Doctors and the Reality of Information Overload

August 22, 2011

Perhaps the biggest challenges facing the next generation of physicians is information overload.  The problem: Unlimited information on limited human bandwidth.  There’s simply too much to read and see.  For physicians the problem is compounded by a perceived responsibility to keep up.

But the idea that we actually can have our hands around everything is reflective of a time when doctors actually could know all there was to know.  Many of today’s physicians were raised at a time when a paper inbox and a pile of journals represented their only information inputs.  But things are very different now.

Here are a few ideas on controlling your inputs:

Accept that you can’t keep up.  I raise this idea at the risk of sounding horribly pessimistic.  But it’s a critical first step in making peace with the new world around you.  Recognize that you are powerless over the volume of information available to any one doctor.  Then you can begin to develop realistic strategies for capturing what you need.

Understand the difference between what you want to know and what you need to know.  These are two very different things. Capturing what you need to know is an approachable goal. Trying to capture all that you want to know is much more difficult and is likely to result in ongoing stress. I try to think of my information inputs in two categories: core inputs and wildcard inputs. My cores consist of clinical information on EPIC, 2-3 journals, 3 email accounts, and about a dozen blogs/news sites. My wildcard inputs include my Twitter feed, Google+, non-fiction books, and other interesting things that find their way into my world.

Allow time for serendipity.  My cores are what I feel I need to stay on top of; my wildcards are the gravy – they’re where I get most of my good ideas. I try to crush my cores in the most efficient way possible (always a struggle) so that I can enjoy the serendipity of my wildcards.  My cores are my homework, my wildcards are playing.

Create a system that brings information to you.  A decade ago we used the web to find information. Now information finds us through our social networks. Surround yourself with brilliant individuals who will bring you what you need. Use their eyes and ears find what you need. I have traditionally followed very select individuals on Twitter for this very reason.  Now on Google+ I am experimenting with circles that contain information from the best curators available.

I have been working recently with the folks from the C3N Project and I participate in their Social Cast network. Here I have some of the brightest health innovators in the free world sharing things in one very concentrated feed. They bring me information that I could never find. I also reciprocate with my best information.

Minimize noise.  The key to successful input management is the minimization of noise. And on social channels this means listening to those with the best signal (information) and tuning out those making the most noise.  Ruthless tuning and control of who you let in is so important.  The sooner you abandon the dated concept of the ‘courtesy follow’ the closer you will be to defining the signal you need.  I struggle with email noise and work desperately to keep ads and non-critical communication out of my inbox.

But what if you miss something?  You will.  Get over it.  Make peace with what you need to know and have fun with the rest.  Follow as little as you can get away with and then trust that if information is important, it will find you.

This is a work-in-progress for me and I’ll have more to say as I harness my ideas.  How do you manage inputs?


{ 13 comments }

Ed August 22, 2011 at 11:02 am

This is an excellent, timely post Doc,
and it is relevant for everyone, not just doctors.
Thank You for penning it; I plan to send people to this post, indefinitely.

DrV August 22, 2011 at 11:22 am

Thanks, Ed. I’m always tempted to extrapolate my ideas to the general public but seem to keep it myopic. I’ll work on that. These principles apply to doctors, nurses, librarians and anyone for that matter.

Margaret Henderson August 22, 2011 at 11:13 am

You could add: Consult a medical librarian or informationist to help find and filter your information.

We can do the searching of the literature for you and set up alerts that will send you the most recent articles from PubMed or any other source. In some cases, we have the expertise to filter out what won’t be useful and just send you a couple of good articles.

DrV August 22, 2011 at 11:23 am

Interesting, Margaret. The medical librarian, like the doctor, is under redefinition in the new world order. This would seem like a potentially critical role.

Thomas Getchius August 22, 2011 at 11:15 am

Hi Bryan,

Great post on physician overload; there is SO much “stuff” out there. One way the American Academy of Neurology (AAN) serves our physician members is to develop evidence-based, clinical practice guidelines (I’m a staff member at AAN). When we can’t make high level recommendations, we still publish the systematic review, which is helpful for our members and other physicians.

Susannah Fox August 22, 2011 at 12:52 pm

Hi Bryan,

I have two thoughts to share about curation.

My inputs are pretty similar to yours, but in my own field: the social impact of technology.

I was chatting with a colleague here at Pew Internet today about LinkedIn (and how we basically don’t use it) when she surprised me by saying that their “internet headlines” email is consistently excellent. Whoever curates it finds a way to feature headlines that my very plugged-in colleague hasn’t seen before, but which are relevant to her work. That’s about as good as it gets, right? So while I do love Twitter, I’ll click that LinkedIn email next time it pops up. Planned serendipity.

Second, pertinent to your situation as a doctor, what about going beyond “accept that you can’t keep up” and acknowledging patients as potential colleagues who can help you keep up?

Dan Hoch, MD, wrote an essay, “What I’ve Learned from E-Patients,” back in 2005 and it’s relevant (even revolutionary) today.

Here’s an excerpt:

“I have also learned that an online group like the BrainTalk Communities epilepsy group is not only much smarter than any single patient, but is also smarter, or at least more comprehensive, than many physicians—even many medical specialists. While some postings do contain erroneous material, online groups of patients who share an illness engage in a continuous process of self-correction, challenging questionable statements and addressing misperceptions as they occur. And while no single resource, including physicians, should be considered the last word in medical knowledge, the consensus opinion arrived at by patient groups is usually quite excellent. And if more expert clinicians offered to consult informally with the online support groups devoted to their medical specialties—as I now do—we could help group members make information and opinion shared in these groups even better.”

See:
http://e-patients.net/archives/2010/05/what-ive-learned-from-e-patients-doc-tom-and-dan-hoch-2005.html

Not every patient is ready & willing to read up on their condition and provide research assistance (essentially) to their clinicians, but some are. I know C3N is building a system to bring in that kind of patient/caregiver to the learning network — is it part of Social Cast yet?

DrV August 22, 2011 at 4:40 pm

The ‘patient as input’ idea is interesting, Susannah, and I guess I do this but not formally. Or, I should say, they do it for me. I recall very recently a girl with ulcerative colitis and liver complication called sclerosing cholangitis. The family informed me of a newly reported trial with the use of oral vancomycin to treat PSC. Ironically, the study was in a journal on my desk. So patients are taking this role on by themselves, some to a greater degree than others.

The concept of a formal forum for this is interesting. C3N hasn’t yet put patients and doctors together but it has been discussed under the ImproveCareNow network for IBD. The challenge as a provider is that we treat so many conditions and offering attention to so many select communities presents obvious challenges when it comes to info overload.

Thanks for chiming in. And wow, 2005. E-patients.net is getting’ old!

Paul Sufka August 22, 2011 at 1:18 pm

Great post. I agree completely that. Information overload is a huge problem… I think we have to find ways to control and filter the information we take in, we also have to deal with finding ways to access the information that we actually did find useful again…. I posted recently on my blog on how I personally deal with the later: http://paulsufka.com/2011/08/03/cloud-computing-for-physicians/

Alex August 22, 2011 at 3:10 pm

Terrific advice, and not just for doctors. I’m an autism mom (the evidence-based kind, not the other kind). I struggle to keep up with research that may help my son. The “noise” from snake oil and fraud is overwhelming at times. I especially love your last point, that good information will find you if you keep good sources, as the Fear of Missing Out is personally urgent for me.

I am glad I have kept your blog on my short list of must-reads. You make good use of the Seth Godin style of blogging, with small, useful entries, rather than a torrent of banality with the occasional nugget.

Margaret Henderson, thank you for recommending the services of a medical librarian or informationist. That had never occurred to me.

DrV August 22, 2011 at 4:41 pm

Thank you for those kind words, Alex….

Matt August 23, 2011 at 9:27 am

Great post – one that really applies to just about any professional. I think it’s now a common occurrence when a client/patient comes in after having read some breaking news and the professional doesn’t know about it because they haven’t had the time to seek it out. Unfortunately, the client/patient then feels as though they aren’t paying for a quality professional’s care as a result. It’s one of the drawbacks of limited time in combination with unlimited information.

Kendra August 23, 2011 at 11:16 am

As the mother of two medically complex children, I strive to practice the filtering that you advocate to identify and maintain contact with good sources of information. As an E-patient parent, your words serve as a gentle reminder that it is appropriate for physicians to initially know less about my children’s medical conditions than I. Rather it is the willingness to accept my information and to utilize additional appropriate sources that defines a physician’s qualification to serve as a member of our medical team.

Andreea August 25, 2011 at 9:22 am

Excellent comments and a one of a kind perspective! In an effort to find this balance in life, mediocrity to an extent, might very well be what can help dealing with the simple fact of “missing” of an important piece of information.

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