Why Online Social Networking Should Change What We Know about Health Care

The rise of ubiquitous online connectivity is bringing a new era to healthcare

Apr 14, 2012 - Production Blog Author


Editor’s Note: Henry Wei, MD, is a board-certified internist and a
Clinical Instructor in Medicine at Weill-Cornell Medical College. He is
currently a Senior Medical Director at Aetna, where he leads Clinical
Research & Development for ActiveHealth Management. (The views expressed
here are the author’s alone and do not represent those of his employer.)

Introverts make up about half the population. In any given year, about 7% of
Americans are also suffering from social phobia, a fear of being in public so
great that’s defined in part by a tendency to get in the way of daily life.
What happens to the health care experience for these demographics? If it’s at
best uncomfortable and at worst panic-provoking to venture out into the world,
does it become impossible for some to seek psychiatric care, let alone regular
medical care?

My bet is that the online experience is changing this, and in particular, doing
so for health care interactions. What happens when computers, tablets and
smartphones start to allow patients to communicate with doctors and therapists
in a virtual space? The rise of ubiquitous online connectivity between patients
and their physicians is bringing a new era to those who prefer to interact from
the safety of their own environments. As a result, there’s currently no
shortage of telepsychiatry startups in the current Health IT bubble, among them
BreakThrough, iCouch, Cope Today, and HealthLinkNow. Behind
the safe, bullet-proof glass of, say, an iPhone or iPad with a front-facing
camera, perhaps it becomes easier to think about visiting a mental health
professional. (Parking, at least, is no longer a concern.)

These seemingly innovative startups may owe a lot to Dr. Warner Slack, a
passionate but otherwise mild-mannered forefather to modern medical
informatics. In the 1960s, while still a neurology resident, Dr. Slack was at
the front of the incipient patient empowerment movement. He was also wildly
optimistic about the use of computers in medicine–this, in the pre-PC era. By
the end of that decade, he had developed computer systems that could directly
engage with patients. Already then, he noted in one seminal paper, nearly 50%
of the 275 patients he studied preferred interacting with the machine, while
only 30% preferred interacting with the doctor. Furthermore, a small but
significant contingent indicated that they preferred both!

Dr. Slack’s findings about how people interface with computers to disclose and
explore their health information would go on to be replicated in different
ways. Other researchers, for example, would show that people in emergency rooms
are more likely to disclose sensitive information about domestic violence and
substance abuse to a computer than to a human clinician. Importantly, we see
these behaviors even more strongly today: On social networks such as Facebook
and Twitter people often feel at liberty to not only reveal the mundane, but
also to expose the deepest, most personal aspects of their lives online.

So, as physicians, we may be foolish to believe that our in-person, one-on-one
scheduled ~12 minute way of interacting with patients will last. Increasingly,
that’s a tough sell when compared to a longitudinal, technology-based
engagement with 24/7 access–all with the benefit of being able to solicit more
in-depth information from introverts or social phobia patients in particular.
It might feel heretical to think that a doctor wouldn’t be the person to figure
out, for example, if patients blood pressure medications are ruining their sex
lives. But in good technology, there’s not only a certain non-judgmental facade
of the machine, there are also ways to gather information that aren’t mutually
exclusive with good bedside manner.

I’ll go out on a limb here to suggest that we can no longer accuse medicine of
being a profession of luddites. For approximately, two decades, we’ve seen
doctors claim that poor electronic medical record adoption is due to old timers
“just not getting it.” That excuse is wearing thin.

We’ll need to push together to figure out the right way to adopt the best
models to start using technology not just for keeping records or ordering drugs
or tests, but to interact with patients. To this end, it would behoove
physicians to consider the opportunity for social networking platforms to
elicit deep, meaningful conversations about the patient experience–check out
IAmA posts on Reddit for example.

As Wendy Sue Swanson(@seattlemamadoc) recently stated it, and as I’ll
horribly paraphrase, we can certainly follow defensive guidelines on the use of
social media such as the AMA Policy: Professionalism in the Use of Social
Media
, but what we need are pioneers to help guide us as how to unlock and
unleash the power of these platforms to effect positive change. While the AMA
policy suggests that physicians’ actions online may negatively affect their
reputations, we yearn for a guideline that suggests other physicians’ actions
online may positively affect entire patient populations.

If social platforms Facebook and Twitter played an instrumental role in
fomenting the Arab Spring uprisings, in mobilizing, empowering, shaping
opinions and influencing change, we physicians are perhaps overly conservative
if we still think Twitter is for twits, rather than a revolutionary channel for
public health.

Warner Slack saw much of this in 1968: computer-based, online patient
interactions can be our avenue into richer, more fundamental patient histories.
They don’t replace good doctors–they augment them. And they’re not just fancy
survey tools. To borrow a cue from Harvard medical anthropologist and
sociologist Dr. Arthur Kleinman, it’s the phenomenology–the “what’s at
stake”–that truly matters for patients’ health care lives. Online patient
interactions and social networking platforms are now combining to elicit and
share deeper, more candid, and more sensitive accounts and narratives of
illness and health–a collective, rather than individual, patient phenomenology.
Needless to say, this is about to change medicine as we know it. If physicians
aren’t there to seize the opportunity now, in 2012, shame on us for once again
not taking the lead.

Social Media and Health Care: The Power of Networked Physicians

Eighty percent of Internet users say they now go online to find health information

Apr 10, 2012 - Production Blog Author


Editor’s Note: Jeff Tangney is Doximity’s CEO. This post originally
appeared on HealthWorksCollective and The Doctor Weighs In.

The impact of social media on health care has been nothing short of
game-changing. Researchers have used sites such as Twitter to track the spread
of disease so that medical providers can respond to epidemics more quickly.
Among potential patients, eighty percent of Internet users say they now go
online to find health information, and 18 percent report using the Web to
connect with others who share their health issues or concerns, according to a
2011 Pew Internet study.

For doctors, who’ve long relied on sifting through medical journals for new
information, networked communities such as Facebook and Twitter have opened up
whole new paths for receiving relevant news quickly. Web searchers and
databases have put targeted information at their fingertips. Indeed, a recent
Google survey found that 86 percent of physicians now use the internet to
research health topics.

Yet in large part that’s where the story’s ended. While patients are free to
discuss their symptoms and cases online, the Health Insurance Portability and
Accountability Act
(HIPAA) of 1996 precludes doctors from using email, text
messaging and social networking platforms to communicate about patient care.
Violations are taken seriously. Last year, for example, a Rhode Island doctor
made headlines when he was fined and fired for posting about a patient on
Facebook, even though he included no identifying information.

Doximity was created to meet what we believe is one of the next major
challenges in health care: facilitating online communication among doctors. Our
service is often described as a kind of LinkedIn for physicians, and in the
year since we launched, we’ve quickly become the largest medical professional
network in the country. To create a framework of trust and expertise, we verify
each member’s identity. To ensure that messages are sent securely, we employ
dual passwords for each user so the message will be encrypted end-to-end. In
other words, what gives us deep value within our particular community is that
we’re a private, real-name and HIPAA-secure means of exchanging information.

This February, we officially launched iRounds, a forum similar to Facebook,
Twitter, and Google+ feeds, where users can expand their reach beyond just
exchanging messages and toward tapping larger communities to discuss patient
cases, new research, emerging medical technologies and more. Already, our
members have put iRounds to work, using it to talk about everything from
practice management or what new EHR platforms are best to some truly
jaw-dropping cases. Among them, for instance, a doctor treating a patient who
had accidentally swallowed a metal bristle from a barbecue grill was able to
connect with someone who had, believe it or not, seen a similar case.

It’s not difficult to imagine these kinds of real-time, long-distance
collaborative teams becoming the norm. We think there’s a tremendous value to
be gained by filtering cases and data through an interactive platform composed
exclusively of doctors, each of whom is able to attach unique clinical insights
to information as it travels. In this way, with each physician linked to a
broad network of experts, treatment stands to become more targeted, specific
and personalized than ever.

The rebirth of primary care

Medicine has clearly evolved to favor specialists

Mar 27, 2012 - Production Blog Author


Editor’s note: Doximity Advisory Board member Peter Alperin, MD, is a
board certified internist currently practicing at the San Francisco VA
Medical Center
. He previously led informatics at Brown and Toland Medical
Group
, and has also worked at Epocrates.

By 2015, according to the American Association of Medical Colleges, the
U.S. health care system will be short approximately 30,000 primary care
doctors. Yet, everything we read says that primary care physicians are the
linchpins of the new (really rediscovered) coordinated care models being talked
about by health care policy cognoscenti. What gives?

Since the mid-1990s the number of medical students pursuing a career in primary
care has been on a steady, sinking decline, a trend likely fueled by the
realization that the traditional Marcus Welby-style primary care practice
doesn’t pay the bills. Throw in hefty malpractice insurance fees and the
average overhead often hits 60 percent. There’s also the question of boredom
and prestige. In medical school, future physicians are exposed to a breadth of
compelling cases; in primary care, they’re asked to refer the majority of those
away. And if you are interested in interesting procedures, medicine has clearly
evolved to favor specialists.

And about the pay disparity–it is stark. Most residents looking at a career in
primary care can expect to earn about $29.58 an hour. This, compared to $74.45
per hour as a specialist (by retirement, specialists will have earned about
$3.5 million more). The main reason is that the options for reimbursement in
traditional primary care practice are limited. Much of what PCPs do is
cognitive work–checkups, simple diagnoses, referrals–and that just doesn’t pay
as well. As for the reimbursable procedures that PCPs are able to perform,
they’re few, but of a wide variety; getting such a breadth of claims paid is
often a job in itself.

So here’s something surprising: In 2010 and 2011 the number of primary care
residency matches increased by ten percent per year. For 2012, those gains were
at least maintained, when the National Resident Matching Program last week
reported a one percent rise in such matches.

Two factors may be accounting for this welcome change of tide. First, there’s
accountable care. Within this premise of having one group–an accountable health
care provider network–hold all the risk and be paid on quality measures and
outcomes, primary care physicians can be even more effective quarterbacks,
coordinating care for a team of specialists. Even more targeted are
patient-centered medical homes, currently being tested within a number of ACOs.
Here, PCPs are available for consultation, and for mapping out care, which is
then put into action by a staff of physician extenders.

The second development is the Direct Care (also referred to as
Concierge) model, such as One Medical and MD VIP, which have
become a viable economic model for PCPs who want to maintain a
traditional primary care practice. While the exact structure of direct
care practices can vary widely–whether insurance is accepted, or scope
and kinds services a patient can expect, for example–they all rest on
the idea that patients pay annual or retainer fees to their primary care
physicians.

If these trends continue, the primary care doctors of the future will
have to be experts at communication, system change and quality
improvement. They will need to focus less on traditional hospital tasks
like putting in a central line (already largely atrophied skills given
the widespread use of hospitalists), and more on skills like promoting
teamwork, being able to build consensus and persuasively articulating
ideas. Many will become experts in healthcare IT. What’s interesting is
that already we’re seeing more young doctors and residents who possess
these skills. We find them every day on Doximity, coordinating
referrals and patient care–using a state of the art platform for
communication. It is these physicians who will lead the charge of
translating medicine into the digital age.

Doximity Notes from the Road: SXSW Recap

We had a great time catching up with some of our favorite physician leaders

Mar 20, 2012 - Production Blog Author


On March 9, the Dox Blog packed up and trekked out to Austin for the SXSW
conference. We had a great time catching up with some of our favorite physician
leaders, including Bryan Vartabedian and Wendy Sue Swanson, both of
whom we bumped into at one of the week’s seemingly endless stream of happy
hours.

We learned about some nifty products, among them, iTriage, an app enabling
patients to look up their symptoms and get guidance on what steps to take next,
and Basis, a device to be worn like a watch that tracks heartbeat,
temperature, and more–all to be tabulated into daily feedback for its user.

Seed accelerator Rock Health wowed us with its ZenDen (they had us at
coffee and a free chair massage), and the health initiative StartUp Health
introduced us to an impressive lineup of health entrepreneurs. We also had some
time to talk Doximity shop. That Saturday, Nate Gross, Doximity’s Product
Manager, had a chance to talk with NBC Austin about some of what we’re
doing on the site. Here’s what he had to say about technology and physician
communication:

Now that the dust has settled a little, we’re interested in hearing your
impressions of the conference, whether as an attendee or from what you saw on
Twitter, Facebook and various blogs. In your view, what were the big takeaways
this year?

Getting to a Better Patient Handoff

There's a need for training in how to communicate better

Mar 06, 2012 - Production Blog Author


Editor’s Note: Vineet Arora, MD, MPP, is an Associate Program
Director for the Internal Medicine Residency and Assistant Dean of
Scholarship & Discovery at University of Chicago’s Pritzker School of
Medicine
. She blogs about medical education at FutureDocs.

My work studying handoffs began back in 2003, after I was chief resident at the
University of Chicago. Through our research, we found that even in optimal
situations (dedicated room, dedicated time, attending supervision, etc.), 60
percent of the time, the handoff receiver was not able to name the top issue
for the patient as determined by the sender–despite having access to the
written record. Part of the problem may be information overload; people simply
cannot decipher the importance of various items when faced with so much
information. Therefore, there’s a need for training in how to communicate
better.

Imagine you’re writing a shopping list for somebody. If you’re putting it
together for a stranger, chances are you’ll be much more detailed in your
instructions than you would be with your spouse, who implicitly knows whether
“buy milk” means 2% or skim, thanks to your rich history of shared experiences.

What may be going on in hospital handoffs is that people are assuming that
they’re seeing the same things–so there’s that illusion of shared
experiences–but since those experiences are in reality happening successively,
there’s no opportunity to create a shared mental model of them. As a result,
directions may be vague and not precise enough for someone who does not
know a patient sufficiently to understand what to do.

In addition to verbal communication issues, there are also problems with the
written records. Eighty percent of handoff notes, for instance, contain a
medication omission of some kind. Electronic health records that integrate with
medications can certainly solve this problem. However, there are downsides to
integrating with EHRs. The ease of the copy-paste function means that handoff
notes are getting longer and longer. What you see is text that looks more like
a wiki than it does a synthesized problem list.

The best handoffs, both verbal and written, are concise and strike the right
balance between pertinent and thorough. They’re composed of a one-liner
diagnosis, followed by clear and specific anticipatory guidance that include
enough rationale so the recipient doesn’t have to guess at what the sender was
thinking.

Along with in-hospital shift handoffs, effective handoff communication is also
the cornerstone for continuity between a hospital-based physician and a primary
care physician. Mobile HIPAA-secure messaging, such as what’s used on
Doximity, has the potential to promote real time physician communication
during these care transitions, such as keeping primary care physicians
up-to-date during a patient’s hospitalization, or to alert them that their
input is needed on a specific question. Some of our other work has shown that
hospital-based physicians spend a lot of time looking up contact information
for primary care physicians–so certainly there is also potential to tighten up
that side of the process and facilitate timely communication. So, whether
it’s in-hospital or out of the hospital, it’s important to remember to handle
the handoff with care.

5 Health Technology Trends to Watch in 2012

Dr. Felasfa Wodajo, an orthopedic oncologist in metro Washington, DC and mHealth editor at iMedicalApps, shares his predictions for the new year.

Jan 05, 2012 - Production Blog Author


One of the most personally rewarding sides of my role at iMedicalApps is consistent and early exposure to the many ways technology is influencing and in some cases changing the way we physicians think about healthcare.

In particular, the proliferation of medical apps has opened doors we just a few years ago wouldn’t have thought possible. Some represent huge opportunities, others are as yet more vague. I’d argue that much of that gray is due to the fact that doctors and medical societies are only just beginning to engage with the task of evaluating what’s feasible and what isn’t in this relatively new landscape.

Given our exposure to what’s needed in the field, I think the conversations we doctors initiate and participate in play a critical role in this process. To that end, I’m devoting this post to a cribsheet of the health tech trends that have proven robust in the past year.


1. Patient education programs

You interact with patients for a brief amount of time, but their questions keep going. We’re starting to see a few good apps, as exemplified by the Orca MD series, that are trying to offer the kind of credible answers that might be tough for patients to find on google or through their social networks.


2. Phones as medical devices

The image is especially appealing–physicians and patients walking around with these incredibly powerful computers right in their pockets. Radio-frequency identification and bluetooth will be a huge component of how this technology develops, enabling doctors to do things such as use a phone as a pressure sensor to find out if a cast is too tight. Another application: Instead of having an ICU where patients are monitored, scannable monitors could be used on their bodies.


3. Networking services for information sharing

HIPAA-compliant networks such as Doximity are benefiting from the two obvious features already on smartphones–cameras and location services. Both are making it easier to discuss cases and make referrals.


4. Apps as prescriptions for behavioral change

On iMedicalApps we’re getting ready to publish some interesting early research on centers that are harnessing existing technology to develop behavior change programs. These apps can track behavior patterns through location services, text prompts asking users to evaluate state-of-mind, and even offer facetime counseling. This is place for great opportunity as mobile phones, as truly personal devices, could help modify behavior at the time and place where it counts the most.


5. Data flow for health records

Health data is shifting toward becoming less and less human-centered. Imagine a patient having his or her weight taken, with that measurement flowing into the medical record passively and immediately from the scale. The implications for data aggregation are profound.

Online physician reviews: 6 essential actions

Word-of-mouth is the number one referral-driver among patients, and that’s no less true online, where testimonials really can reward you for a job well done

Dec 29, 2011 - Production Blog Author


Editor’s Note: Howard Luks, MD, is Chief of Sports Medicine and
Arthroscopy at University Orthopaedics, PC and Westchester Medical
Center
, and blogs at howardluksmd.com.

Digital content has profoundly changed the way we think of patient feedback and
referrals; what used to be private has now become very public, thanks to the
proliferation of review sites like Yelp and Angie’s list. This is
largely positive. Word-of-mouth is the number one referral-driver among
patients, and that’s no less true online, where testimonials really can reward
you for a job well done.

Nevertheless, like it or not, negative feedback is also part of this landscape.
No matter how hard you try, you’re never going to please absolutely everyone.
For example, you may have someone in your office with whom on a normal day
you’d get along extremely well, and you’re just running late. That person may
well go online and share that.

Patients have a right to freedom of speech, and you can’t practice as if each
case is a potential bad review. You can, however, take this newer, more public
feedback loop as an opportunity to assess how strong your communication lines
are–not just in the context of the broad social media universe, but also among
your existing patient base. Here, six factors to consider:

Make sure you’ve educated your staff on how to treat patients properly: A
well-managed practice is the easiest way to keep patients from being
disgruntled. Do a careful assessment of the experience in your office, thinking
about how well you and your staff handle common bottlenecks such as intake and
wait times.

Designate an on-site point-person to deal with patient dissatisfaction as it
happens:
In our office, we have a point person who has actually gone through
HR training for patient complaints. We’ve designated a comfortable room off of
the examining area, and if someone is unhappy, we bring him or her there to air
grievances.

Give patients a way to reach someone directly after the fact: All of my
patients leave with an email address at which they can reach me. I make it
clear to them that I check it often, and if there’s a complaint, I’ll address
it directly.

Show who you are, online: Think about what your message is, how you’re
going to portray to yourself and select your site and topics carefully. I’m a
big believer in generating meaningful content, and giving other people a chance
to share it. One obvious benefit is that your online presence will drive down
any negative reviews, but more importantly, this kind of communication offers
patients additional ways to get to know you.

Remember that one bad comment won’t kill you: No matter how hard you try,
you’re inevitably going to annoy a patient or two. But you know what? It’s okay
to have a bad review. The world will hardly stop spinning. In fact, given that
75 to 85 percent of people never go past the second page of a search, it will
most likely not change course at all.

Let patients know you welcome positive reviews: The real message: Rather
than worrying about bad content, it’s much easier (and more rewarding) to focus
on generating the good. There’s absolutely no harm in being proactive about
engaging happy patients in supporting your public reputation, so be it through
your website or your office, be sure to invite them to post reviews on sites
like Yelp, or even a Testimonials page directly on your own site.

We've passed our 30,000 user milestone!

We’re excited about how far we’ve already come, and are looking forward to rolling out some new features in the next few months

Dec 03, 2011 - Production Blog Author


In April, when we first launched Doximity, we set a goal to reach 30,000
members before the end of the year. There are 600,000 physicians currently
practicing in the U.S., so 30,000 would represent 5% of our market. For
companies that rely on registered users, this is typically the point where
growth shifts well beyond early adopters.

This past week–just eight months later–we hit that mark. (You can read more
about it in the context of other healthcare companies in this TechCrunch blog
post
, and for even more nitty gritty, on our press page.) We’re also
wrapping up the year having become the largest medical professional network in
the U.S. To give you a sense of size, LinkedIn, which is the biggest
professional network overall and the only other such medical network requiring
real name users, currently has 15,000 physician members nationally.

We’re excited about how far we’ve already come, and are looking forward to
rolling out some new features in the next few months. Please continue to reach
out to us here, on the site, and through Facebook and Twitter.
We’re committed to addressing the unique needs of doctors and, as such, we take
your feedback very seriously.

Sincerely,
The Doximity Team

Debate: Is Kaiser good for medicine? (Part 2)

When it comes to issues of choice, namely the freedom to pursue an untried or very tailored treatment plan, there are significant compromises

Nov 25, 2011 - Doximity Blog


Editor’s Note: Marc Lawrence, MD, is a member of Doximity’s Advisory
Board.

Last month, advisory board member Peter Alperin wrote an essay outlining
the strengths and advantages
of Kaiser and other integrated delivery
systems. Like Peter, I have worked for Kaiser, and I, too, have found it to
be a good place for doctors. While the pay isn’t overwhelmingly high, the
employee benefit program is excellent, and physicians certainly face a smaller
risk of litigation there than they would in independent practices. Patient
follow-up is exemplary, and standard procedures and courses of treatment are
carefully developed and researched. However, when it comes to issues of choice,
namely the freedom to pursue an untried or very tailored treatment plan, there
are significant compromises.

Kaiser has a certain way of delivering care, and the bottom line is that you
can’t just see any specialist you choose when you want to get a second opinion.
You first have to go through Kaiser’s own system. If you’re a patient with an
oddball disease–a rare cancer, for example–Kaiser is therefore a tough sell.
The bureaucracy can be frustrating, and the kind of deeply targeted care you
would get somewhere like MD Anderson or the Cleveland Clinic, while not
impossible, will be more challenging to pull off. It’s reasonable that
patients, empowered as they are with information resources, will resist having
to march through all the steps and go through all the Kaiser ropes when the end
result will be exactly what they already know–that they need to get care
elsewhere.

Looking at this same issue from a physician’s perspective, one could argue that
Kaiser is getting considerable press for being the “right” system, but an
environment where there’s only one style of care is a limited one. Just as some
patients may not fit the Kaiser model, there are most certainly brilliant
doctors who don’t thrive in the kind of ultra-integrated environment.
Individuals whose personalities make them impatient to innovate, for instance,
will undoubtedly find the pace too slow. Because Kaiser is committed to proven
approaches, change does not come right away. In certain cases, there may be
other, more cutting-edge ways of delivering care that just haven’t yet made it
into the pipeline.

There are countless arguments for why Kaiser and other integrated care systems
are well-run and effective models, and I agree with the vast majority of them.
But as we continue to develop new approaches in healthcare, I want to make a
case for remembering to look outside of the box of what’s already working on a
broad scale, and continuing to make room for the small-scale and even the
untried.

Essential tips for easy digital content searches

With over 21 million citations, here are some shortcuts to navigate this abundance of information

Nov 18, 2011 - Doximity Blog


Editor’s Note: Jey Balachandran is a software engineer at Doximity.

For those of you tracking medicine’s digital shift, here’s some interesting
news: In January, 81 year-old William H. Welch Medical Library at Johns
Hopkins University will go completely online. The move was precipitated in
response to calculations showing that in a day only about 40 of the 400,000
books currently housed in the building were checked out compared to 35,000
downloaded online. By the end of the transfer, nearly 95% of the collection
will be available virtually.

The Hopkins case is, of course, a reflection of just how far the scales have
tipped in favor of online medical research. PubMed, for instance, now
comprises more than 21 million citations, and most journals make some if not
all of their content available on the Web. In the interest of maximizing
returns as you navigate this abundance information, it’s worth having a few
shortcuts.

To get around needing to go back and login to your institution’s website, for
example, Doximity product developer Nate Gross wrote this basic
bookmarklet
that allows readers easy journal login using their institution’s
proxy server. Additionally, whether you’re searching Google or an institution’s
online medical library, order counts. Most search engines will give strongest
weight to the first words you type in (if you know exactly what you want, add
quotation marks for extra heft). In addition, they’ll let you jump from your
search engine to a search within a specific website if you add a colon after
the last word of the search term, directly followed by the site name (no space
in between).

You probably already know to use “and,” “or” and “?” in searches just as you
would when you speak. Similarly, you can use the minus sign directly before a
word (again, no space in between) to exclude that word from your search. Also
helpful: When you’re vague on exact wording, you can simply type an asterix in
place of a word you think you might be missing–this essentially says “give me a
wildcard.” Another approach is to tell the engine to include synonyms in your
search by using the tilde symbol (looks like this: ~) directly before the word
in question. Lastly, once you get to your text, you’re actually able to
search
within it by holding down the “command” and “f” keys simultaneously.

For a more in-depth list of tips, we asked Welch library director Nancy K.
Roderer, and her colleagues Sue Woodson and Blair Anton to share some of their
best advice for navigating the digital stacks. Their top suggestions, below.

Books by an author/ISBN
To see the most popular books by an author we like
WorldCat Identities, an online catalog of over 72,000 library collections.
You’ll get your search results itemized according to popularity. (here’s a
sample search we did). The government also assigns each book what’s called
an ISBN number (you’ll see these listed on Amazon, for example). Most digital
stacks enable searches using just those digits.

Latest on my topic
A search in PubMed always returns its results by “most
recently added.” So, whenever you do your search, you’ll see the latest
information on your topic at the top of the results list.

Current issues of a journal I know
On a familiar subject, physicians often
know the relevant journals and the easiest thing to do is go to the website of
the journal and search there. Many journals now offer a pre-print or
articles-in-press service for very current articles on a topic. To stay up to
date afterwards, you can often also register your search for an alert service.
The journal runs your search on a fixed schedule and if the results include new
things you’ll receive those citations by email.

Introduction to a new subject
While Wikipedia is good for getting a general
overview of many topics, it doesn’t always work that well for clinical
questions. Google Scholar, on the other hand, covers the medical literature
and allows you to limit your results to the current year. But don’t forget
Google itself, either. It’s an excellent way to pull up media writing on
medical treatments or issues.