An ongoing dialogue on HIV/AIDS, infectious diseases,
January 25th, 2024
Printed Medical Textbooks — Going, Going, but Not Quite Gone
Take a look at the things behind my desk at work:
- cute photos of family and dog
- a bunch of sentimental objects, gifts from grateful patients or colleagues
- a smattering of miscellaneous plaques and clocks
- pictures of our current (awesome) first-year ID fellows and other stuff
- a bunch of books, several of them many inches thick
You may not be familiar with item #5 on this list — those hefty books — so allow me to remind you what they are. Those are medical textbooks. Because if you’re like me, there’s a decent chance you haven’t opened a medical textbook in months, or even years. It’s these that we’ll be chatting about today.
There was a time when consulting these heavy tomes fortified our approach to clinical care on a regular basis. Now, many of us barely ever open them; instead, we look online to recently published papers, comprehensive reviews, the latest treatment guidelines, or other sources to stay up-to-date.
(See what I linked there? Full disclosure, I’ve been a contributor to UpToDate since its very early days, as I’ve detailed previously.)
For evidence supporting this move toward online sources and away from print textbooks, take a look at the results of this poll:
Granted, those who respond to polls on Twixter already live much of their lives online, and hence least likely to turn to an actual printed book. That’s why I repeated it below — different audience, maybe a different response. But still, if you’re a doctor, nurse, pharmacist, or student, chances are excellent you own one or more textbooks, but they’re sitting somewhere in your office, their hundreds (or even thousands) of pages as fresh as the day they left the publisher.
Here are some representative comments I received related to this post:
I literally never use paper textbooks for anything and haven’t for about a decade.
I’m 35 and have a deep nostalgia for physical print books, so I have all my old textbooks (including Harrison’s), but I never use them.
Textbooks in print? Never. Last time over 15 years ago. I do read from the textbooks online.
Have these books in my office shelf for the sentimental value. I have used them twice in last few years.
Wrote a chapter in a textbook. Received free copy. Can’t find a med student around here who will take it off my hands.
Several of these textbooks might include outdated information, pointing to a critical problem with printed books highlighted by Dr. Michael Calderwood:
They look pretty on a shelf but are already outdated by the time that they arrive. Knowledge is changing quickly, and we need readily accessible, expert curated, living documents.
Even worse, how many of us replace the old versions? Guilty as charged — I checked the publication dates on some of the textbooks displayed on my shelf. One is from 2003! Another, 1997! No doubt there are some clinical pearls in these old books, but my advanced math skills calculate that they are decades outdated. Reader beware!
Or maybe your textbook serves another function:
In our fellows’ room, we have an old version of Mandell holding up a computer monitor (which occasionally displays the electronic pdf from the new version). That’s how we use it.
Importantly, there was a vocal contrasting opinion, no doubt representing the 10-28% from the poll. And it’s so interesting that it’s not just older doctors who have this favorable view of printed textbooks! Dr. Courtney Harris, a recent graduate from our ID fellowship program, weighed in with this comment:
I love them. I probably pull one out once a month for hard clinical questions or when I just need a deep overview of something I feel like I really don’t have a good grasp on. Plus I love physical books in general – having a few in my office just gives me joy.
This minority but opinionated group must help sustain the traditional textbook market. Some who continue to use print textbooks say that they can’t learn things as deeply from online sources — a reminder that there’s no right way to learn, just that people take different paths to their own education.
But going back to the numbers from the poll, I maintain that print medical textbook users represent a small (and I suspect shrinking) group. I wonder how long this fragile relationship will continue, especially because writing, producing, and publishing these books isn’t cheap — and neither is their price tag should you want to purchase one.
I confess that exploring this topic fills me with a tinge of nostalgia, one almost reaching melancholy. It has a similar emotional effect to hearing the accounts of other print media dropping in popularity and becoming decreasingly viable economically. Newspapers and magazines (in particular) have been decimated.
Augmenting the sadness is my longstanding participation in writing for some of these texts. For generations of doctors, an invitation to contribute to these pivotal books signaled a true honor. You felt a deep responsibility to research and know the topic thoroughly, to get it just right. After all, someone reading it could make treatment decisions based on your summary of the existing literature. Authorship in these well-known reference books acted as a good way for academic physicians to plant a flag that reads, “I belong.”
Today? A colleague of mine recently submitted a revised version of a chapter to one of these pivotal texts, one that I co-author with him. As it was being revised, I seriously wondered who would ever read it. I can’t imagine the numbers would come anywhere close to a comparable topic in UpToDate, or as covered in a treatment guidelines paper.
I wouldn’t give up on the printed stuff completely, though. Not only are there still people like Dr. Courtney Harris who still value the concrete, real thing you can hold in your hand, but perhaps there’s a burgeoning market: my 20-something-year-old daughter told me recently how much she loved subscribing to the print versions of two high-quality magazines.
They arrive in her mailbox each week — her actual mailbox, not the electronic one. Imagine that.