Author: Dr Angus Grant
Specialty Doctor, Palliative Medicine, Aneurin Bevan University Health Board
Palliative Care asks us to sit with uncertainty with patients every day. What I didn’t expect was how much of my own professional uncertainty would come from a different source: the ever-increasing volume of literature that I planned to read but hadn’t.
In my day-to-day job as a Specialty Doctor, it’s often easy to sideline this work for other, more pressing clinical duties. This isn’t a unique experience, with all of us clinicians juggling increasingly busy caseloads. As a result, keeping up to date with best practice often falls to the bottom of our priority list, potentially to the detriment of the care we deliver to our patients.
This is a piece about that problem, and about the habits we can build in our daily practice to help solve it.
The barriers I kept running into
Despite my best intentions, keeping up with the literature was a challenge. When a moment arose to undertake reading, I ran into barriers. These included:
- The volume of new evidence exceeded what I could read.
- The burden of prioritising what’s most important to read.
- Trying to balance reading in depth vs breadth.
These challenges, alongside a busy schedule, made keeping up to date with the literature feel unrewarding, and hence I frequently deprioritised it.
Reaching the unknown unknowns
Some may argue that trying to keep up isn’t necessary, with modern search engines and artificial intelligence being so efficient at providing us with answers to the questions brought to them. They will not, however, tell you what you should have brought, and help you address the gaps in your knowledge that you didn’t know existed.
Search is sufficient for the known unknown. It does nothing for the unknown unknown — the new trial, the changed guidance, the reframed debate that you would only encounter by reading broadly. Keeping up and looking up are two different jobs. Without a commitment to both, we may struggle to deliver the best possible evidence-based practice.
A new approach
It became clear that without a better system I would never manage to keep up with the sheer amount of literature published on a weekly basis. As such, a new approach was needed. Books such as Atomic Habits by James Clear advocate for a little and often, consistency focused approach to behavioural change.
What does this look like when built into our own practice? For me, this looked like adjusting how I approached keeping up with the literature. It changed my approach from sporadic ‘as and when’ cramming sessions, where little was retained, into a regular and achievable habit.
My first step was identifying a set time slot each week. This helped me transform the ‘as and when’ approach into a scheduled, intentional commitment – no matter how small this starts off as. The next step was removing the barrier of “what should I read today”. Identifying a source in advance is a big-time saver, for example, committing to catching up on the newest publications from a pre-selected journal. I make use of weekly research digests, such as The Monday Clinical Brief, which provide a summary of the most recent relevant publications in palliative care.
When undertaking reading, I’ve allowed myself permission to read the summary and stop. We’re taught in medical school to go through articles with a fine-tooth comb, but in reality, this is not practical nor necessary most of the time. Most weeks I quickly identify the two or three truly impactful papers which will change my practice and focus on these.
Top tips to sustain your new habit
Through making mistakes and improving my approach, I’ve landed on some helpful tips that may help other clinicians starting from scratch in this area:
- Start small and achievable. Overambitious plans are likely to be abandoned, and a consistent 15 minutes beats an hour that never happens.
- Schedule your reading into a regular time slot and try to stick to it. If the goal is to fit it in when the clinical work allows, it often never happens.
- Sometimes, just let the summary be enough.
- Make it social. A short message to a colleague about a paper can really help with retention.
- Forgive the missed weeks. A habit is defined by its return after a gap, not by an unbroken streak.
Three take home messages
- Keeping up and looking up are different jobs. Targeted searches do nothing for the unknown unknown.
- A small, fixed, regular reading slot is more likely to be sustained than an ‘as and when’ prolonged session that never happens.
- Not every paper needs to be read in full. Permission to read the summary and stop can help in making your new habit achievable and sustainable.
Declarations of Interests
I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: No competing interests