Literature As A Weapon





By:  The Generation Y Surgeon (@GenYSurgeon)


Every now and then I play anthropologist and try to observe people from a different angle.  I don’t have to go far to observe some very unique behaviors.  In fact, I don’t go anywhere because there is plenty to see in the hospital.  My conclusions?  The hospital is an entirely different world and the subjects of this world are strange.



Yes, I Have Opinions…And One Of Them Is About Using Literature As A Weapon

I have a lot of opinions on the behaviors of patients, nurses, students and administrators in the hospital but today I want to focus on physicians and one of my least favorite behaviors – using literature as a weapon.  For most physicians the hospital is a jungle with danger around every corner…crouching malpractice lawyers, hidden administrators.  Each week your pride is offered as a sacrifice on the shrine of the M&M.  And every day you find yourself at the mercy of whatever patient or emergency that screams the loudest.  As a result we’ve developed pathologic ways to defend our egos.  My (least) favorite is the literature-as-a-weapon maneuver.


What The Literature Should Do Versus What It Is Used For


Literature is supposed to improve patient care, develop safer treatment options and educate the masses.  You’ve seen or heard all of theses examples before, I’m sure.  “The literature says…” spouts the Dinosaur as he converts a lap appy to an open case.  The literature says a lot of things, but that case just needed a surgeon facile in laparoscopy.  “Studies show that…” you hear as another bad outcome rolls back to the OR.  Once again surgical error is somehow magically forgiven after an article (possibly from the year of my birth) gets stuffed into the chart.  As you stand at the podium in the morning you find yourself battered with outdated studies supporting anything and everything EXCEPT what you are presenting.  Worse yet you actually use literature to support an event that shouldn’t be supported at all.  PubMed is meant to help you prevent misadventures, not justify them.

Medical students using studies to look smarter on rounds, not to actually learn.  The Gunners even memorize obscure articles to make their colleagues look dumber.  Residents build landmark studies into their vocabulary to get the Dinos to back off and somehow they’re satisfied with this, even though we never read past the abstract.  Your attendings wave papers over your head and at each other as a posture to establish dominance.  People build their entire careers by doing this.  It’s like a bunch of peacocks scratching the ground and pecking each other’s eyes out….but instead of shiny green-blue feathers they have a bunch of randomized controlled trials sticking out of their assess.

Literature As A Tool To Establish Dominance


The purity of research has succumbed to the pathological behaviors of physicians working in cut-throat environments.  Somehow we’ve turned the literature into a weapon to shame others, defend our egos and establish dominance among our peers.  Somehow the more you “know” about the literature, the higher up the food chain you climb.  I use the term “know” lightly because the real truth is that very few physicians truly understand what a paper means.  You and I are both guilty of skimming through the methods, especially the stats.  Why?  Because we don’t understand stats.  If you think that you do, you’re lying to yourself.  Stats are what make the paper good, bad, or just plain retarded. Face it, if the authors made up stats over mojitos and made it sound fancy, you’d buy it.  That’s the danger of the literature, most of us don’t know what we don’t know when it comes to stats.



I Admit, I’ve Done It Too

Yes, I’m pointing fingers, yet I admit I’ve been guilty of using the literature-as-a-weapon maneuver myself.  After meeting someone who truly understood stats I realized how foolish I looked wielding a weapon I didn’t understand.  Stats are in fact a completely separate science and as a general rule doctors just don’t understand, not even the Dinosaurs writing the literature.  Do yourself a favor and spend some time with someone who knows something about stats.

I still read the current literature with the help of apps like Read by QxMD* but I now refrain from vomiting abstracts at my colleagues as a means of showing my feathers and protecting my ego.  You should stop posturing too and just appreciate the literature for what it is…a tool, not a weapon.


* Who am I kidding?  I don’t read nearly enough.  Neither do you.  QxMD however is a great resource for GenY-ers.  You check off items that you’re interested in and you get emails with abstracts that you will likely find interesting.  The app is well-designed and easy to use.  You can even link up with your local library and gain access to the full article though the app.  I have ZERO affiliation with QxMD s there’s no conflict of interest here, but if you haven’t heard of it you should check it out.


Whew...another highly charged post.  Yes, I've seen the literature-as-a-weapon maneuver.  You may have introduced a new term into my vocabulary that will be on my list of favorites behind "surgical schadenfreude".  I'll call it "laying down the LAW" (Literature As Weapon).

Thanks, GenY, for another entertaining post.  I continue to try and remember that, while I may not agree with everything you write, I do think your viewpoint from Generation Y is key to progress in the profession.