Comment and opinion
are involved is quite demanding and leaves them little time or inclination for involvement in other networks. In conclusion, a cross-training
program can benefit library administrators, be both positive and negative in terms of library users, and serve the desired purposes of some librarians, but not of all.
Mary Ellen Thomas Tompkins-McCaw Library Medical College of Virginia Virginia Commonwealth University P.O. Box 582 Richmond, Virginia 23298-0582
Remembering our history: the roots of knowledge* studies the page for a few moments, then turns to the librarian. "I guess I would rather have a computer search. I don't want to copy all this stuff." Professor Johnson greets a librarian in the corridor of the Medical Center. "Your online catalog is wonderful. I access it from my office, and I never come to the library anymore." Dr. Tim Walsh is a first-year resident. He smiles at the librarian. "Look at this-it's wonderful and I did it myself!" He picks up his printout with 250 citations produced from a CD-ROM database. These are daily occurrences in our institutions, and they are achieved by the advances in technology. There is nothing wrong with the technology: databases allow access to the literature that cannot be achieved through manual searchand he learned from reading how ing; the online catalog provides to use a stethoscope and to take a keyword access to holdings in a university-wide system that the history from the patient [1]. That setting was grand rounds. printed catalog cannot; and CDHere is another: The librarian ROM gives users a chance to exshows a medical student the print- plore the database without online ed Science Citation Index.t "This is charges. The technology is a trethe author you asked about and the mendous asset to librarians who specific paper from 1984," ex- seek information and who help plained the librarian. "The items users to unearth it. The technology listed below are the papers that cit- has increased our capabilities and ed the 1984 paper. Thirteen of productivity; it has enhanced our them-that will give you plenty of image and enriched the scope of relevant articles." The student our jobs. I use it. I like it. And I want every electronic device that Presented May 22, 1989, at the Eighty- helps manage and transfer inforNinth Annual Meeting of the Medical Li- mation and knowledge. What, then, is the problem? My brary Association, Boston, Massachusetts. t Science Citation Index is a registered trade- concern is that these electronic mark of the Institute of Scientific Infor- marvels have become the driving mation. force of our libraries, that we no
One of the places that a physician or scientist can tell a poignant story about a patient or write about personal concerns in medicine is in the JAMA series "A Piece of My Mind." One such "piece" was Michael A. Lacombe's description of a medical student presenting a patient at grand rounds. The student examines the patient with his hands, with a stethoscope; he observes and listens. That his diagnosis is correct astounds the audience, for he has not used the latest techniques and devices to arrive at his diagnosis. His professor chides him for not using the patient's "database," questioning how he could consider diagnosing without the aid of a computer. The student'replies that he had found some old books on physical diagnosis that were not in the database,
*
66
longer determine what we can do more effectively without them or in other ways. We do only what the machine is capable of doing. Consider the three examples: the medical student misses the unique information Science Citation Index offers because searching through the volumes takes time and so she chooses a quick computer search instead; the professor knows only those resources he finds in an inadequate search of the online catalog, but no longer handles or browses through the riches of the library's collection; and the resident retrieves hundreds of citations, wondering why so many seem irrelevant. The machines performed their tasks very well, but the librarians did not provide these users with the best sources and information. Lewis Thomas says, "Medicine is no longer the laying on of hands, it is more like the reading of signals from machines" [2]. Of course, many of these machines help to cure patients and Thomas' concern is not that the change has made the doctor less able to cure the patient, but that the doctor-patient relationship has lost meaning. He adds, The close-up, reassuring warm touch of the physician, the comfort and concern, the long, leisurely discussions ... are disappearing from the practice of medicine, and this may turn out to be too great a loss, for the doctor as well as for the patient [3].
Are we librarians so enamored with our electronic tools that we Bull Med Libr Assoc 78(1) January 1990
Comment and opinion
fail to notice the diminishing use of our minds as a source of knowledge? In our rush to become technology-oriented, are we neglecting to give the students in our discipline an understanding of the literature, the history, the traditions that have formed the basis of our profession? Will library schools, in response to our demands, turn away from the training in bibliography, cataloging, indexing, and the construction of literature in order to focus on the wonders of mechanization? Many schools are eliminating the study of cataloging because of the emergence of OCLC and RLIN, despite the fact that catalogers' background and understanding are critical to the development of the online catalog. It is the reference librarians, with their knowledge of the literature, who can give the best assistance in the development of databases and indexes. Yes, we must use the computer to enhance our capabilities, but we must not abandon the underpinnings of our profession. Traditionally, the librarian has been the expert in the world of literature. The reason: the fundamental understanding of how knowledge is organized, how literature is constructed, and how to follow the information trail. Before the advent of databases, librarians created bibliographies by searching and reading the literature. It was painstaking and time consuming, and you were often required to read the articles and chapters to determine their relevancy and accuracy. You were required to find the original source and to follow the information derived from it. In the process, you handled many resources in order to find the best one. These experiences linked librarians to the scholarly community. In a recent lecture, Estelle Brodman posed several questions. Will journals cease to publish, ending one of our uses of literatureBull Med Libr Assoc 78(1) January 1990
browsing through the riches of biomedicine? Will the tendency of many busy physicians to want only the latest information result in a societal forgetfulness of what has been uncovered in the past? Who will teach the methods of information transfer; who will ensure that medical information continues to be available [4]? Librarians must influence the answers to these questions. Today's complex educational process for health professionals places increasing emphasis on self-directed learning and problem solving. Educators are concerned to give their students the skills and techniques for life-long learning, instilling the curiosity, the doubt, and the questioning that is necessary to the scientist's mind. Librarians are a part of the academic process, and as we move into the information age of the next century, we need to maintain a balance between our use of and demands for technology and the unique skills librarians derive from their understanding of literature, how knowledge is organized, the history and bibliography of med-
icine. In earlier days, the profession of librarianship was clearly defined. Everyone knew what a library was and what a librarian did. Positions such as "cataloger" or "reference librarian" had job descriptions that varied little from institution to institution. If you were a library director, you managed a staff that built collections and provided information services. Literature and the information derived from it was the stuff of librarianship, the center of our circle. Today, those descriptions are much too narrow. Automation has widened our horizons so that cataloging and reference no longer fully describe what we do. Today, we are building networks, linking institutions and databases. We are learning to index information and combine electronic data with print and nonprint resources, providing
the user with the most relevant information possible. Librarians must be the communicators, the conduit between the modes of accessing information and the medical information. Librarians understand the literature and how to make it available. There are medical students who may never read Osler, or handle a Vesalius or a Jenner, who may never discover Fleming's original article on penicillin, or revel in the modern medical writers such as Thomas, Medawar, Sacks, or Selzer. These students miss the richness of medicine. Richard Selzer says, In the matter of physical diagnosis greed is not a sin; it is a virtue. There can never be enough hearts and lungs to teach a doctor his business. Do not rely upon the X-ray machine, the electrocardiograph, or the laboratory to tell you what your hands, eyes, and ears can find out, lest your senses atrophy from disuse. The machine does not exist that can take the place of the divining physician [5].
If you substitute the word "information" for "physical diagnosis," then greed for knowledge is a virtue. There can never be enough books, journals, and databases to teach a librarian his business. We must not rely on machines to do our work, for they can retrieve information, but they cannot think or draw on years of experience, or put together bits and pieces from a variety of sources. The machine does not exist that can take the place of the thinking, knowledgeable librarian.
Lucretia W. McClure Medical Librarian and Associate
Professor of Medical Bibliography Edward G. Miner Library University of Rochester School of Medicine and Dentistry Rochester, New York 14642 67
Comment and opinion
References 1. LACOMBE MA. The cabalist. JAMA 1988 May 27;259(20):3045. 2. THOMAS L. The youngest science: notes of a medicine-watcher. New York: Viking Press, 1983:58-60. 3. Ibid.
68
4. BRODMAN E. Toward the future medical libraries. Paper presented the University of Rochester School Medicine and Dentistry, October 1987.
of at of 6,
5. SELZER R. Letters to a young doctor. New York: Simon and Schuster, 1982: 17.
Bull Med Libr Assoc 78(1) January 1990
are involved is quite demanding and leaves them little time or inclination for involvement in other networks. In conclusion, a cross-training
program can benefit library administrators, be both positive and negative in terms of library users, and serve the desired purposes of some librarians, but not of all.
Mary Ellen Thomas Tompkins-McCaw Library Medical College of Virginia Virginia Commonwealth University P.O. Box 582 Richmond, Virginia 23298-0582
Remembering our history: the roots of knowledge* studies the page for a few moments, then turns to the librarian. "I guess I would rather have a computer search. I don't want to copy all this stuff." Professor Johnson greets a librarian in the corridor of the Medical Center. "Your online catalog is wonderful. I access it from my office, and I never come to the library anymore." Dr. Tim Walsh is a first-year resident. He smiles at the librarian. "Look at this-it's wonderful and I did it myself!" He picks up his printout with 250 citations produced from a CD-ROM database. These are daily occurrences in our institutions, and they are achieved by the advances in technology. There is nothing wrong with the technology: databases allow access to the literature that cannot be achieved through manual searchand he learned from reading how ing; the online catalog provides to use a stethoscope and to take a keyword access to holdings in a university-wide system that the history from the patient [1]. That setting was grand rounds. printed catalog cannot; and CDHere is another: The librarian ROM gives users a chance to exshows a medical student the print- plore the database without online ed Science Citation Index.t "This is charges. The technology is a trethe author you asked about and the mendous asset to librarians who specific paper from 1984," ex- seek information and who help plained the librarian. "The items users to unearth it. The technology listed below are the papers that cit- has increased our capabilities and ed the 1984 paper. Thirteen of productivity; it has enhanced our them-that will give you plenty of image and enriched the scope of relevant articles." The student our jobs. I use it. I like it. And I want every electronic device that Presented May 22, 1989, at the Eighty- helps manage and transfer inforNinth Annual Meeting of the Medical Li- mation and knowledge. What, then, is the problem? My brary Association, Boston, Massachusetts. t Science Citation Index is a registered trade- concern is that these electronic mark of the Institute of Scientific Infor- marvels have become the driving mation. force of our libraries, that we no
One of the places that a physician or scientist can tell a poignant story about a patient or write about personal concerns in medicine is in the JAMA series "A Piece of My Mind." One such "piece" was Michael A. Lacombe's description of a medical student presenting a patient at grand rounds. The student examines the patient with his hands, with a stethoscope; he observes and listens. That his diagnosis is correct astounds the audience, for he has not used the latest techniques and devices to arrive at his diagnosis. His professor chides him for not using the patient's "database," questioning how he could consider diagnosing without the aid of a computer. The student'replies that he had found some old books on physical diagnosis that were not in the database,
*
66
longer determine what we can do more effectively without them or in other ways. We do only what the machine is capable of doing. Consider the three examples: the medical student misses the unique information Science Citation Index offers because searching through the volumes takes time and so she chooses a quick computer search instead; the professor knows only those resources he finds in an inadequate search of the online catalog, but no longer handles or browses through the riches of the library's collection; and the resident retrieves hundreds of citations, wondering why so many seem irrelevant. The machines performed their tasks very well, but the librarians did not provide these users with the best sources and information. Lewis Thomas says, "Medicine is no longer the laying on of hands, it is more like the reading of signals from machines" [2]. Of course, many of these machines help to cure patients and Thomas' concern is not that the change has made the doctor less able to cure the patient, but that the doctor-patient relationship has lost meaning. He adds, The close-up, reassuring warm touch of the physician, the comfort and concern, the long, leisurely discussions ... are disappearing from the practice of medicine, and this may turn out to be too great a loss, for the doctor as well as for the patient [3].
Are we librarians so enamored with our electronic tools that we Bull Med Libr Assoc 78(1) January 1990
Comment and opinion
fail to notice the diminishing use of our minds as a source of knowledge? In our rush to become technology-oriented, are we neglecting to give the students in our discipline an understanding of the literature, the history, the traditions that have formed the basis of our profession? Will library schools, in response to our demands, turn away from the training in bibliography, cataloging, indexing, and the construction of literature in order to focus on the wonders of mechanization? Many schools are eliminating the study of cataloging because of the emergence of OCLC and RLIN, despite the fact that catalogers' background and understanding are critical to the development of the online catalog. It is the reference librarians, with their knowledge of the literature, who can give the best assistance in the development of databases and indexes. Yes, we must use the computer to enhance our capabilities, but we must not abandon the underpinnings of our profession. Traditionally, the librarian has been the expert in the world of literature. The reason: the fundamental understanding of how knowledge is organized, how literature is constructed, and how to follow the information trail. Before the advent of databases, librarians created bibliographies by searching and reading the literature. It was painstaking and time consuming, and you were often required to read the articles and chapters to determine their relevancy and accuracy. You were required to find the original source and to follow the information derived from it. In the process, you handled many resources in order to find the best one. These experiences linked librarians to the scholarly community. In a recent lecture, Estelle Brodman posed several questions. Will journals cease to publish, ending one of our uses of literatureBull Med Libr Assoc 78(1) January 1990
browsing through the riches of biomedicine? Will the tendency of many busy physicians to want only the latest information result in a societal forgetfulness of what has been uncovered in the past? Who will teach the methods of information transfer; who will ensure that medical information continues to be available [4]? Librarians must influence the answers to these questions. Today's complex educational process for health professionals places increasing emphasis on self-directed learning and problem solving. Educators are concerned to give their students the skills and techniques for life-long learning, instilling the curiosity, the doubt, and the questioning that is necessary to the scientist's mind. Librarians are a part of the academic process, and as we move into the information age of the next century, we need to maintain a balance between our use of and demands for technology and the unique skills librarians derive from their understanding of literature, how knowledge is organized, the history and bibliography of med-
icine. In earlier days, the profession of librarianship was clearly defined. Everyone knew what a library was and what a librarian did. Positions such as "cataloger" or "reference librarian" had job descriptions that varied little from institution to institution. If you were a library director, you managed a staff that built collections and provided information services. Literature and the information derived from it was the stuff of librarianship, the center of our circle. Today, those descriptions are much too narrow. Automation has widened our horizons so that cataloging and reference no longer fully describe what we do. Today, we are building networks, linking institutions and databases. We are learning to index information and combine electronic data with print and nonprint resources, providing
the user with the most relevant information possible. Librarians must be the communicators, the conduit between the modes of accessing information and the medical information. Librarians understand the literature and how to make it available. There are medical students who may never read Osler, or handle a Vesalius or a Jenner, who may never discover Fleming's original article on penicillin, or revel in the modern medical writers such as Thomas, Medawar, Sacks, or Selzer. These students miss the richness of medicine. Richard Selzer says, In the matter of physical diagnosis greed is not a sin; it is a virtue. There can never be enough hearts and lungs to teach a doctor his business. Do not rely upon the X-ray machine, the electrocardiograph, or the laboratory to tell you what your hands, eyes, and ears can find out, lest your senses atrophy from disuse. The machine does not exist that can take the place of the divining physician [5].
If you substitute the word "information" for "physical diagnosis," then greed for knowledge is a virtue. There can never be enough books, journals, and databases to teach a librarian his business. We must not rely on machines to do our work, for they can retrieve information, but they cannot think or draw on years of experience, or put together bits and pieces from a variety of sources. The machine does not exist that can take the place of the thinking, knowledgeable librarian.
Lucretia W. McClure Medical Librarian and Associate
Professor of Medical Bibliography Edward G. Miner Library University of Rochester School of Medicine and Dentistry Rochester, New York 14642 67
Comment and opinion
References 1. LACOMBE MA. The cabalist. JAMA 1988 May 27;259(20):3045. 2. THOMAS L. The youngest science: notes of a medicine-watcher. New York: Viking Press, 1983:58-60. 3. Ibid.
68
4. BRODMAN E. Toward the future medical libraries. Paper presented the University of Rochester School Medicine and Dentistry, October 1987.
of at of 6,
5. SELZER R. Letters to a young doctor. New York: Simon and Schuster, 1982: 17.
Bull Med Libr Assoc 78(1) January 1990
