Dr. Joshua Schwimmer from Kidneynotes.com – Part III

UBC faculty and students have expressed an interest in medical blogs – how to find them, where to search for blog content, and whether blog-info is worthwhile. Obviously, medical blogs supplement peer-reviewed content in journals – but blog use is growing, symbolic of a new collaborative spirit, and openness in medicine.

UBC faculty in medicine showed their interest in blogs by reading the top medical bloggers, like Stanford med student Graham Walker and Cleveland Clinic’s Dr. Ves Dimov. Perhaps you have some interest in blogging now? Let’s hear next from a specialist – a nephrologist from New York City, Dr. Joshua Schwimmer, who writes KidneyNotes.com, whose ideas about medical searching are worth reading for their candour.

1. How important are tools like PubMed and Google Scholar to you and how often do you use them?

Dr. Joshua Schwimmer: Like many people on the internet, I use Google so many times daily that I hardly remember a time without it. But there was a moment almost ten years ago, when I first encountered Google Search, when I realized that searching the internet wasn’t necessarily a frustrating experience. At the time, I was using Altavista, an early search engine, which required scrolling through pages of irrelevant material to find anything useful. With Google, I found exactly what I wanted right away. It’s easy to take this for granted now, but at the time, searching was a very different experience.

Recently, I had a similar realization while using Google Scholar to search the medical literature. To put this in perspective, when I trained — and many people may have similar memories — searching the medical literature was difficult. It required trudging to the medical library, finding an open terminal, scrolling through a list of several hundred journal articles for ones that sounded promising, printing out and annotating the list, walking through stacks of hardbound journals until you found what you were looking for, bringing the pile of journals to a copying machine, copying them, then finally reading through a stack of articles. At the time, this all seemed like a natural and necessary part of the process. Now, most of it seems like a waste of time and effort.

Using Google Scholar is an entirely different experience. Search results are displayed in order of importance, which is based on how often they are cited and who they are cited by. Potentially, Google Scholar can instantly direct you to the most important papers in any field anywhere you can access the internet, and many of these papers are now available online. I use it at least several times weekly and sometimes daily.

Google Scholar is not a complete substitute for searching PubMed, because it isn’t updated as frequently. But Google Scholar is especially useful for rapidly assimilating the literature on a topic you know little about. Two recent experiences illustrate this. A seventy year old woman with neurofibromatosis came to me with severe hypertension. I was initially concerned that she had a pheochromocytoma, which is associated with neurofibromatosis. To look for other associations, I searched “hypertension” and “neurofibromatosis” in Google Scholar, which revealed that renal artery stenosis from vascular neurofibromas was also possible. We looked, and that’s what she had. Her blood pressure improved dramatically after an angioplasty of her renal artery.

A second patient was referred to me complaining that he had stopped sweating three months ago. I’d never seen anything like this before. So I searched Google Scholar, which quickly directed me to the literature on acquired idiopathic generalized anhydrosis, a rare neurologic disorder. I sent him to a neurologist for a skin biopsy, and this confirmed the diagnosis.

2. What do you find the most helpful tool that you have access to, beyond Web search engines?

For rapidly reviewing the latest ideas on many medical topics, I find UpToDate extremely useful. The articles strike an excellent balance between clinical practice and basic science. It’s not a substitute for reading the most recent literature on a topic, but it comes close, and it’s a useful place to start.

3. How do you keep up in your specific area of medicine (ie. nephrology)? Do you know about RSS feeds, podcasting, e-alerts, and other “sharing” technologies?

I try to keep current with the major journals in my field (JASN, AJKD, and others) and other general medical journals (NEJM, Annals of Internal Medicine, and others). Email alerts are helpful, because many articles are released online before they are published in print. I keep track of a number of PubMed searches of authors and topics I’m interested in using RSS feeds. I also read the UpToDate “What’s New” sections, which are useful summaries of new developments in many fields. I occasionally listen to medical podcasts, and I especially like the NEJM interviews and weekly audio summaries. I also use HDCN, a website which offers many audio files of recent nephrology lectures.

In my experience, physicians are becoming more familiar with these tools, and especially with UpToDate, but judging from the responses I’ve received at conferences, plenty of physicians still haven’t heard of newer technologies like Google Scholar. This is understandable, because many physicians aren’t familiar with computers. and learning to use some of these tools may require a significant time commitment. In the long run, most of these tools actually save time and make keeping current much easier.

4. Do you have access to a good medical librarian? If you could ask them to teach you something, what would it be?

While I have access to a number of medical libraries, I don’t visit them as often as I should, because I try to get as much work done online as possible. I’m sure there are many useful databases and other resources out there that I’m not aware of. If it doesn’t already exist, I’d particularly like to see a website designed by a medical librarian which allows users to simultaneously search Google Scholar (both all articles and recent articles), PubMed, Google News, and other medical and nonmedical databases and display links to the results.

5. What are your favorite medical blogs?

Clinical Cases and Images, by Ves Dimov, an internist, has excellent discussions about the use of new technologies in clinical practice.

Kevin, M.D., an internist, abstracts important medical news articles.

Intueri, by a psychiatry resident, has the best writing of any medical blog.

GruntDoc, an emergency physician, has fascinating clinical stories and commentary.

Blogborygmi, by Nicholas Genes, an emergency medicine resident, discusses medical training and other issues and is often insightful.

Medgadget discusses interesting new medical technologies.

These are only a few. There are many others.

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