虽然这里医生不多，但这篇文章还是有借鉴意义，而且也是发表下个人的感慨。

 

今天无意间在neurology的网站上看到Resident and Fellow Section 的一篇文章，讲作者在信息时代到来的过程中，逐渐中查阅口袋里的各种手册，到今天充分利用文字、图像、音频、视频资料，各类医学软件的过程中，极大增强了获取最新最权威最详尽医学信息的能力，特别是在需要时实时获取，比如查房时主任问个问题，一时语塞，迅速掏出手机，这时对答案的记忆一定深刻，还有会诊时一时想不起药物的副作用或者剂量，随手打开丁香药物助手，心里那个踏实啊。因此，这篇文章很值得借鉴，其中的个别软件我也试用过，medscape,确实非常方便，医学知识、药物知识很全，信手掂来。另外我们园子的药物助手也很方便，并且功能逐渐强大，感觉有的地方比medscape琮要好。下面是全文

Media and Book Reviews: Introduction: Taking the digital plunge

• Daniel M. Goldenholz, MD, PhD

+ Author Affiliations

• 
  From the Department of Neurology, UC Davis Medical Center, Sacramento, CA.[i]
  

• Address correspondence and reprint requests to Dr. Daniel Goldenholz, Department of Neurology, UC Davis Medical Center, 4860 Y Street, Suite 3700, Sacramento, CA 95817 Goldenholz@alum.bu.edu

When I was a medical student, residents would often say—always with an air of confidentiality—“trust me, you'll need it.” Then they would reveal a must-have medical book tucked into the pocket of their white coat. Even back then I shuddered at the idea of carrying all those books. There were so many of them! Even less did I want to use a magnifying glass to read the 2-point font such books typically employ. More than anything, I did not want to waste time searching for information. I wanted it ready at a moment's notice.

Many physicians today are blending smartphones, PDAs, laptops, tablets, and e-readers with their clinical practice. Some of us have been doing this from the beginning of our careers, others are just now wondering what the fuss is all about, and some Luddites are stubbornly holding out (though today this requires a conscious decision).

So what is all the fuss about? Yes, font sizes are adjustable, 100 textbooks do fit in a shirt pocket, and information is indexed and searchable in seconds. Every day since I was a medical student, I have had at my fingertips a complete dictionary ([i]Stedman's), a drug reference (I started with Epocrates), a couple of internist manuals (Pocket Medicine: The MGH Handbook of Internal Medicine and Harrison's Manual of Medicine), and a pediatric reference (Harriet Lane Handbook). I realized early on that my electronic reference library represented a different way of doing things because most people at that time were still squinting at tiny printed pages or waiting until after rounds to look for answers to questions that had arisen. And I still work with many attendings who do not use any portable electronic reference device. Often I was the only one who could find answers to clinical questions on the spot, and they were updated answers.

But that's old news. The fuss, the one worth talking about, is that not too long ago, the game changed. It changed in 3 ways. First, there is new content. Before we were just putting books into our pockets and then into our PDAs. Now we collect “media” rather than books, and this might include a blend of text, video, audio, Web links, computations, or interactive software. This broader definition puts a wider range of useful tools at our disposal. As a medical student, my PDA held a series of high-quality audio clips demonstrating the different cardiac and pulmonary sounds (provided on an audio CD by Littman with my stethoscope). When I thought I was hearing something abnormal, I would open my PDA and listen to an example, to see if there was a match. As an intern I had an iPhone app (Afib Educator) that played a short video demonstrating for patients what atrial fibrillation looked like on a 3-dimensional heart. Now I keep handy a medical calculator (MedCalc) for things like corrected phenytoin levels, creatinine clearance, and NIH Stroke Scale score. I also keep handy an app for interpreting arterial blood gases (Acid Plus).

The second change is that of timing. Staying up to the minute is not only possible but is now expected, and many media offer users the option to auto-update. Drug index apps (Epocrates, mobileMicromedex, Medscape, mobilePDR) do this routinely. I have a fun little app called Eponyms that currently has more than 1,700 entries of common and obscure medical eponyms (Have you heard of Gonda's maneuver?) that get updated regularly and automatically. Such systems permit physicians instant access to the same information previously found only in the hands of experts.

Finally, the context of the game has changed. It used to be that pocket textbooks served as reminders of facts already known to the owner. It is no longer possible to be the renaissance physician. There are too many details, and the details are constantly changing. Today the goal is to have access to, sometimes for the first time ever, the most updated expert opinions on various subjects. My favorite example is Medscape, a free product available online and as an app. Medscape is continuously updated with peer-reviewed articles on seemingly everything. Whenever we have a clinical question on rounds that is outside the knowledge set of the team, my first move is to check Medscape. Invariably I find something relevant. Many physicians now routinely use the online resource UpToDate, which is a subscription service with a similar aim. Thus, because of content, chronology, and context, we have moved beyond merely collecting books to continuously exchanging ideas based on the latest (and hopefully highest quality) available research, and putting those ideas into clinical practice.

We will be changing the name of the Book Reviews section to Media and Book Reviews. This change reflects the paradigm shift that has already happened out there—medical knowledge now comes in all kinds of wrappings. If you are one of the Luddites out there holding on to your printed textbooks in your white coat pocket, it's time to get an app-capable device. Trust me, you'll need it.