I remember as a medical student, which was some time ago (over 25 years ago to be truthful), that if I wanted to find a journal citation as part of a literature search, then I had to search by hand, a collection of tomes called Index Medicus (ring a bell anyone?). It was published monthly and I checked recently, it ceased publication in 2004. It was replaced by CD and then on line products which if you think about it, is a natural progression in the evolution of technology within the publication industry. However progress moves on even more quickly, our practice library is rarely used now, despite being well stocked. It just can’t compete with some fantastic and often free on line medical knowledge bases.

It is not just the medical world that is changing, newspapers are struggling to compete with the ferocious competition from on line news sources which can update within seconds. Trusted and long standing news purveyors are jockeying for your eyeballs along with new upstarts on the web. As a result, print editions of newspapers are suffering and big cities such as San Francisco may soon be without their local daily newspaper. Mobile devices such as the BlackBerry and the Kindle allow us to read on the move. The days of reading a newspaper or even any paper based reading source in its traditional format, may be numbered.

In medicine, the pace is frenetic. Medical records are commonly transforming into an  electronic format though the process is far from complete with many institutions still dependant on paper. Meanwhile medical journals and textbooks commonly have a companion website or even may exist digitally only. Even better, free access to some of the contents of medical journals is available, sites such as http://www.freemedicaljournals.com/ can point you in the right direction. Free access to medical books is also available via http://www.freebooks4doctors.com/ and often if you purchase a medical textbook, it comes with access to a companion website. Often containing the contents of the book and more.

There are also excellent, high quality knowledge bases which are freely available on line, take for example the superb NHS Clinical Knowledge Summaries. Such top quality and reliable web sites are updated regularly and frequently, something that books just cannot compete with. Furthermore such web sites can offer multi-media presentations such as clinical examination, again something that paper based resources will struggle to deal with.

With the proliferation of broadband and easy access to high speed internet enabled computer terminals, certainly in the developed world, it is easy to see why paper is no longer the superior medium for knowledge distribution.

Sure the death of paper has been prophesised for some time but I think we are on the cusp of the next digital revolution when we will rely more and more on screens rather than hard copy. Part of the reason may simply lie with the fact that a whole generation of workers, such as medical students ready to graduate have grown up relying on electronic mediums rather than traditional paper based storage methods. These people are graduating on to the job market, at ease with digital storage and using on line knowledge sources as a primary source of  medical information. They don’t need as much paper as their predecessors. This up and coming generation of workers are the Twitter and Facebook generation who will set the tone for years to come.

Don’t worry, I am sure paper will be with us a little while longer, it is not dead yet but it is dying and its use in the future could be far less than now. Old habits die hard but remember what happened to Index Medicus.

Harry Brown is a general practitioner in Leeds

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