Richard Smith: Review of “bring back browsing”

Richard SmithAlthough I bemoan prepublication peer review, I do a fair bit of reviewing. I’m never quite sure why, but it’s probably that I’m still insufficiently practised at saying no. I reviewed for the BMJ Jerry Kassirer’s article published last week in which he regrets that young doctors don’t browse more. I wasn’t greatly impressed, and one of my arguments was that the world of Twitter and other social media means that there is more browsing than ever.

Anyway, I thought that I’d share my review with you. One positive result from my review was that Jerry, who was once editor of the New England Journal of Medicine, removed the word hortatory. Here goes:

“I’m unconvinced that me reviewing this article adds much value. It’s for the editors to decide how much they like the article, but I’ll add my comments anyway.

1. I’m not convinced that young people are not browsing or that things are any worse than they were. The first survey that Jerry quotes shows about a quarter of residents reading more than 7 hours a week, which I find high. And the second survey finds medical clerks to be reading on average of 10.8 hours a week, which strikes me as very high. The first survey shows that residents were concentrating primarily on reading around patients, which rightly Jerry applauds. My experience is that many young doctors read primarily for exams, which seems to me less admirable than reading in relation to patients. My experience is also that young doctors read for considerably less than 8 or 11 hours a week. I’m not sure that as a young doctor working an 80 hour week I read anything at all—apart from the novels that have always been important to me.

2. Like Jerry I meet with young doctors all over the world, and I usually ask them what they read. I ask for a show of hands and find fairly consistently that half read the NEJM (which will please Jerry), the Lancet, a local journal, and a specialist journal, a third the BMJ, and most a local newspaper. About half are reading a novel, and about a third have read a poem in the past week. Almost all are on Facebook but very few on Twitter. (This may be of course what they say they read rather than what they actually do read, but that’s a problem with all surveys.)

3. Jerry makes “no excuse for the hortatory style,” and inevitably this article reads like an old man bewailing a lost golden age (which, I suspect, like most golden ages never existed). Such an article may appeal to your “grumpy old men” readers but may be passed over quickly by anybody under 45. (I ought to explain to you, Jerry, that “Grumpy old men” is a very popular television programme in Britain. My brother, who is two years younger than me, is prominent in the programme.)

4. Like many of your readers, I suspect, I had to look up “hortatory.” To save you the trouble it means: “urging to some course of conduct or action; exhorting;encouraging: a hortatory speech.”

5. Jerry bemoans empty libraries, but I think he may severely underestimate how electronic media, particularly social media, make it easy for people to browse or at least to encounter material that that they weren’t searching for. I’m an enthusiastic user of both Facebook and Twitter, and at least once a day—and often much more often—I access articles in a wide range of publications, most of which I don’t read routinely that I’ve been pointed to by Tweets or friends on Facebook. People point me towards all sorts of things that I wouldn’t have, otherwise, discovered. I also belong to several listserves that point me towards material that I wouldn’t otherwise reach. One of these listserves is run by young doctors interested in global health. Generally young people use social media and listserves much more than older people.

6. Jerry says that “few [young doctors] subscribe to a clinical journal despite the low cost,” but most doctors receive several journals through the professional organisations to which they belong and many free newspapers that include clinical material. Plus many receive the electronic table of contents to journals, including open access journals from PloS, Biomed Central, and other open access publishers and can access articles simply by clicking on links.

7. Jerry writes that “Paradoxically, browsing keeps one up to date more effectively [than using up-to-date and other electronic sources],” but I’m very sceptical that this is the case.

8. In short, I think that Jerry may be pining for an age that never existed, patronising young people, and failing to understand the new, electronic ways in which people, especially young people, access a wide range of material. So I suppose I’m against this article, although it’s ironic that I’ve spent so much time thinking about the piece and  written an opinion almost as long as it.

Competing interest: I know Jerry, although not very well, and we tend to have very different ways of looking at the world.”

Richard Smith
was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.