The paperless physician

I want to expand on a comment I made in response to this post on Ad libitum.
As the original post puts it:

I did a strange thing yesterday. I went to the library. Yes, I meant the actual physical library – you know, the one where books are kept. When I entered it, it was quiet and cool. It brought back a lot of memories – of hours and hours spent in such libraries, reading text books, searching for bound volumes of journals, lugging stacks of bound journals to the photocopier and making photocopies, browsing through the racks of new issues of journals.

I remember as a first year graduate student photocopying article after article. I got very good at knowing which machines were best and starting with the last page so the copies were already in order

I have been in this job 10 1/2 months and I don’t even know where the library is! I have gone completely paperless, at least as far as journals and articles. No stacks of unread journals or piles photocopied articles waiting to be filed for me.

I download articles directly onto my laptop in PDF form. It helps being associated with an academic medical center because almost any journal I’d ever want if available online with no incremental cost to me (Pitt probably spends a fortune in aggregate).

Every weekday I receive an email from MDLinx with papers published in Allergy/Immunology. This is a free service (unobtrusive advertising) and is available in myriad specialties and sub-areas within each specialty. I recommend it highly.

Then each Thursday, I scan the table of contents (TOC) of major general journals (NEJM, Lancet, BMJ, JAMA) and download articles I want to read. I also have a spreadsheet that keeps track of major pediatric journals (Pediatrics and Journal of Pediatrics) and journals is my field (many, high noise to signal ratio in many) and in basic immunology (few, mostly reviews) which I go through. I download articles and put them in a “to read” folder, the electronic equivalent of the pile of paper journals. An occasionally very important article I’ll read right away, but most get lumped in with the rest.

As regular Dr. Andy readers know, I’m generally between 10-14 days behind in my reading (that is I get to an article about that many days after it is published). Most articles I read (often just the abstract) and then throw away, but ones I want to keep I give a name (usually author, journal, basic idea) and file. Periodically I burn a CD with all the articles on it, but I’m in no danger of running out of hard drive space.

This system takes time, but a lot of it is time I’d spend with paper journals too. I believe people read slower off a monitor than paper, but I’d be interested in seeing how big the difference is in those who regularly read off a monitor, like me. Organizing/renaming takes a bit of time, but not that much.

But the payoff is huge. No more thinking I’ve read something and having to search my office for it. I just find the appropriate folder an voila. Of course things can get misfiled electronically, too, but the “find” function on my Powerbook really helps.

And information is right at my fingertips. No more not being able to remember what an article says (don’t you hate that? people arguing about what they think they remember). I bring my laptop to meetings and conferences and we get the answer right away. Once we get WiFi (why are universities so behind on this?) I’ll even be able to prospectively search for answers to question (Dr. Google as I call him in addition to pubmed). Finally, when I want to pass on an article I don’t have to waste paper and time photocopying. I simply forward it by email.

I don't think many physicians have made the step, but my impression is that in the harder sciences, particularly physics, it is more common.

One other point is that most journals will forward you their TOC by email each month. I don't use this because most don't allow you to download the articles, even if you have free access (they do if you are actually an individual subscriber), limiting it's usefulness.