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On impulse I posed a question regarding information resource preferences on the Fam-Med discussion list ( in July of 1996. Fam-Med is a list with several hundred members, most of who are practicing family physicians with a strong interest in clinical computing. Many of the list members are "power users" of computer technology, and virtually all are comfortable with email and net surfing.
I was curious as to what resources these computer users and clinicians would turn to. Would they favor electronic tools, or would they prefer pocket-sized pamphlets? To find out, I asked the question shown below. I received 40 responses (some only partial), which I've enumerated below
This is not a scholarly or scientific study. The way I asked the question will bias people's recall. I included my personal preferences in the results! Still, it is intriguing, and might suggest directions for more scholarly work. I discuss the results below.
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I'm writing to ask that fam-med and family-l subscribers send me a short list of
the top 3 non-human information sources they _really_ use routinely, and why. These need
not be things you love or are very proud of, but I would especially like to hear your
emotional attitude towards the resource. (ie. I use Prescribing Monthly, but it's paid for
by drug companies and is designed to make me use their costlier products).
I'll summarize the results on a web page ("eyeball qualitative summaries). I
won't mention your name unless you'd like me to (if you want I'll put in your email
address and/or web page). I doubt I'll publish the results, but I might. Since I'm in the
"informatics business" I'm just curious to hear what primary care docs like, and
why. The results can help guide future information tool development.
For example, here are my top three: (Note none of them are electronic! You don't
have to be as verbose.)
Prescribing Monthly: I really like this monthly booklet, because it's organized
just right for my quick access and fits in my pocket. It's always completely current. It
lists preparations, dosages, and some side-effects. Entries are terse and very quick to
read completely. The multiple indices are color coded. It has handy tables for steroids
and anti-hypertensive agents. It's organized by trade names, so it's easier to sort out
preparations. Of course it's chock full of pharmaceutical ads, which make it clumsier to
use, and it's very much influenced by its advertisers. It's designed to make me use
expensive new agents.
Sanford's Guide to Antimicrobial Therapy: Pocket-sized, tells me things I can't
find anywhere else, up-to-date, very quick to use. Describes unapproved uses of
antimicrobials. I trust Sanford. I really like it.
Five Minute Clinical Consult: Fast, concise, direct, up-to-date. Covers the
things I see fairly often. Helps me out a lot. Like it.
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Sanford's Antimicrobial Therapy is the clear winner (Sanford, J.P. Guide to Antimicrobial Therapy, Matthews Books). Twelve of the 41 respondents named this as their top choice, and 18/41 put it in the top 3. This author's influence on American medical practice is phenomenal, yet he may be little recognized in the academic world. I suspect he has far more influence on clinical practice than all the AHCPR guidelines yet produced.
What makes Sanford's Guide so popular, and such a worthy target for imitation and emulation by we informaticians? That's another study, and a worthy one. I'd venture the following. It is trusted, and authoritative. It provides the right amount of information -- enough, but not overwhelming. It answers the questions we have: how to treat "lung infection" rather than just how to treat "mycoplasma". Since the booklet fits in one's pocket it necessarily provides "just-in-time" information (Elson, http://www.hinf.umn.edu/~relson/ ).
After Sanford comes the famous, or infamous, "PDR". The Physician's Desk Reference is distributed free of charge to clinicians. Content is provided by pharmaceutical companies, and is thus somewhat suspect. Still, the PDR is very well organized, is close at hand, and answers our most common questions. Interestingly, many of the Fam-Med respondents use computerized PDA versions of the PDR, such as Franklin's product.
MEDLINE, in its various incarnations, was quite popular. In fact, depending on how one counts varied MEDLINE derivatives, it may rival the PDR.
After these big 3 come a number of less common but noteworthy references. Drug information is by far the biggest overall category, including the PDR, Sanford, Micromedex, etc. Tarascon's Pocket Pharmacoepia ($7.95 from Tarascon Publishing, Box 1522, Loma Linda,CA 92354) was new to me, but it sounds quite intriguing. The Five Minute Clinical Consult is also a newer reference, but it's available in several electronic forms. Habib's Clinical Dermatology was mentioned several times; after drug therapy I'd venture that dermatology answers are the number one need of family physicians. Informaticians take heed!
The Stat!Ref CD-ROM throws things off a bit. This monster reference encompasses several textbooks. I think it's noteworthy that all the favored electronic references are comprehensive within their domain (pocket PDR for pharmacology, Stat!Ref for disease information).
All in all, an interesting, albeit unscientific, survey.
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Here are the results of the survey. I totalled them up in Excel, then used Ken Sayward's XTML tool to make the html table (I prefer it to Internet Assistant for Excel). Some folks cheated and gave more than three choices, I list the 4+ preferences in column 4, but I didn't include them in the totals.
Information Resource Preferences
|Information Resources Preferences Results|
|Number of Responses:||41|
|Resource||1st||2nd||3rd||Other||#times top 3|
|Ambulatory Medicine (Barker)||1||1|
|American Family Physician||1||1||2||4|
|Clinical Dermatology (Habif)||1||3||4|
|Clinical Reference Systems (Computer)||1||3||1|
|Clinical Strategies Series||1||1|
|Compendium of Pharmaceuticals and Specialties (Canada)||1||1|
|Current Clinical Strategies, Family Practice (Chan)||1||1|
|Current Medical Diagnosis and Treatment||2||2|
|Evidence Based Medicine Journal||1||1|
|Facts and Comparisons (AMA, Pharmaceutical)||2||2||1||4|
|Family Practice Desk Reference||1||1|
|Five Minute Clinical Consult ("new" text)||1||5||6|
|Franklin Adverse Drug Interactions Computer Book||1||1|
|Handbook of Commonly Prescribed ...||1||1|
|Harriet Lane Handbook (pediatrics)||1||1|
|Internet (Web Searching)||1||1|
|JAMA and Archives Journals on CD-ROM||1||1|
|JFP Journal Club||1||1|
|Mayo Clinic Procedings||1||1|
|MEDLINE, Grateful Med, etc.||3||1||5||1||9|
|Monthly Prescribing Reference||1||2||3|
|Musculoskeletal Manual (Birnbaum)||1||1||2|
|Oxford Handbooks of Clinical Medicine & Specialties||1||1|
|personal article collection||1||1|
|Physician's Desk Reference (elect, Franklin, paper)||4||6||1||1||11|
|Primary Care Medicine (Goroll)||2||2||4|
|Rakel's Family Practice||1||1|
|Red Book (AAP, pediatrics)||1||1|
|Sanford Antimicrobial Therapy||12||4||2||18|
|Scientific American Medicine CD and Text||2||2||2||4|
|STAT!Ref CD-ROM (may include SciAm, others)||2||2||2||1||6|
|Tarascon Pocket Pharmacopeia||3||2||5|
|The Medical Letter||1||1|
|Throw Away Journals||1||1|
|US Preventive Services Task Force Guidelines||1||1|