Journals and me: a long-term relationship

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Having access to current editions and back catalogues of medical journals is critical for effective literature review, ongoing education and professional development, and is a mainstay of medical research. Through CKN, Queensland Health maintains one of the most comprehensive online medical libraries in Australia, and includes subscriptions to popular and widely used journals, such as Australian Medical Journal, The Lancet, New England Journal of Medicine, British Medical Journal and JAMA, as well as journals of relevance to Queensland Health’s comprehensive Coronavirus pandemic response.

CKN spoke with Dr David Pincus, consultant paediatrician and Honorary Adjunct Professor at Bond University, who reflected on how life with journals has changed over the past 40 years.

I am a consultant paediatrician working on the Gold Coast. I first started my career as a medical student back in 1977, with my training running from 1984 to 1991. I have worked as a consultant since that time, and so many things have changed during those years.

Many people have noted that so much of what we learnt as medical students has now been found to be incorrect. I agree, and it is impossible to be a competent doctor without keeping up with the current literature. I work in a group of 16 general paediatricians, all of whom I admire and would be happy to take my own sick child along to for care, and we all have different ways of keeping up.

Personally, I prefer to spend a couple of hours per week reading the latest journals and through that attempting to keep my differential diagnosis wide and my knowledge base current. But when I come up against a case where I can’t make the diagnosis or I am unsure of the management, I tend to involve a relevant sub specialist. Typically, they will have a practical and current knowledge base which is in advance of the literature.

A number of my colleagues have a different approach whereby they don’t spend much time reading through the literature but spend much more time than me researching diagnosis and management of patients by performing literature searches. Either approach will enhance patient care.

Regardless, how we go about doing those searches has changed substantially over the years.

For the first 10 years of my career searching for journal articles consisted of finding the applicable volume of Index Medicus, then trooping around the library trying to find the appropriate journal and hoping that the specific issue was available. Often this resulted in spending extended periods of time searching through microfiche. The main way of finding other relevant articles was to read through the references on a review article on the topic you were after. This meant that performing a literature search often saw you months or years behind current practice.

During part of my training as a registrar and then perhaps for the first five or 10 years as a consultant, an efficient way to keep up with the literature was to read review journals. These were generally too expensive to buy and were best read in the library before or after outpatient sessions. Several world experts in a particular area, for example paediatric respiratory physicians, would select a couple of topics and summarise recent world literature for instance on bronchiectasis in children with and without cystic fibrosis. In general, such reviews were pretty dry.

During the 1990s, new options became available for keeping up with the medical literature. In particular there were monthly newsletters and also audiotapes. These would mention interesting articles from a whole series of journals from around the world relevant to your area of interest. Generally, they were much more readable or listenable and would often result in particular papers being sought out afterwards.

For the first 20 years of my career I would also subscribe to a number of journals including the New England Journal of Medicine, Pediatrics, Journal of Pediatrics and Archives of Diseases in Childhood. At one stage I took a six-month sabbatical off work and went sailing up the Queensland coast, but still organised for the journals to be forwarded so that they arrived in each new port and I could read them over the subsequent couple of weeks!

Throughout those first 20 years of my career, librarians were critical for care. They were the experts in doing literature searches, and they were your friend if you needed to get a more obscure journal from another hospital’s library stock through an interlibrary loan. They were also of use if you were going to write an article on a topic as they could always identify more relevant articles than you could possibly find through usual searches.

Jump ahead to more recent years the advent of online resources was a revelation. Logging into the Clinical Knowledge Network it’s easy to read any articles of interest in favoured journals such as NEJM, JAMA, JAMA Pediatrics, BMJ and BMJ Quality and Safety. CKN also has other excellent resources particularly with current guidelines, the Cochrane collaboration, specific pharmacology handbooks and excellent resources for literature searches. 

Currently I know of no service that is as well set up and convenient for literature searches as the Clinical Knowledge Network. 

Medicine continues to be both fascinating and challenging, and keeping up with the latest information is always a challenge for the competent doctor. From days spent searching through dusty tomes deep in libraries we now have the latest in medicine and research, available instantaneously at the click of a mouse. 

David Pincus
Consultant Paediatrician