Show Me the Data!

By  |  March 19, 2014 | 

by Weijen Chang, MD, FAAP, SFHM

Last August, I sat in a packed ballroom at PHM 2013 in New Orleans, enjoying a raucous yet edifying romp through the highlights of a year’s worth of literature at Top Articles in Pediatric Hospital Medicine.  Barrett Fromme and Ben Bauer wove together education and entertainment while tackling what often can be not much more than a dry list of journal abstracts. Less than a week later, I was honored and horrified to be asked if I would join Barrett in presenting the Top Articles talk at Hospital Medicine 2014.

But after the initial shock and fear wore off, the business of planning and preparing a talk began to mitigate my fears of measuring up to Ben Bauer’s comedic timing (and dancing).  Speaking with Barrett, I was impressed by the relative lack of systematic efficiency utilized in refining their list of articles.  While a mountain of pediatric literature was reviewed, the criteria for picking what was a Top Article boiled down to one basic question: Does this article change what I do as a physician?

Of course, how one answers that question depends much on what they do with their day as a physician. It’s a testament to the Big Tent of pediatric hospital medicine that a pediatric hospitalist may also spend some of their days as an administrator, educator, primary care physician, or urgent care physician.  I’ve been lucky enough to have worn all these hats at some point in my career, as it’s allowed my interest to piqued by articles in many domains.  Yet this diversity of experience (exacerbated by my Med-Peds training) also cursed me in my attempts to whittle down the list of articles.

But whittle we must, and over the past several months Barrett and I squeezed in phone conferences between rounds, meetings and other phone conferences, slowly congealing a molten blob of literature into distinct groupings.  Without giving away too much, the topic areas that solidified over time include bronchiolitis, pneumonia, SBI, ALTE, administration, child abuse, and the dreaded miscellaneous.  I can state with some confidence that each article that “made the cut” could change the daily practice of a pediatric hospitalist, although not necessarily in clinical practice.

How do we keep up with medical literature in this day and age of pre-digested literature summaries and emailed updates?  Is attending a Top Articles-type lecture at a national meeting a reasonable substitute for tackling that stack of journals (or in this day and age, that Inbox)?  I posed this question to a group of medical students and residents before giving them a dry run of the slides I had begun to prepare for the talk.  Surprisingly, they answered the questioned much the way I would have; – the best way to stay on top of literature important enough to change your practice is to constantly seek literature that changes your practice.  In other words, always seek the evidence.  Even today, I can still hear my old Duke Medicine residency director, Ralph Corey, echoing in my ears as I try to make decisions on rounds – “Weijen, show me the data!”

At Duke, Ralph was feared and respected for being a stickler for making sure that when you made a clinical decision that you could back it up with primary data.  Many a long call night was spent not just on the wards but also in the library (yes, in a real library) if you knew Ralph would be at morning report.

But for the modern physician and trainee, life is a bit easier.  If you have an uncertainty about diagnostic, therapeutic, or even administrative approaches, shedding some light on the subject is often just a few keystrokes (or finger swipes) away.  No treks to the Medical Library are necessary, and an account on PubMed is free.  Over time, as you save articles to your “favorites” collection, you can even create your own Top Articles collection (and perhaps you have).

So, which articles would make your Top Articles talk?


DrWeijenChangDr. Weijen Chang MD, FAAP, SFHM is a hospitalist in both Internal Medicine and Pediatrics at the University of California San Diego Medical Center and Rady Children’s Hospital San Diego. He serves as the director of hospitalist services for UCSD Medical Center in La Jolla, CA. You can follow Dr. Chang on Twitter @wwchang.

Dr. Chang will be presenting the Pediatric Update of Top Artiles in Pediatric Hospital Medicine on Wednesday, March 26th at 12 noon at Hospital Medicine 2014 in Las Vegas, NV. He will be co-presenting with Dr. H. Barrett Fromme MD, MHPE.

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