Ocean Deep

Staying afloat on a sea of medical information?  

 On graduating in 1986 I vividly remember someone suggesting that half of the knowledge I had been taught would be out of date within 6 years. That was a very sobering thought as it represented about the same period of training I had just completed, and as a medical student I had believed I would emerge from medical school reasonably ready for the many years ahead of my medical career. Knowledge then was largely accessed through the medical school library’s extensive book collection or by discussion with local colleagues. 

Since then of course the World Wide Web has turned a trickle of information into a flood and gone on to fill lakes, seas and now oceans of medical knowledge. This knowledge is ready to swamp us as we seek to make well informed and up-to-date decisions in our consulting rooms, with those in our care who also have access to this wealth of information. 

Here in the UK there have been recent lively debates about the nature of medical professionalism following the Royal College of Physicians report in late 2005 entitled ‘Doctors in society: Medical Professionalism in a changing world’ and I am also aware of the work of David Stern (University of Michigan) and his colleagues in the book he edited ‘Measuring Medical Professionalism’. However, whilst acknowledging the enormous change in the context of medical practice that the internet and associated media have caused- there is little more said in these discussions than doctors should be ‘life long learners’ engaged in continual professional development.  

I believe we are in danger of being overwhelmed by the modern flow of information and need to recognise that a core part of professionalism is a need for learning how to manage the information available to us. Along with the call for doctors to work in partnership with those in our care we must learn not only how to frame the health problems presented in mutual terms but also the information and aspirations that define and might meet those expectations. This is no mean task within a time limited encounter with patients who often bring information from different sources to ours or when a situation remains one of uncertainty and risk.  

For my work in family practice I find I must rely not only on clinical skills, communication skills and experience but also information skills. I believe these information skills comprise knowing how to access reliable information, rapidly and from sources concise enough and straightforward enough to be useful real time with patients in the consulting room. This is extremely challenging but also extremely rewarding when done well. 

I believe it is time that the learning of how we access and use information –the work of medical informatics- is put to work in partnership with those shaping the professional lives of doctors. The necessary educational methods must support both doctors and their patients.  

I believe that the management of medical information has become a fundamental part of modern professionalism. 

Do join the debate: how do you stay afloat on the oceans of medical knowledge?  

MRI

Over the years many of my patients have benefited from the use of Magnetic Resonance Imaging. It is a technology that has always wowed me with the incredible anatomic detail the scans produce and the astonishing physics of the technique being based on the magnetic manipulation of atomic particle spin.It is also a technology I have felt some affinity to as it was developed at my Alma Mater the University of Nottingham which saw the first clinical use of this technique in 1967. At Nottingham Professor Sir Peter Mansfield, Emeritus Professor of Physics led the work who together with Paul C Lauterbur won the Nobel prize for Medicine in 2003 for their pioneering work developing MRI. http://nobelprize.org/nobel_prizes/medicine/laureates/2003/press.html 

This time though I was to have an MRI as I had been suffering for over a year with tinnitus in my left ear which had also started to disturb my sleep. Given there was a small chance a tumour may be growing on my nerve for hearing, a scan was needed. 

For such a modern and glorious technical achievement it was disappointing to learn that the hospital’s main machine was being replaced and so my scanner was a mobile one humbly housed in the back of a lorry trailer sat in a car park at the back of the hospital, and my wait was in a Portacabin temporary waiting room. Then despite my respect for the machine- when the time came to be moved in to the centre of its narrow tunnel a moment of abject panic came over me. It was even harder to restrain as I had imagined the scan taking just a few minutes only to be told there would be a sequence of scans each lasting several minutes and so I was to remain in position in the machine a full 25 minutes.Eyes shut, fervent prayer, visual imaging of seashore scenes, and mentally turning the machines clanking operation into the clackety clack of a rail journey I controlled my fears.

However, nothing can dim my admiration for the star quality of the technology and the images produced. Happily my scan has proved normal. 

Do take the time to browse some of the images of MRI scans at The Wellcome Trust Medical Photographic Library and to read about exciting developments in the field of functional MRI which literally watches the brain work. Links below: 

http://medphoto.wellcome.ac.uk/ 

http://www.fmrib.ox.ac.uk/