Finally, a medical text that's never out of date
Robert Patterson, MD
CMAJ 1999;160:1613
During my latest household move, I made a decision I had been putting off for more than a decade. I threw out my old medical textbooks. Like the albatross around the Ancient Mariner's neck, these books had followed me around for years, serving no useful purpose.
Harrison's Principles of Internal Medicine, 11th edition. Goodman and Gilman's The Pharmacological Basis of Theurapeutics, 7th edition. Robbin's Basic Pathology, 5th edition. And many more — some with their $100-plus price tags still displayed — were piled high in cardboard boxes, loaded on the back of my truck and tossed into a local landfill. (There was no recycling program where we lived, and the public library refused to take them.) Nearly 200 pounds of scholarly works in all, according to the scale at the dump.
Driving away, it seemed almost sacrilegious to leave those once vital volumes to rot with common household garbage, but those texts had become the last place I would look for current information on diagnosis and treatment. Printed text is the Achilles' heel of medical knowledge, because most of the information is soon passé. Medical publishers are acutely aware of this quandary and have tried various strategies to keep their works contemporary.
One solution is monthly or quarterly updates. I tried this for a while with Scientific American's Care of the Surgical Patient, but soon found that I was paying $100 a year to have unopened packets gather dust on my desk.
The perfect solution would be to have an always current, always accessible source of information at a reasonable price. Printed texts won't do it, and the CD-ROM simply poses the same problem in a different format. The answer lies with the Internet, where everything can be up to date.
One example is Harrison's Online (www.harrisonsonline.com), launched by McGraw-Hill in June 1998 to showcase the 14th edition of Harrison's Principles of Medicine. It includes features not available in the printed version, such as regular updates, links to related Web sites and databases, and new references. This virtual textbook will never be out of date. An individual subscription costs US$89 per year, and institutional rates are available. A free 4-week trial is available.
If you want a whole library at the click of a mouse, try MD Consult (www.mdconsult.com), which offers works from several publishers and agencies. It contains the full text of 37 reference books, with core classics such as the Nelson Textbook of Pediatrics, Cecil's Textbook of Medicine, Rosen's Emergency Medicine and Sabiston's Textbook of Surgery. A search engine lets users query all of the texts simultaneously about a given topic.
MD Consult also has 48 online journals, including staple fare such as Anesthesiology, Annals of Surgery and Chest; subscribers access full-text articles, not just abstracts, and the company boasts that it has articles available before they appear in MEDLINE.
Other available services include a collection of more than 600 clinical practice guidelines and more than 2500 patient-education handouts, which can be personalized and printed with individual instructions and information. There are more than 90 handouts for surgery alone, covering everything from appendicitis to uterine prolapse.
In these days of the informed (and often misinformed) consumer, the site offers a particularly useful feature called "What Patients Are Reading." The popular press is surveyed weekly and hot topics are highlighted. Full-text, peer-reviewed material on each subject is then presented to provide the physician with preemptive answers.
One interesting feature is an analysis of the TV show ER. The previous week's script is summarized, and discussion and articles are presented on the topics raised. Remember when Dr. Ross saved a kid from drowning, but the patient had hypothermia? Links to 4 recent articles on management of hypothermia are provided. Or the Nigerian janitor with erectile dysfunction? That's covered too. MD Consult offers a free 10-day trial; the service costs US$199.95 per year.
These sites have their limitations. Some illustrations took a while to download, and even then were of poor quality. And there's nothing quite like curling up in a comfy chair with a good book — it is much easier than staring at a screen.
However, these 2 services, although far from perfect, are harbingers of a new age. Always up to date, and far cheaper then buying individual textbooks, they signal that the end of ink and paper medical libraries is on the horizon.
These services make it easier on your back, too. You will no longer have to hoist those heavy books into the moving van, or drive them to the dump. — Robert Patterson, robpatterson@attcanada.net, is a general surgeon from Leamington, Ont.
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© 1999 Canadian Medical Association
