BMJ  2003;326:1228 (7 June), doi:10.1136/bmj.326.7401.1228

Editorial

What do you think of the BMJ's POEMs?

Please answer our short questionnaire on bmj.com

Just over six months ago the BMJ began publishing a weekly POEM (patient-oriented evidence that matters).¹ You can find them next to Editor's choice in a pink tinted box. They are gobbets of evidence that should be useful to clinicians. POEMs are selected by searching the current issues of over 100 peer reviewed journals, looking for relevant studies (potential POEMs), which are then evaluated for validity. The valid POEMs are summarised, and the summary is then reviewed and revised. The service is provided by InfoPOEM, a US based medical information company. Apart from some minor editing we publish them as they come. They have sparked an intense debate among editorial staff and advisers, and we want you—our readers—to tell us what you think by answering a short questionnaire on www.bmj.com

The research papers that give birth to POEMs are chosen for both their relevance to clinical practice and the validity of the research being described. Some POEMs indicate that the research is relevant but flawed. They are in essence chosen for their ability to answer (or to contribute to what we know about) a particular clinical question. For the most part these are the routine questions of daily clinical consultations: do long term inhaled steroids increase the risk of fractures in postmenopausal women, or how safe are cyclooxygenase 2 inhibitors?

InfoPOEM suggests that even if a research paper is valid it doesn't qualify as a POEM unless it addresses a question that is important to patients (and therefore their doctors). In other words, relevance is more important than validity—something that upsets some enthusiasts for evidence based medicine. As we are in the business of helping doctors do the best for their patients we think this is an attribute rather than a failing.

Some people argue that by publishing POEMs the BMJ sometimes brings attention to research that is not of the highest calibre. This may be true, but where there is very little published on an important question the paper that a POEM highlights may simply be the best available. In the context of the ever evolving world of medicine this is the way in which medical knowledge unfolds in real life. The "answer" to a particular question may change overnight with the publication of a new piece of research. Old POEMs are not revised: they are simply overtaken by events, and a new POEM is published.

To help readers understand POEMs each one includes a "level of evidence." For each category of research (diagnosis, therapy, prognosis, etc) there is an internationally established and accepted hierarchy of valid evidence. Systematic reviews are considered more valid than randomised controlled trials, which in their turn are more valid than cohort studies, and so on. Readers can thus quickly see that a POEM might have been selected—because of high relevance—and yet have low validity. These POEMs need to be treated cautiously.

Another criticism levelled at POEMs is that their pragmatic approach will stop people thinking for themselves. But practising doctors need all the help they can get to find quickly the information they need. POEMs are designed to help separate the wheat from ever increasing mountains of chaff. Their intention is to encourage people to think more, rather than leave them so overwhelmed by information overload that they give up thinking altogether.

Some readers may simply glance at "the bottom line" to find "the answer," whereas some will read more of the synopsis. The style of writing is often more chatty than the conventional BMJ scientific style, which has caused some disquiet. The style is deliberate. Those who write the POEMs believe that by writing like journalists they are making the material more accessible.

The debate about POEMs has generated discussion both inside and outside the BMJ. As part of our review of POEMs we want to find out what you think about them. Please answer our short questionnaire on www.bmj.com

Questions:

1. Are POEMs relevant to your clinical work?
   
2. Do you like the style that POEMs are written in?
   
3. Do you find the section on level of evidence useful?
   
4. Should the BMJ continue to publish POEMs?
   

BMJ (aberger{at}bmj.com)

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A short questionnaire is on bmj.com

AB is a general practitioner and oversees POEMs for the BMJ.

Competing interests: None declared.

References

1. Smith R. A POEM a week for the BMJ. BMJ 2002;325: 983.

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