Practical Pointers


      During my years of practice as a primary care internist, I had little time for keeping up with the current literature. Journals would pile up, most unread; many unopened; until I discarded them to make room for another pile. I am convinced that most busy clinicians, trying to balance a demanding practice with a semblance of family life, cannot adequately keep up.

      Since retiring, I review each issue of NEJM, JAMA, BMJ, LANCET, ANNALS INTERNAL MEDICINE, AND ARCHIVES INTERNAL MEDICINE. I choose articles for abstraction on the basis of my own "clinical appraisal". Does the article present anything of practical importance? Can it be applied immediately to practice? Would it lead to a change in practice? I give priority to systematic reviews, but also abstract editorials, commentary, and occasionally, letters to the editor.

      I use some secondary criteria: Does the article present any new concepts (including ethical issues) that a well-informed primary-care clinician should know as a basis for care and caring? If not immediately applicable, is the information potentially important? Is the article amusing or entertaining?

      I think of the abstracts that journals place at the beginning of the articles as "entrance" abstractions -- an explanation of what the author(s) put into the article. I think of mine as "exit" abstracts -- what I, as a clinician, received from the article.

      Each month I include a "Highlights" section that contains, along with the title of the article, a sentence or two describing the essence of the paper. Reader can rapidly scan the capsule-form contents and read only those abstracts of interest. Each highlight is linked to the abstract. The citation in the abstract is linked to the journal.

      Beyond trying to absorb current information from the literature, one must be able to remember (or perhaps more importantly, to quickly retrieve) information in order to apply it should the occasion arise. Because of this need for easy retrieval, I compile a cumulative index which is based on medical subject headings (MeSH -- eg, “diabetes”; “hypertension”). Each MeSH is linked to the list of highlights of each article abstracted on that subject during the year.. The highlight in turn is linked to the abstract. The citation at the end of each abstract is linked to the journal. This is an excellent memory-jogger. Indeed, in a few minutes, one can easily recall all articles abstracted on a given subject during the year.

      Distribution of the publication has grown over the years. It is available free of charge as an e-mail attachment. Anyone with an e-mail address may receive the publication each month on a timely basis. Requests to:

      Practical Pointers is incorporated in the state of North Carolina as a public service for which there is no charge. It contains no advertising. The editor-publisher personally underwrites all expenses.

Richard T. James Jr. M.D.
Editor/ Publisher