When we were interns we had to get used to the seemingly constant presence of Dr. Santell at the hospital. Although he usually left work in the late afternoon, his pervasiveness began early in the morning. He routinely showed up at 5:30 am, although you never saw him on the floor before 6:00 am. He understood the importance of starting the day early but he didn't like the idea of patients being woken up before 6:00 am. Even on the busiest inpatient service, he wouldn't allow us to begin rounds before this hour.
In that case, what was Dr. Santell doing in the building at 5:30 am? This was one of those top-secret questions you didn't know the answer to until your second year. I say secret not because no one would tell you what Santell was up to at that hour, but because you had to be a resident for a while to understand the rhythms of the hospital, whether or not they involved Santell. You also had to develop your Santell radar. I swear, by the end of my third year I knew when that man was in the building. I felt it like a nagging doubt that I'd left something undone, or hadn't thought everything through properly.
Ultimately we all came to understand why Dr. Santell arrived at work earlier than he wanted the patients woken up. His first stop was not Med-Surg but the hospital library. He always began his work day by browsing through the collection of textbooks, reading about the clinical problems facing him and his Medicine team on the service that day.
Dr. Santell was a lover of textbooks above all other sources of information. He said textbooks might not be updated as often as information in journals or online references, but their chapters represented the most refined collation of the state of knowledge at the time of the books publication. I think he appreciated the refinement of information--the careful consideration of what to include in a book, and what to leave out--more than up-to-the-minute status. He'd been in medicine long enough to know that the big changes don't happen overnight, and much of keeping current in medicine involves reviewing old ground as well as new discoveries.
I think about Dr. Santell's disciplined reading a lot these days, as I scramble to keep up with current standards of care, health care policy developments, and health care providers' opinions. The fine balance between being well-informed and not succumbing to the wealth of trivia available on the Internet on blogs, news sites, RSS, and fly-by-night health care sites and publications is a narrow platform to maneuver. Every time I filter through the feeds on my reader, or delete newsletters from my inbox, I think of Dr. Santell, who did nothing more than show up 30 minutes early and read a few pages, every day, from something as hopelessly outdated as Harrison's Internal Medicine. Then I remember how, doing so over the course of a 40-year career, he became the wisest doctor I've ever known. The rest of us might scramble to stay current, but we might be wiser to look down and see the great doctors upon whose shoulders our own accomplishments are based.
That is true. Review articles have their place...but textbooks have a better big picture approach.
Posted by: dragonfly | October 15, 2008 at 05:28 AM
Awesome to actually see someone as seasoned as he actually _recommend_ textbooks. It's not about being up-to-date, it's about making sure your fundamentals are always sound. It's like a musician who never thinks they have to play an etude or scale after they start learning "real" repertoire. Rubbish. You need both.
Posted by: enrico | October 14, 2008 at 03:42 PM
Two notes:
1. Things actually do change overnight.
2. What would Dr. Santell think of UpToDate?
Posted by: anon | October 14, 2008 at 11:58 AM