Intended for healthcare professionals

Feature Christmas 2010: Reading between the Lines

On the impossibility of being expert

BMJ 2010; 341 doi: (Published 14 December 2010) Cite this as: BMJ 2010;341:c6815
  1. Alan G Fraser, reader in cardiology1,
  2. Frank D Dunstan, professor of medical statistics2
  1. 1Wales Heart Research Institute, School of Medicine, Cardiff University, Cardiff CF14 4XN, UK
  2. 2Department of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
  1. Correspondence to: AG Fraser fraserag{at}

More scientific and medical papers are being published now than ever before. Alan G Fraser and Frank D Dunstan think that new strategies are needed to deal with this avalanche of information

Every doctor has an ethical duty to keep up to date. Is this just getting more difficult or has it already become impossible? Since Alvin Toffler coined the phrase “information overload” in 1970,1 the growth of scientific and medical information has been inexorable. There are now 25 400 journals in science, technology, and medicine, and their number is increasing by 3.5% a year2; in 2009, they published 1.5 million articles.2 PubMed now cites more than 20 million papers.

One response of the medical profession to the increasing scientific basis and clinical capacity of medicine has been to increase subspecialisation. This may restrict the breadth of knowledge of the ultraspecialist, but can such subspecialists still maintain their depth of expertise? Taking one medical subspecialty as an example, we have examined the gap between information and human capacity, and we explore the implications for any doctor who wants to practise evidence based medicine.


We searched the database of the US National Library of Medicine (PubMed) on 12 September 2010 for references relating to diagnostic imaging in cardiology. Table 1 shows the search terms used.

View this table:
Table 1

Search strategies for identifying articles on diagnostic imaging in cardiology

Citations with any reference to echocardiography (the mainstay of diagnosis) were searched first, and then the strategy was narrowed to echocardiography as a main topic and restricted to controlled clinical trials (strategies 1-4; table 1). It is recommended that junior colleagues should be trained in several imaging modalities,3 and so we performed further searches for the concept of “multimodality imaging” in cardiology. This included single photon emission computed tomography (SPECT), positron …

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