This the summary of my Twitter discussion with an academic nephrologist (by the way, the founding editor of UpToDate is also a nephrologist):@DrVes: UpToDate is likely the most read medical reference tool, at least in the U.S. - how did Harrison's, Cecil's, etc. manage to lose that war?
@kidney_boy (Joel Topf): Reasons for UpToDate winning: Harrison's had no search, and an editorial style that told you about disease but not how to treat it
@DrVes: Exactly. It's amazing that those publishing companies didn't realize that they shipped "malfunctioning" product for years, and never fixed it.
@kidney_boy (Joel Topf): Harrison's is the great preclinical prof teaching pathophysiology, UpToDate is the smart clinician teaching you how to care for the patient with EBM.
@DrVes: UpToDate now has sections on pathophysiology, some of them quite good, check T-cells types, for example. Unfortunately, a lot of medical students get their basic pathology knowledge from Wikipedia nowadays. Just go to the library section where medical students are and have a look at the monitor screens during study time.
@kidney_boy (Joel Topf): Remember Harrison's is the youngest of the medical texts, it won by having regional approach (headache rather than CNS) to organization.
@DrVes: Classic-style textbooks (e.g. Harrisson's) feel like "half-book" nowadays. The doctors in training often find themselves asking "Where is the second part with treatment, updates, etc.?"
Related reading:
Review of the much anticipated UpToDate iPhone app, arguably the most read medical reference tool. iMedicalApps.com.
Are You Dependent on UpToDate for Your Clinical Practice?
"With UpToDate, students and interns may be as capable of teaching the resident (or attending) as visa versa"
Study: UpToDate More Likely than PubMed to Answer Patient Care Questions
How Current Are Leading Evidence-Based Medical Textbooks? An Analytic Survey of 4 Online Textbooks (including UpToDate) http://buff.ly/X2kUKw
Comments from Google Plus:
Neil Mehta - Ves one of the most useful aspects of Harrison's is/was the approach to symptoms. This is the first 100 or so pages of Harrison's. Understanding this can be a huge help in becoming a good clinician. It is pretty dense reading but internal medicine residents can benefit from spending time on this. Agree UpToDate is a tremendous resource. One thing to remember about U2D is that sections can be written by one author and this does run a risk of bias creeping in (no different than textbooks) but readers should learn to look at other sources/primary literature when necessary.
Ves Dimov - Right. UpToDate is far from perfect but it is very time efficient. It provides quick actionable info within 5-10 minutes of conducting a search. The depth of the content is limited by the person who wrote that particular article, of course.
Robert Silge - Yes, but by and large the people writing that content are qualified to do so. It is to medical textbooks what Wikipedia is to general reference books. Updates faster, to the point, and has info on (almost) everything. Its depth may be lacking, but for clinical practice I doubt the benefits of reading through primary literature is worth the time spent doing it for most endeavors.
And frankly for your first foray into a field, as a med student for example, Wikipedia is a darned useful place to start.
Ves Dimov - And that's why UpToDate is most users' favorite resource. One of the few drawbacks is the price though, $495 per year.
Robert Silge - Wonder how many people pay for it out of pocket vs use an institutional login?
Gary Levin - Up to date is like rounding with your attending or professor with instantaneous gratification. Harrison belongs in the library or for a second year med student to learn the language.
For genetics and other medical science, Wikipedia might come in at #1, if docs would admit it.
ReplyDeleteI think the cost of up to date had much to do with it.
ReplyDeleteUpToDate is actually quite expensive. If anything, the cost of it would have brought the adoption down rather than increase it. UpToDate is so expensive that medical librarians are often against paying for it because purchasing the service for a medium-size hospital often means cutting a lot of other medical journals from a an ever shrinking library budget. Doctors love UpToDate because it saves time and it's down to the point so they keep pushing for it. Doctors usually prevail over medical librarians in purchasing decisions because they provide the revenue for the hospitals.
ReplyDeleteHarrison's (with e-updates) is searchable through the very user friendly AccessMedicine. I used it frequently (along with many other resources) during my preclinical years in a problem-based learning curriculum. I used it somewhat less during the clinical years as I had less time to read.
ReplyDeleteDuring my Medicine internship, I was surprised to find I could apply many basics I learned from Harrison's 3-4 years after I had read & discussed the material with classmates. While UpToDate is more instructive, it didn't help me improve my clinical reasoning skills as well as Harrison's, Robbins, & other electronically searchable specialty-specific texts did.
I'm not opposed to using UpToDate to quickly find answers, but I think UTD's explanations are too efficient to promote deep consideration of mechanisms and thought processes that underlie treatment. For many younger or less thoughtful physicians, the net gain may be knowing what to do this time without learning how to approach a similar-yet-different case next time.
You are absolutely right. The search of the electronic version of the classic books is bringing new life to them.
ReplyDelete