Medical Tuesday Blog
Continuing Medical Education after Graduation
When I was in training to become a physician, I spent my time at the University of Kansas School of Medicine. In one of the introductory lectures, we were told to study diligently and to keep on studying for the rest of our lives. The professors stated that the science of medicine was expanding, and we should consider that by the time we finished our training, which may include the usual four years of internship and another four to six years specialty and subspecialty training, that information would have reached the half life point of relevance. In other words, approximately one-half of the information we learned during those 8-10 years would be obsolete which he stated was the half-life of medical information. If we didn’t continue our studies after graduation, we would become out of date in caring for our patients.
At that time, we were told there were 420,000 articles published yearly in medicine. Obviously, we would not be able to read even a small portion of those medical journals, so we given guidance on how to read journals. First, subscribe to the most important journal in your field to keep current in your practice. The Journal of the AMA and the New England Journal of Medicine were very popular at that time. But what to do with the others in the library? We were taught to scan the “Table of Contents.” Then proceed to the summary of those of major interest and mark with a felt pen the several we would return to read in depth.
I’ve done web research to determine the current number of medical articles that are published in a given year. So far, I’ve not been able to come up with a number even on the National Library of Medicine site. The NLM indexes 5225 journals. Most medical journals have one to four volumes per year. That would suggest that individual articles may doubled since.
When I set up my pulmonary practice, which over a decade became the largest in the United States, we subscribed to all the major journals in our field. We included the surgical and international journals and came up with about 20. We devoted a room in our clinic as a pulmonary medicine library with open shelving to display the current issues. We had them bound on an annual basis. I felt this was key to our keeping up with the advances in medicine along with our yearly specialty meetings. Between appointments, or when a patient came late, or during lunch, it was convenient to go our library and peruse the latest medical literature.
Then, reflecting on how we had been advised to read the vast medical literature, I would take a felt pen and check mark the title of the articles of interest and read the introductory paragraph which was usually a summary. If this was important and relevant, I would further underline it, return the journal to the display case if my patient had arrived. I could easily return to that article when the next 5- or 15-minute pause occurred in my schedule.
We also went to the medical conferences of our specialty, the AMA annual meetings, and our hospital grand rounds to maintain our expertise. My specialty goes by five different names. It was started in 1904 as the American Trudeau Society, after its founder, Edward Livingston Trudeau who developed the first laboratory in the United States dedicated to the study of tuberculosis. We subsequently became the American Thoracic Society. (Our lay counterpart was originated as the American Lung Association.) The lung surgeons have generally maintained the name of Thoracic Surgeon. We were also known as Respiratory Physicians but have bequeathed the Respiratory name to the technical area of Respiratory Therapist—hence the name of the respiratory therapy service which administers the inhalation treatment to our hospitalized patients. Our nursing colleagues in our specialty frequently go by the name of Respiratory Nurse Specialist. We are also known as Chest Physicians and one of our main journals is Chest. In view of the names of our other internal medicine colleagues, such as Cardiologist, Gastroenterologists, Endocrinologists, Neurologist, and others, we are now more commonly referred to as Pulmonologists.
I’ve noticed that the majority of physicians retire after about 40 to 45 years, or approximately by the time they turn 75 or 80 years old which would be approximately four or five half lives of medical literature. I think most of us at that time would be able to carry on a general type of practice, but acute medicine would be fraught with danger that could end your career.
For instance, there are four or five types of blood pressure drugs that are commonly used. There are more additional drugs that affect the heart muscle and conduction system. They have become so specific that some may control the atria and others work on the ventricle and still others on the conduction node between the atria and the ventricle, either slowing or speeding the conduction. Thus, it becomes critical to know the specific effect the drug has on different portions of the heart, or the treatment could cause a catastrophic cardiac response. In an office practice this may not be a serious problem. However, in a hospital base practice, this could precipitate a malpractice claim that would also claim your medical degree—the life blood of your work. That medical degree which costs you, or your parents, or the military, or the state approximately a quarter to one-half million dollars would instantly have a zero value, without which you could not make a living.
So, I returned to an office practice at age 72 and closed my office at age 80. I know a number of my colleagues that were advised by their physicians to close their offices at about age 75 or age 80. I think that was good advice.
I hope I have another 20 years to carry on a literary and journalistic practice. After near destruction of my profession over the last decade, there certainly is a lot of work that needs to be done. You may follow my endeavors by subscribing to my journals. MedicalTuesday is my practice related newsletter that we currently post at www.MedicalTuesday.net. Or by subscribing to www.HealthPlanUSA.net in which we explore what healthcare plans would be appropriate for our country.
With our experience of having treated 40,000 patients over the past 45 of practice and 12 years of medical training, we think we have a certain perspective on the health problems in our nation which includes, diabetes, weight problems, aging problems, deconditioning of our bodies, as well as memory and cognition problems. We have also published our first book to address some of these issues. You may read or purchase our Handbook of Total Body Re-Conditioning which was published last month. The paperback and he Kindle editions are available on Amazon. The DVD to demonstrate the exercise portion should be available next month.
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