How many doctors does it take...

by Dr. S. Russell Vester, MD 14. June 2013 11:21

This week I'm going to take a break from crabbing about the general lunacy of cigarette smoking and give you a look at one of my pet peeves in our professional literature. Every doctor has to work to keep up with the advances in medical knowledge in their chosen specialty. For the most part we do this by reading journals filled with articles written by our peers and go to a meeting or two each year to hear talks again given by our peers. The amount of information produced each year in my world, the cardiac and thoracic surgery world, is prodigious. I read a half dozen journals each month related to my field alone. This covers all of what are considered the major journals for someone in my line of work. I could read more, but I doubt I could stay conscious. Some of this stuff gets, shall we say, pretty dry.


The number of articles published is fueled by an academic medical industry that fairly broadly holds those wishing to advance in the academic ranks to the standard of "publish or perish." This makes the search for worthy topics a real challenge considering that there are around 125 academic medical centers in the U.S. If each had 100 clinical staff members, that would be 12,500 doctors looking for topics. The reality is that the number is probably three to four times this as each medical center usually has a staff larger than 100 plus having a college of medicine attached to the hospital is a common pattern. These medical colleges are typically packed with researchers who are working to expand our fund of medical knowledge. So in reality the medical world is supported by tens of thousands of people working to help us understand everything there is about the human body and what gets its out of whack.

Now the question presents itself from time to time, is all this new information worthwhile? The answer to this question is "probably." I would think that in writing an article any author would have a target audience in mind. I would think. But I'm not certain. Every once in a while I run across an article that begs the question of usefulness. Perhaps a better way to ask the question is why did the authors think their piece needed air time?

What started this blog was my reading an article in this week's Journal of the American College of Cardiology (JACC for short). It was written by, get this, 14 doctors, both PhD’s and MD’s from none other than Johns Hopkins Hospital. Hard to believe there was any room left on the wagon with a committee of this many authors. The title this group of uber-authors came up with was this: "Dual Antiplatelet Therapy and Heparin "Bridging" Significantly Increase the Risk of Bleeding Complications After Pacemaker of Implantable Cardioverter-Defibrillator Device Implantation."

You still awake? I told you. And that's just the title.

What this crowd ends up telling us is this. If you are going to do an operation to put a pacemaker or a defibrillator in someone, and they happen to be on some sturdy blood-thinning drugs right before the operation, they have a higher risk of bleeding complications.

No kidding.

And it took them seven pages to say this. Another way of looking at it that each author had to write a half a page. At least the article was "supported by" grant money from private industry rather public money. It would be unfortunate to see our tax dollars spent on something like this. A private company can spend its money any way it wants. In this instance, I have to wonder if this was the best investment they could have made with their dollars.

So the reality is this. We, your doctors, read a ton. Or at least some of us do and I believe the readers are in the distinct majority. And much of this reading doesn't change what we do. Some stuff is interesting, much of it is dry beyond belief, some of it is way over my head (e.g.- molecular genetics) and every once in a while I find something useful.

But you gotta wonder. Couldn't these guys from Hopkins have answered this question just by asking one of their surgeon buddies that they might have seen in the parking lot?

They could have saved a lot of trees. That would have been useful.



From the Heart...

Comments (1) -

6/18/2014 8:04:45 AM #

I just want to thank all of the drivers of this blog,and really would love to appreciate not just S.Russell but all of the authors Dr.Robert,Dr.James,Katie.B and Paula M.its really good to find a blog after surfing 8 to 10 blogs which is actually updated and reading worthy.

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