The failure of modern textbooks

I cannot see why a doctor needs to know who discovered oxygen and
where the name comes from. Roger K Allen may be confusing a degree with
medicine with one in chemistry or the history and philosophy of science.

Competing interests:
None declared

Fresh from the textbook drenched nights of medical school, I present
the student perspective.

The modern medical student remains time pressured. A fundamental
imbalance exists; an unrelenting requirement to acquire masses of facts
inextricably linked to incessant formal assessment yields little time to
simply enjoy medicine. The concise, pragmatic layout of the ’typical’
modern textbooks, that readily double up as revision notes, are much
appreciated and easily devoured by students hungry for only essential exam
facts. Such texts may be considered the academic equivalent of a microwave
meal; the basic bodily requirement is fulfilled but much editing and
processing curbs both intellectual nourishment and academic pleasure. This
perhaps brings into question the educational establishment and the type of
doctor we are attempting to generate.

I believe it crucial for a scientific text to be crisp, partly due to
the nature of the material conveyed and largely due to time constraints.
Acquiring clinical knowledge in itself can be most fulfilling, having that
conveyed with literary flair could, indeed, boost the learning experience.
I advocate moderation. Perhaps medical textbooks also require labels
showing carefully determined portions or ‘Recommended Daily Amounts’ of
wit, anecdote and ‘additional’ knowledge amidst the indispensable
information. I deem the Oxford Handbook of Clinical Specialties as a
modern text partly on its way to satisfying the requirements of the more
desirable ‘holistic’ text; dominated by clinical knowledge and punctuated
with a little introductory anecdote, a few snippets of medical history and
even some lines of humour acting as pleasant surprises in a sea of
evidence based fact.

Competing interests:
None declared

Dear David if I may use my colonial informality,
I observe that we have entered a computer age where the
consumer is used to a more interesting and creative medium;
interactive, palatable and alluring and not a Metro time
table.

My son at junior high school now has a Toshiba tablet on
which all his work is done, with the teacher being able to
see any tablet in class as they are all linked. They are
not sitting down as I did as a kid with a slate or pen with
nibs and ink.

The old recipe for a text book has reached its "used-by
date". I think this applies to journals too but that is
another matter. The recipe has been reached because editors
are conforming to what they see as a scientific recipe but
is is more than that; it is "safe" and boring to boot. The
crême brulée has no caramelised sugary crust and the taste
is bland. We are getting Spam instead.

As one who has participated in writing textbooks as an
author, one is given blinkers and hobbles and told to stay
within the guidelines. The remuneration is also abysmal for
the work it takes. If medical publishing is going to
succeed, it has to attract back the disaffected like me.

I cannot see why a book cannot teach as most currently
don't. They present facts and that is not teaching. The
reader either has the stuff taught by an external source
e.g. medical teacher/tutor or learns to navigate the stuff
and works out a teaching method himself.

I am currently learning Greek and have a teacher and
observe that the book which is all in Greek (no English),
teaches up to a point but could be made so much more useful
with specific teaching points, footnotes, reference to
words in English, Ancient Greek, or how to remember a word
which seems impossible to remember; sort of aides mémoires.
The editor and author are not putting themselves in the
shoes of the reader who is a novice. In a nutshell, it's
all Greek to me.

It is also possible now to have a website attached to
textbook for further reference, footnotes etc. Teaching
takes more intellectual input than just presenting facts
and what may appear to be patently simple and clear to the
boffin writing the book, may be less than simple to the
novice reader. Just look at the chapter on pseudo-
pseudohyperparathyroidism etc or porphyrias and see how the
authors fail to show you how to remember them.

Rapid Responses is just one example of the change in
publishing. We can now discuss "live" rather than writing a
letter with quill and ink six months after the BMJ arrived
by clipper ship to Australia and long after you Poms had
read it.

Kind regards,
Roger Allen

Competing interests: None

If there is a dilemma, which is not uncommon in practice, I delve
into medical textbooks of 70s or even earlier for a comprehensive
description of clinical history, symptoms and signs. I have collected
these old textbooks from a local library when they were discarded to make
room for the new ones.The next step is to pick up one of the popular
handbooks for a synopsis and this is supplemented by the modern textbooks
for management including investigations and treatment. Searching web and
journals complete the information gathering particularly in terms of
research and practice, which have not yet included in the most recently
published textbooks.As the saying goes "a place for everything and
everything in its place".

shah.tauzeeh@barnet-pct.nhs.uk

Competing interests:
None declared