Keeping up with the medical literature - no longer the impossible dream

W E Fabb 費伯威

How many times have we been told that keeping up with the thousands of articles that appear in the medical literature each week is beyond us, all the more so if we are full time clinicians in a busy practice? Convinced of this, any attempt to do so is overshadowed by the sinking feeling we can never really keep up, no matter how hard we try, no matter how conscientious we are. So we have had to rely on browsing through the few journals we receive, whatever CME we can find time to do, and on our specialist colleagues and pharmaceutical representatives to give us the "good oil". But we have never really felt on top of it.

It will therefore come as a pleasant surprise to you that the impossibility of keeping-up is a myth, the result of no one ever checking how many relevant articles there are in the literature each week. It is much, much smaller than you think.

Almost two years ago, the staff of WONCA's website, Global Family Doctor - WONCA Online, decided to provide a new unique service - a journal review that identifies articles that are relevant, informative and interesting for the family doctor, and summarises them for posting on Global Family Doctor (GFD). The number of items posted each weekday was set, somewhat arbitrarily, at three or four, and gradually increased to the current level of seven, 35 per week. Our experience over the last year is that there are not many more articles out there that are relevant. When we look for more, they are hard to find.

So we are convinced that if you look through the 35 items on GFD each week, you can readily keep up with what is important - a process that takes about 10 minutes a day or 30 minutes a week.

How are we so sure? Almost all journals relevant to family medicine are now online; GFD reviews over 80 of them. They include the family medicine journals, American Family Physician, the British Journal of General Practice and so on; the classic general journals such as the BMJ, JAMA, The Lancet and The New England Journal of Medicine; many specialist journals such as the "Archives" series from the AMA, the "Annals" series, and publications such as Pediatrics, Circulation, Heart, Thorax, Gut, Neurology and Stroke, plus journals devoted to sports medicine, psychiatry, epidemiology, public health, community health and academic medicine; along with a variety of medical news services. Most articles useful to family doctors come from the family medicine and general journals, but there are always a few from the specialist journals.

How are articles selected? Relevance and importance are the most critical criteria, but interest to the family doctor is also important. Most articles report cutting edge research, while there is a steady stream of clinical review articles on a wide variety of topics relevant to the practice of family medicine. In particular, we keep an eye out for articles that have hit the media, ones that our patients may have read in the papers or heard on radio or TV, or seen on the Web - for example, articles about the benefits and drawbacks of HRT. We aim to post these articles in a timely way so that doctors can keep ahead of their patients. Most articles are posted on GFD within days of publication, and are therefore available before the physical journal is available.

Research articles are summarised into three paragraphs - the first describes why the research was done, how it was done - the type of research study, the number of participants, where it was done and by whom. The second paragraph gives the results with the essential statistics, while the third describes the researchers' conclusions, usually verbatim. Important sentences are in bold type, while the key sentences are in red to attract attention, making it easy for the reader to "pick the eyes" out of the article - and the all important "bottom line". Every article carries a full citation, which is hyperlinked to the actual abstract, and in some journals such as the BMJ, to the full text.

Why should family doctors keep up with research? Perusal of the research articles on GFD will show that some give guidance on therapy, such as those on HRT, while many point to steps that can be taken to improve risk assessment for our patients, such as, for example, the increasing importance assigned to C-reactive protein in assessing cardiovascular risk; or to measures that can be taken to lessen risk, such as, for example, diet, exercise, or specific therapy such as statins. All this is essential knowledge for the family doctor.

Clinical review articles begin with an introduction and sometimes a summary. To read the complete review the user clicks on the hyperlink to the article. These clinical reviews are first class, ranging from conditions prevalent in family practice such as hypertension, diabetes, asthma and so on, to contemporary topics such as the "new genetics" and percutaneous coronary intervention. The family medicine journals carry a wide variety of good review articles, but so do general journals such as the BMJ.

It is this combination of cutting edge research and comprehensive clinical reviews that enables family doctors to keep up to date, to stay ahead of their patients, and up with their consultant colleagues.

All summaries are archived on GFD for future reference. There are now several thousand research articles and several hundred clinical reviews in the 2002 and 2003 archives - virtually all the relevant articles for those years. A search facility is available to search the archives, indeed the whole GFD site. All summaries on GFD can be printed out for future reference.

Each Wednesday GFD provides "Weekly Clinical Check", a set of 10 true/false questions that test what has been learned from the previous week's items. The answers appear only after "true" or "false" is selected. Educational feedback is provided explaining why the correct answer is indeed correct, plus the summary from which the question was drawn, and in turn, via a hyperlink, the original online article. So the user can pursue the issue as far as desired.

GFD also offers a "Daily Alerts" service that notifies recipients by way of a personal email what has been posted on GFD that day. All items are hyperlinked to the summary of the article - a quick click takes the user directly to the summary. Almost 2000 doctors worldwide receive Daily Alerts. To enroll for this free service simply go to http://www.globalfamilydoctor.com/enrollment.htm and enter your email address. You will enjoy receiving this daily update, knowing that it is keeping you right up-to-date. You will quickly look over the list of items for the day and select for quick reading those that interest you, just like perusing a journal, a process that takes only a few minutes.

GFD offers many other educational programs for family doctors, recognizing that they probably have the hardest job of all keeping up with advances in the vast sphere of medicine. As Dr Peter C Y Lee rightly points out elsewhere in this issue, in , education of the family doctor needs to start early with the "staunch academic support of a strong and potent Department of Family Medicine". And it needs to continue in vocational training and throughout the doctor's professional life. The latter is where GFD makes its special contribution.

There is something for everyone on Global Family Doctor http://www.globalfamilydoctor.com - a daily visit will pay you rich dividends.