This book, now in its third edition, is intended to change all that. It is designed to make the clinician fluent in the language of the medical literature in all its forms. To free the clinician from practicing medicine by rote, by guesswork, and by their variably integrated experience. To put a stop to clinicians being ambushed by drug company representatives, or by their patients, telling them of new therapies the clinicians are unable to evaluate. To end their dependence on out-of-date authority.
To enable the practitioner to work from the patient and use the literature as a tool to solve the patient’s problems. To provide the clinician access to what is relevant and the ability to assess its validity and whether it applies to a specific patient. In other words, to put the clinician in charge of the single most powerful resource in medicine.
When I was attending school in wartime Britain, staples of the curriculum, along with cold baths, mathematics, boiled cabbage, and long cross-country runs, were Latin and French. It was obvious that Latin was a theoretical exercise—the Romans were dead, after all. However, although France was clearly visible just across the Channel, for years it was either occupied or inaccessible, so learning the French language seemed just as impractical and theoretical an exercise.
It was unthinkable to me and my teachers that I would ever put it to practical use—that French was a language to be spoken. This is the relationship too many practitioners have with the medical literature—clearly visible but utterly inaccessible.
We recognize that practice should be based on discoveries announced in the medical journals. But we also recognize that every few years the literature doubles in size, and every year we seem to have less time to weigh it,1 so every day the task of taming the literature becomes more hopeless.
The translation of those hundreds of thousands of articles into everyday practice appears to be an obscure task left to others, and as the literature becomes more inaccessible, so does the idea that the literature has any utility for a particular patient become more fanciful.