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MEDLIB-L  August 2001, Week 3

MEDLIB-L August 2001, Week 3

Subject:

Chat: In Praise of Books - longish

From:

"Wentz, Reinhard" <[log in to unmask]>

Reply-To:

Wentz, Reinhard

Date:

Wed, 15 Aug 2001 18:05:47 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (133 lines)

Dear Medlibbers,

The message below was sent to lis-medical in the UK. It has been suggested
that I also send it to medlib-l. Perhaps some points strike a cord and are
of interest to colleagues in the US as well ...

With best wishes from hot (85+ F) and sunny London,

Reinhard Wentz



Dear Colleagues,

Occupied as we are (are we not?) with electronic databases, information on
the Internet, and full-text journals on the web, do we not sometimes
overlook the value of information in current textbooks?
I have gone  through my file of reference enquiries over the last six months
and looked at those questions where clients insisted on a search on Medline,
other electronic databases, or the Internet.  I would think that more than
60% of the questions were actually so general and unspecific that
comprehensive and current information could have been found with ease in a
current textbook or other printed source.
I refer to questions like 'Where do I find something / everything on
*       diabetes in pregnancy
*       sectioning under the Mental Health Act
*       how to write a research paper
*       crisis intervention
*       hepatitis C
*       screening for prostate cancer
*       the principles of evidence-based medicine
*       preceptorship
*       priority setting in the NHS'

        In each case the attempt to get more information from the reader in
order to develop a specific, focused question (only those can generally be
searched on e.g. Medline or the Internet) failed. Sometimes clients reacted
with remarks suggesting that I am prevaricating and preventing access to
current information. Sometimes I am told that 'my tutor has said I should do
a search on the Web'. Sometimes the suggestion of starting with a book is
obviously perceived as an insult to the client's intelligence.
        I am aware of the dictum that 'half of what we learn in medical
school will be outdated by the time you start practising: we just don't know
which half'. I know of studies which indicate that it takes five or more
years for new research finding to filter through into medical textbooks(1).
        I belief such statements and research-findings are instances of hard
cases making bad laws and offer the following observations:
*       In everyday reality, valid answers to questions like the ones above
can best be answered from textbooks, which put the subject in context,
investigate background, describe current practice, and highlight problems.
Typically, articles on MEDLINE deal with very specialised aspects of a
problem; even 'review' articles tend to review a specific aspects which
happen to be well documented.

*       It is also worrying that during facilitated searches clients are
unwilling to scan, say, 40 references to pick five which are directly
relevant. Even the minor effort to scan and select is considered too time
consuming.

*       Even using my skills(?) as a librarian during a facilitated search
tends to test the client's patience. They often do not realise that I use
various shortcuts and tricks in order to get quick and focused results.
Trying to generalise some of the steps involved meets with little
appreciation.

*       Focusing a database search to retrieve a general overview is
difficult: scanning table of contents of a book or the index of a printed
source is easy. One can even ignore TOC or index: the introduction to the
subject is usually located, in my experience, at the beginning of a book ...
Which of 10 relevant and current Medline records (if any) contains a general
introduction to the subject is a matter of inspecting each of them.

*       It appears to me that results of  MEDLINE searches tend to confirm
that 'scientific medicine deals only with body parts' while books tend to
give a 'holistic view' of the disease and patients affected by it. Books on
specific topics usually have a 'holistic' feel to them.

*       I am aware that an actual topic search offers an ideal training
opportunity to demonstrate the power of using electronic sources. But this
is only true if the question is focused.

*       I suspect among reasons for this de-contexualised (sorry) approach
to medical information, this reluctance to use books, is EBM's stance that
only the most current and validated information  should be used. This is
only true for focused questions derived from clinical settings where valid
information may age quickly.

*       Medicine, an art based of science (sorry), thrives on more than just
'valid information'. It depends on 'knowing', which is characterised 'by the
fact that we know more than we can impart' (2). I would claim that 'that
what cannot be imparted' is more easily found in a book than a number of
articles found on Medline or a site on the Web.

Part of the problem which I am trying to describe may be related to the fact
that clients don't want to use the computerised book catalogue. They rely on
a cursory scan of books on the shelves. They of course miss books which are
out on loan and books on subjects 'scattered' over several shelfmarks.
In order to help clients overcome these barriers, I have recently updated
our printed 'Subject Index to the Books Section' to incorporate keywords
expressing concepts like the ones above, which don't always have a directly
equivalent MeSH term or NLM shelfmark. This index mentions, when
appropriate, that more books on this subject may be found under other,
related subject headings (I don't claim that this is original) and that a
comprehensive impression about the range of books on given subjects can only
be gleaned from searching the computerised book catalogue.
I also promised myself to exercise at least once every week a policy of
'benign refusal' to launch a full MEDLINE etc. /  Web search when I do not
think it is appropriate, and insist on consulting a relevant printed source
first.  If the client than uses that source to re-frame and focus a
question, so much the better. My subsequent facilitated search or
search-tutorial on Medline, PycInfo, WoS or the Web will be more
enthusiastically executed, generate more benefits for the client and still
highlight the valuable source of medical knowledge:
THE PRINTED BOOK

With kind regards
Reinhard
Reinhard Wentz, Dipl. Bibl.
Imperial College School of Medicine
Medical Library
Chelsea & Westminster Hospital
369, Fulham Road
London SW10 9NH    e-mail: [log in to unmask]

(1)Altman EM et al. A comparison of results of meta-analyses of randomized
controlled studies and   recommendations of clinical experts. JAMA
1992;268:240-8
(2) Polanyi M. The tacit dimension. Gloucester 1983. Quoted in: Malterud K.
The art and science of clinical knowledge: evidence beyond measures and
numbers. Lancet 2001;358:397-400  (Malterud uses Polanyi's concept of Tacit
Knowledge in the context of qualitative research. The extension to books is
mine. RW)

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December 2004, Week 5
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November 2004, Week 5
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November 2003, Week 5
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October 2003, Week 5
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January 2003, Week 5
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December 2002, Week 5
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October 2002, Week 5
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March 2002, Week 5
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April 2001, Week 3
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March 2001, Week 5
March 2001, Week 4
March 2001, Week 3
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February 2001, Week 1
January 2001, Week 5
January 2001, Week 4
January 2001, Week 3
January 2001, Week 2
January 2001, Week 1
December 2000, Week 5
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December 2000, Week 3
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December 2000, Week 1
November 2000, Week 5
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November 2000, Week 3
November 2000, Week 2
November 2000, Week 1
October 2000, Week 5
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October 2000, Week 3
October 2000, Week 2
October 2000, Week 1
September 2000, Week 5
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January 2000, Week 1
December 1999, Week 5
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January 1999, Week 3
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December 1998, Week 5
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December 1998, Week 3
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December 1998, Week 1
November 1998, Week 5
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April 1998, Week 5
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April 1998, Week 1
March 1998, Week 5
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March 1998, Week 3
March 1998, Week 2
March 1998, Week 1
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February 1998, Week 1
January 1998, Week 5
January 1998, Week 4
January 1998, Week 3
January 1998, Week 2
January 1998, Week 1
December 1997, Week 5
December 1997, Week 4
December 1997, Week 3
December 1997, Week 2
December 1997, Week 1
November 1997, Week 5
November 1997, Week 4
November 1997, Week 3
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November 1997, Week 1
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December 1995, Week 5
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April 1995, Week 5
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April 1995, Week 1
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March 1995, Week 2
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February 1995, Week 1
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December 1994, Week 5
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