Medicine: Preserving the Pasion in the 21st Century PDF
Preview Medicine: Preserving the Pasion in the 21st Century
Medicine PRESERVING THE PASSION IN THE 21ST CENTURY Also by Lois DeBakey, Ph.D. The Scientific Journal: Editorial Policies and Practices Medicine PRESERVING THE PASSION IN THE 21ST CENTURY SECOND EDITION Phil R. Manning, M.D. Professor of Medicine Emeritus Paul Ingalls Hoagland-Hastings Foundation Professor of Continuing Medical Education Former Associate Vice President for Health Affairs Former Associate Dean for Postgraduate Affairs Keck School of Medicine of the University of Southern California Los Angeles, California Lois DeBakey, Ph.D. Professor of Scientific Communication Baylor College of Medicine Houston, Texas PHIL R. MANNING, M.D. LOIS DEBAKEY, PH.D. Keck School of Medicine Professor of Scientific Communication University of Southern California Baylor College of Medicine 1975 Zonal Avenue One Baylor Plaza Los Angeles, CA 90033 Houston, Texas 77030 USA USA . . . LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA Manning, Phil R., 1921– Medicine: preserving the passion in the 21st century / Phil R. Manning, Lois DeBakey.— 2nd ed. p. ; cm. Rev. ed. of: Medicine: preserving the passion. c1987. Includes bibliographical references and index. ISBN 0-387-0046-2 (h/c : alk. paper) ISBN 0-387-00427-0 (s/c : alk. paper) 1. Medicine—Study and teaching (Continuing education) I. DeBakey, Lois. II. Manning, Phil R., 1921—Medicine: preserving the passion. III. Title. [DNLM: 1. Education, Medical, Continuing—trends. W 20 M284m 2003] R845.M36 2003 610'.71'5—dc21 2003042484 PRINTED ON ACID-FREE PAPER. ISBN 0-387-00426-2 (hardcover) ISBN 0-387-00427-0 (softcover) © 2004 Springer-Verlag New York, Inc. All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York, Inc., 175 Fifth Avenue, New York, NY 10010, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if the are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Text design by Steven Pisano. PRINTED IN THE UNITED STATES OF AMERICA. 9 8 7 6 5 4 3 2 1 SPIN 10908273 (hardcover) SPIN 10908280 (softcover) www.springer-ny.com Springer-Verlag New York Berlin Heidelberg A member of BertelsmannSpringer Science+Business Media GmbH Dedicated to practicing physicians, who have invested many years in medical school and graduate training, often at great personal and financial sacrifice, and who place the highest priority on the health and welfare of their patients. The outstanding advances in information technology are simplifying and encour- aging independent, practice-related study, making it easier for physicians to enhance learning in the practice environment. Phil R. Manning, M.D. An inquiring, analytical mind; an un- quenchable thirst for new knowledge; and a heartfelt compassion for the ailing—these are prominent traits among the committed clinicians who have preserved the passion for medicine, even with the advent of “managed” care. Lois DeBakey, Ph.D. The education of the doctor which goes on after he has his degree is, after all, the most important part of his education. JOHN SHAW BILLINGS Boston Med Surg J. 1894; 131:140. . . . The art of medicine cannot be inherited, nor can it be copied from books .... PARACELSUS Foreword,Das zweite Buch der Grossen Wundarznei,1536 (verso of leaf b, ed. 1562) . . . [T]he student begins with the patient, continues with the patient, and ends his studies with the patient, using books and lectures as tools, as means to an end. WILLIAM OSLER Aequanimitas, with Other Addresses, “The Hospital as a College,” 1903 Foreword . . . The Association of American Medical Colleges recently recom- mended that the traditional model for lifelong learning, which fo- cused on attendance at courses, should be replaced by individualized study closely related to personal medical practice. Phil R. Manning has dedicated almost all of his professional life to demonstrating that continual medical education should occur precisely in this fashion. Lois DeBakey has devoted much of her professional life to instructing physicians and biomedical researchers in critical reasoning and its companion, clarity of thought, writing, and speech. Together, they have created a highly readable book that shows physicians how to gain the most from their clinical experience and, in doing so, preserve their passion for clinical practice and lifelong education. The authors describe techniques used by highly successful clini- cians and academicians to achieve these goals, synthesizing lessons from their clinical experience with reading of medical publications ix MEDICINE: PRESERVING THE PASSION IN THE 21ST CENTURY and discussions of clinical problems with colleagues. Personal essays and reflections by distinguished physicians are woven into the text. The book’s emphasis is on immersion in practice, with tips on how to live with this commitment. Chapters discuss the remarkable advances in information technol- ogy and medical library services that facilitate the active approach to learning. In fact, Manning insists that “With the current information services, there is no excuse for a physician not to remain current.” On the other hand, the traditional mental model of “information re- trieval” as equivalent to “staying current” runs aground fairly quickly when the current medical advances outpace the doctor’s education and understanding. Few practitioners today attended medical school lec- tures on introns, exons, transposons, or epigenetics (to name just a few of the bewildering concepts in the most recent medical journals). Con- sequently, the highly fragmented research papers that reach us so quickly via computer searches must fail to educate us if we have not— somehow, somewhere—gotten a satisfactory understanding of the sci- entific theories and assumptions that underlie the “current” progress. This is difficult. Manning and DeBakey include an emphasis on a physician’s continuing need to be part of the profession, part of a net- work of colleagues. The computer can, indeed, retrieve facts with great facility. Yet for us to advance our understanding of difficult areas needs the interplay of minds. Here, too, this update of the popular first edition of Medicine: Preserving the Passion in the 21st Century gives the reader a good start in getting both understanding and facts. DONALD A. B. LINDBERG, M.D. Director National Library of Medicine x Preface . . . Since the first edition of Medicine: Preserving the Passionwas pub- lished in 1987, the practice of medicine has changed notably and so, therefore, has the physician’s approach to lifelong learning. The spread of managed care has discouraged many physicians for several reasons: (1) they must often obtain approval from healthcare organiza- tions for certain procedures, (2) because employers often shop for more economical health plans, patients may be required to change physicians, (3) paperwork has increased, and (4) physicians must see more patients to maintain their income. On a more positive note, healthcare organizations routinely collect data on individual prac- tices for financial reasons, and these data can be used to identify ed- ucational needs of practitioners. Unprecedented educational opportunities on the Internet are rev- olutionizing physicians’ access to information, both reliable and unre- liable. Although the rapid growth of electronic services precludes xi
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