From the Editor

From the Editors: Halsted, Holmes, and penguins


Is it not ironic that in a profession that is always seeking answers – What does this patient have? Is that mass malignant? What’s the best way to make a diagnosis? – too much information has become a major problem?

Unlike William Stewart Halsted or Theodor Billroth, who blazed surgical trails in an age when much was unknown, today’s surgeons face a jungle of information obscuring the trail ahead. Every morning we wake up to another 30 or 40 unread emails. Journals multiply on our desks. The books we need to read pile up and spill over onto our desks, bookshelves, and side tables. Sometimes, it makes one long for the old days when definitive answers might not be found in the literature. These days, we know it is likely that someone has published exactly what we need at any particular moment, and yet finding it in the jungle of information can be a great challenge.

Gentoo penguins jumping off an iceberg in Antarctic waters. S_Lew/Thinkstock
The Internet was formally hailed as the “information superhighway.” Are you old enough to remember the first time you googled a question and got the answer in a flash? It was a revelation. What you may have missed that day is the little information tab that said, “1 of 100,653.” The answer you sought was brought to you by an algorithm that prioritized the rank order. Answer #1 may have satisfied the algorithm, but in fact, answer #62,500 was what you needed. It was the one not sponsored by a certain company, yet it was hidden among the search results because the wrong keywords or some other characteristic may have baffled the algorithm.

Another outcome of too much information is the accumulation in our brains of unsorted bits of medical/surgical knowledge. Some of those bits are pearls, and others are just gum wrappers that take up space. It becomes an overwhelming task of ranking, sorting, prioritizing, and discarding.

A friend of mine years of ago called his brain an iceberg on which thousands of penguins stand. The penguins just kept coming and, finally, in order to learn anything new, he had to push some penguins off the iceberg. We have a lot of penguins on our icebergs these days.

This brings to mind many doctors’ favorite fictional character, Sherlock Holmes. That denizen of 221B Baker Street was a master at data management. He always had the right information available in his head relevant for the mystery at hand. How did he do it? Recall that Dr. Watson (a surgeon, I might add) was intermittently shocked by what Holmes didn’t know, to which the tobacco- and opiate-addicted hero would reply that he purposely forgot things that did not help him solve his cases.

And so, what is the modern surgeon – who must keep in the forefront of his or her mind every best practice, algorithm, and guideline – to do in this age of too much information? Like Holmes, we need to sort what is critical from what is not and let go of those items that no longer are germane. We then need to triage the vast amount of information delivered to us yearly, weekly, monthly, daily, hourly. The stream of little notes flashing at you from your black mirror (the screen of your mobile device) needs to be controlled lest it control you.

So, might I suggest a few strategies I have used to triage the flow of information? For hourly and daily information, I tend to ignore everything except ACS NewsScope and the ACS Communities items I find most interesting. For monthly information, I tend to use ACS Surgery News (plug intended) because it is “news” – the stuff that just happened in the meeting sphere or has not yet hit print (sorry, e-publication). The Journal of the American College of Surgeons is another monthly source that is reliable.

Dr. Tyler G. Hughes, clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus
Dr. Tyler G. Hughes
For a yearly update of information, filtered for significance, there’s nothing like the Clinical Congress. The Clinical Congress program is your filter, and the amount of solid information gained there through direct contact with the authors and leaders can’t be beat. For the huge picture, my final filter is Selected Readings in General Surgery and the Surgical Education and Self-Assessment Program (SESAP).

You may see a theme here. I’ve used the American College of Surgeons as my main filter. What gets through the editors of these outlets generally is viable and useful information. That’s what I need to know for right now. Such knowledge allows me to push those penguins no longer needed off my iceberg and greet the new ones with joy. We often wonder what the benefit of membership in the College may be. For me, these filters are worth the price of admission.

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