With ever-increasing patient care responsibilities, long hours at hospitals and clinics, and a need to keep up with an increasingly high-tech environment, it’s no wonder that many medical professionals have little time to read medical research. There are thousands of medical studies published each year that only add to the existing pile of classic studies most medical professionals are expected to review.
Recognizing a pressing need to help physicians, nurses and other health care providers keep up with important research, Robert Wood Johnson Foundation (RWJF) Clinical Scholar (2010-2012) Michael Hochman, MD, decided to do some of the work for them in his new book, 50 Studies Every Doctor Should Know. “I’ve always had an interest in making complex medical information more accessible,” says Hochman, who has written about medicine for the Boston Globe and several other publications, and now works as an internist at the VA of Greater Los Angeles.
“I have increasingly realized that many medical professionals are not aware of the key studies that have shaped clinical medicine,” Hochman explains. ”It may be possible to practice good medicine without knowing about these studies, but a good understanding of the primary research can certainly enhance medical decision-making.”
Teaching the Top 50
Hochman began by researching thousands of studies to determine which ones had the greatest impact on the practice of medicine. “I then tried to simplify and extract the most important information from each study, then offer advice on how to apply the study findings to patient care,” he says.
The impressive range of research he reviewed is organized by topic: Preventive and internal medicine; surgery; obstetrics; pediatrics; radiology; neurology and psychiatry; and systems-based practice.
“Most of the studies included in the book were published within the past 20 years, but a few are older than that,” Hochman says. “For example, I reviewed the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial [ALLHAT]. This research is one of the most significant works available for the treatment of hypertension. I also looked at the findings of the Women’s Health Initiative, which evaluated post-menopausal hormone therapy.”
Examples of less well-known studies include a trial that compared medications to psychotherapy for the treatment of Attention Deficit/Hyperactivity Disorder, and a trial that evaluated the use of ear tubes for children with chronic ear infections.
Highlighting Key Findings
To make sure that his readers learn as much as possible about the research, Hochman was careful to emphasize findings that might help providers make better decisions. “Many doctors and nurses assume, for example, that palliative care reduces longevity in terminally ill patients, but some of the best studies in the field challenge this notion. I included a trial in my book suggesting that palliative care not only improves the quality of life for patients with advanced lung cancer, but may actually extend life. This study provides an important perspective for medical professionals who care for patients with advanced cancer.”
Another example of a study included in Hochman’s book is the Keystone ICU Project, which showed that a simple checklist protocol could dramatically reduce the occurrence of bloodstream infections in patients receiving central line catheters. “Most doctors and nurses are aware of the checklist protocol, which is now used in ICUs across the country,” Hochman says. “But I don’t think many of us realize the importance of the protocol. After reading about the dramatic success of the protocol, I think most medical professionals would follow it more faithfully.”
Self-Publishing to Protect Principles
In choosing to self-publish the book, rather than work with a big publisher, Hochman may also have set an example that could be helpful to other medical professionals who want to write about the field. “I decided to publish the book on my own because several of the publishers wanted me to expand the book to include 100 studies so that they could justify selling it for over $100. I thought that was too much money for this book and too many studies for readers to sift through.”
“Another publisher suggested that I include a handful of positive drug company studies in the hopes that this might entice a pharmaceutical company to sponsor the book. But this was not consistent with my mission,” Hochman adds.
By maintaining control of his work, Hochman was also free to select a rigorous review process. “My summaries were sent to the original study authors to be approved for accuracy,” Hochman explains. “It was my form of peer review.” Judging from the accolades received from many in the field, Hochman’s approach to the book hit the mark. “He expertly and clearly summarized the top 50 studies that influenced medicine. These summaries are balanced, scholarly and helpful. A must read," said reviewer Peter J. Pronovost, MD, PhD, a professor of medicine at the Johns Hopkins University School of Medicine and an elected member of the Institute of Medicine.
"The summary [of our study] was perceptive and accurate. I hope this and the other studies included in this work are inspirational to a new generation of clinical investigators," said Jeremy Fairbank, MD, professor of spine surgery, University of Oxford.
New Book in the Works
While completing 50 Studies, his first book, Hochman says, “I got a great deal of support from the Robert Wood Johnson Foundation Clinical Scholars program. Program mentor Ken Wells, MD, MPH, the director of the Health Services Research Center at the University of California, Los Angeles (UCLA), was incredibility supportive. He encouraged me to continue writing. I also got a great deal of guidance from the Clinical Scholars writing seminar at UCLA.”
“Now that the book is completed, I’m working on turning this into a series,” Hochman says. “I would like to produce similar books in some of the medical specialty fields—such as cardiology and oncology—with the help of colleagues from these fields. I hope that the next time around, I will work with other Clinical Scholars. My overall goal is to show medical professionals how valuable, interesting and important it is to read the medical literature.”
Clinical Scholars program
The Robert Wood Johnson Foundation Clinical Scholars program advances the development of physicians who are leaders in transforming health care through positions in academic medicine, public health and other roles. The program trains clinicians in the program development and research methods that will enable them to find solutions to the many challenges posed by the health care system, community health and health services research.