope ?Return to Sender? and post it back at their expense.
2) review the journals that you subscribe to or receive – cancel any that haven?t been opened in the last 3 issues, however worthy.
3) consider subscribing to a POEMS clipping service – maybe Infopoems InfoPointer at www.infopoems.com, who review 90 journals monthly and email a summary of any POEMS found ($US 129 annually)
An example InfoPoem -http://www.infopoems.com/InfoPointerSample/Synopses/EB03200001.htm
Are oral antihistamines an effective treatment for atopic dermatitis?
There is no evidence that anti-histamines reduce pruritis in patients with atopic dermatitis. They may have a benefit because of their soporofic effects. If you prescribe an anti-histamine, use an older, sedating agent and recommend it for use at bedtime. Heck, maybe we should have them read some journal articles! There is no evidence to support the use of expensive non-sedating agents for this condition. (ME)
4) schedule some time to skim through any journals that make the cut – if they keep piling up, cancel them.
5) only look at any articles that are relevant to your practice,are scientifically valid and have appropriate outcomes. Reject all DOES.
if the article fulfills 5) and would change your current practice, ie if the article is a POEM
6) circle the relevant information in the abstract.
and most importantly
7) share the knowledge – have your secretary copy it for your partners – if they then follow your example you are leveraging your time. Also ask your secretary to fax the clipping to the MedAu POEMS service at 02 66223185 – we will collect and assess all Poems we receive, summarise those that are valid and relevant, and make them available online, via email, and as a regular newsletter – you can then benefit from the efforts of many peers. Membership is free. Continue to contribute.
8) file the clipping – more on filing in a later column.
9) vigorously discard the left over journal, with its DOES, crappy anecdotes, columns, endless advertisements and other distractions.
Sherlock Holmes went on to tell Watson
“A man should keep his little brain attic stocked with all the furniture that he is likely to use, and the rest he can put away in the lumber-room of his library where he can get it if he wants it.”
We will talk further about maintaining the lumber-room of the library in future columns
|References and further reading|
Mark Ebell, Department of Family Practice ,Michigan State University,
An Introduction to Information Mastery
Slawson DC, Shaughnessy AF
Obtaining useful information from expert based sources.
BMJ (England), Mar 29 1997, 314(7085) p947-9
Eye patches for corneal abrasions
Idiot’s Guide to Time Management
- Time is our most valuable resource.
- Seek out POEMS – patient orientated evidence that matters.
- Reject all other information and cancel unsolicited and irrelevant journals.
- Share the knowledge you gain.