Personal views: In praise of books
Authors: Reinhard Wentz
Journal: BMJ (2001)

Occupied as we are with electronic databases, information on the internet, and full text journals on the web, do we not sometimes overlook the value of information in current textbooks?


I have gone through my file of reference inquiries over the past six months and looked at those questions where clients insisted on a search on Medline, other electronic databases, or the internet. I would think that more than 60% of the questions were actually so general and unspecific that relevant information could have been found with ease in a current textbook or other printed source. 


Typically, articles on Medline deal with specialised aspects of a problem



I refer to questions such as “Where do I find everything [sometimes the word “something” is used] on: diabetes in pregnancy? sectioning under the Mental Health Act? how to write a research paper? crisis intervention? screening for prostate cancer? hepatitis C? the principles of evidence based medicine? preceptorship? priority setting in the NHS?”


In each case the attempt to get more information from the reader in order to develop a specific, focused question (only those can generally be searched on, for instance, Medline or the internet) has failed. Sometimes clients react with remarks suggesting that I am prevaricating and condescendingly preventing access to current information. Sometimes people say: “My tutor/lecturer has said that I should do a search on the web.” 


Books tend to give a holistic view of the disease and patients affected by it



I am aware of the dictum that “half of what we learn in medical school will be outdated by the time you start practising: we just don't know which half.” I also know of studies that indicate that it takes five or more years for new research findings to filter through into medical textbooks (JAMA 1992;268:240-8).

I believe such statements and research findings are instances of hard cases leading to bad laws and I offer the following observations:



In everyday practice, it is possible to find in current textbooks valid answers to questions such as those above. Textbooks put the subject in context, investigate background, describe current practice, and highlight problems. Typically, articles on Medline deal with specialised aspects of a problem.


It is worrying that during facilitated searches (a search conducted with the help of the librarian) clients are unwilling to scan, say, 40 references to pick five that are directly relevant. Even the minor effort to scan is considered too time consuming.


Focusing a database search to retrieve general overviews is difficult. Scanning a table of contents or the index of a printed source is easy. One doesn't even have to scan a table of contents or indices: in my experience you can find the introduction to the subject on pages 1-18, with pages I-IV or the dedication note giving background on the enthusiasm, dedication, and sometimes human costs involved in producing the book. It is here that authors mention instances of spouse and child neglect, and also, sometimes, the help of a librarian.


It appears to me that results of Medline searches tend to confirm the prejudice that scientific medicine deals only with body parts while books tend to give a holistic view of the disease and patients affected by it.


I suspect that among reasons for this decontexualised approach to medical information—this reluctance to use books—is evidence based medicine's stance that only the most current and validated information should be used. This is true only for focused questions derived from clinical settings where valid information may age quickly.


Taking this point a bit further, I would suggest that “electronic information” is to “information in context in books” what “evidence based medicine” is to “narrative medicine.” As the patient's narrative forms part of good clinical practice, so should a book or printed source be part of the information gathering process for finding the external evidence.


Medicine, an art based on science (sorry), thrives on more than just “valid information.” It depends on “knowing,” which is characterised “by the fact that we know more than we can impart” (Lancet 2001;358:397-400). I would claim “that what cannot be imparted” is more easily found in a book than a number of articles found on Medline or a site on the web.




I promise myself to exercise at least once every week a policy of benign refusal to launch a full Medline or internet search and insist on consulting a relevant printed source first. If the client then uses that source to reframe and focus a question, so much the better. My subsequent facilitated search or search tutorial on Medline will be more enthusiastically executed, generate more benefit for the client, and still highlight the valuable, albeit old fashioned, source of medical knowledge: the printed book.