Complexity and simplicity in healthcare: a vision of the future: Complexity and simplicity in healthcare: a vision of the future
Kamran Abbasi, acting editor BMJ
What I will talk about: What I will talk about
Where will medical research be published in the future and how?
What can paper journals and traditional publishing houses offer?
Do we know what clinicians want to read?
Do journals affect practice?
Doctors—be they clinicians or journal editors—are in the communication business and the challenge we face is how to create simplicity out of the complexity of information available to us? : Doctors—be they clinicians or journal editors—are in the communication business and the challenge we face is how to create simplicity out of the complexity of information available to us?
Does this mean we should stand defeated by complexity? Far from it : Does this mean we should stand defeated by complexity? Far from it
Suppliers of information to doctors—and doctors themselves when informing patients—must grapple with complexity to deliver a message of such simplicity that it aids decision making and prevents adverse outcomes: Suppliers of information to doctors—and doctors themselves when informing patients—must grapple with complexity to deliver a message of such simplicity that it aids decision making and prevents adverse outcomes
Both google and ipod are interfaces (metaphorical gateways through which humans enter and navigate around a technology): Both google and ipod are interfaces (metaphorical gateways through which humans enter and navigate around a technology)
Both are picture book examples of simplicity concealing complexity underneath: Both are picture book examples of simplicity concealing complexity underneath
Everything should be made as simple as possible, but not simpler (Albert Einstein): Everything should be made as simple as possible, but not simpler (Albert Einstein)
Keep it simple. The healthiest buildings, according to the ancient Chinese principles of feng shui, are those that have no clutter, because clutter, which is complexity by another name, deadens the energy in a house (Economist): Keep it simple. The healthiest buildings, according to the ancient Chinese principles of feng shui, are those that have no clutter, because clutter, which is complexity by another name, deadens the energy in a house (Economist)
But is this some Einsteinian fantasy? How might simplicity defeat complexity?: But is this some Einsteinian fantasy? How might simplicity defeat complexity?
Research will be published in international registers and archives, probably not in journals: Research will be published in international registers and archives, probably not in journals
Predictions of Lord Kelvin, president of the Royal Society, 1890-95 : Predictions of Lord Kelvin, president of the Royal Society, 1890-95 Radio has no future
X rays will prove to be a hoax
Heavier than air flying machines are impossible
What are the drivers of a new form of publishing? : What are the drivers of a new form of publishing?
Failures of the present system
A vision of something better
Money
Balkanisation of the literature
Slowness
Governments and consumers
A vision of something better: A vision of something better
“It's easy to say what would be the ideal online resource for scholars and scientists: all papers in all fields, systematically interconnected, effortlessly accessible and rationally navigable, from any researcher's desk, worldwide for free.”
Stevan Harnad
A vision of something better: A vision of something better
“If you have an apple and I have an apple and if we exchange these apples then you and I will still each have one apple. But if you have an idea and I have an idea and we exchange these ideas, then each of us will have two ideas.”
George Bernard Shaw
“You can resist the invasion of an army, but you cannot resist the invasion of an idea” Victor Hugo : “You can resist the invasion of an army, but you cannot resist the invasion of an idea” Victor Hugo
People are no longer divided by geography but by language: People are no longer divided by geography but by language
Research will be made available for free on publicly accessible databases: Research will be made available for free on publicly accessible databases
OPEN ACCESS
What I will talk about: What I will talk about
Where will medical research be published in the future and how?
What can paper journals and traditional publishing houses offer?
Do we know what clinicians want to read?
Do journals affect practice?
Benefits of publishing in the BMJ: Benefits of publishing in the BMJ Full text articles available free
Wide international exposure in print and on web
Media exposure
High impact factor >7
Fast track peer review and publication
High quality reviewing and technical editing
Indexed by Medline and Current Content
Authors retain copyright, share reprint revenue
Should a journal/newspaper be more like a computer screen (something the Times compact tries to do), and use visual prompts to guide people around the “screen”? (Robert Thomson): Should a journal/newspaper be more like a computer screen (something the Times compact tries to do), and use visual prompts to guide people around the “screen”? (Robert Thomson)
The internet has changed newspapers’ role in society. Newspapers compete with the internet but also find ways to complement it (Robert Thomson): The internet has changed newspapers’ role in society. Newspapers compete with the internet but also find ways to complement it (Robert Thomson)
Newspapers can’t compete with the web and tv for breaking news, but they can for views (Simon Kelner): Newspapers can’t compete with the web and tv for breaking news, but they can for views (Simon Kelner)
Technology has made life more complex (Chris Caposella, head of Microsoft’s desktop applications): Technology has made life more complex (Chris Caposella, head of Microsoft’s desktop applications)
People read journals in different ways in print and different ways on the web: People read journals in different ways in print and different ways on the web
What I will talk about: What I will talk about
Where will medical research be published in the future and how?
What can paper journals and traditional publishing houses offer?
Do we know what clinicians want to read?
Do journals affect practice?
Words used by 41 doctors to describe their information supply: Words used by 41 doctors to describe their information supply Impossible Impossible Impossible Impossible Impossible Impossible
Overwhelming Overwhelming Overwhelming Overwhelming Overwhelming Overwhelming
Difficult Difficult Difficult Difficult
Daunting Daunting Daunting
Pissed off
Choked
Depressed
Despairing
Worrisome Saturation
Vast
Help
Exhausted
Frustrated
Time consuming
Dreadful
Awesome
Struggle
Mindboggling
Unrealistic
Stress
Challenging Challenging Challenging
Excited
Vital importance
Conclusions of studies of doctors’ information needs during consultations: Conclusions of studies of doctors’ information needs during consultations
Information needs do arise regularly when doctors see patients (about two questions per consultation)
Questions are most likely to be about treatment, particularly drugs
Questions are often complex and multidimensional
The need for information is often much more than a question about medical knowledge
Doctors are looking for guidance, psychological support, affirmation, commiseration, sympathy, judgement, and feedback
Conclusions of studies of doctors’ information needs during consultations: Conclusions of studies of doctors’ information needs during consultations Most of the questions generated in consultations go unanswered
Doctors are most likely to seek answers to their questions from other doctors
Most of the questions can be answered—but it is time consuming and expensive to do so
Doctors seem to be overwhelmed by the information provided for them
The information paradox: Muir Gray: The information paradox: Muir Gray
Doctors are overwhelmed with information yet cannot find the information they need
Information paradox: Information paradox
“Water, water, everywhere
Nor any drop to drink”
The Rime of the Ancient Mariner
What I will talk about: What I will talk about
Where will medical research be published in the future and how?
What can paper journals and traditional publishing houses offer?
Do we know what clinicians want to read?
Do journals affect practice?
Evidence based policy making sets the context in which evidence based clinical practice can take place (Muir Gray): Evidence based policy making sets the context in which evidence based clinical practice can take place (Muir Gray)
Would it be better to stop talking about EBM and instead talk about evidence informed practice?: Would it be better to stop talking about EBM and instead talk about evidence informed practice?
NICE guidance is implemented variably, suggests a national study BMJ 2004;329:999-1003: NICE guidance is implemented variably, suggests a national study BMJ 2004;329:999-1003
Factors that favour implementation are: strong professional support, convincing evidence base, no more costs, implementation tracking, and professionals not isolated: Factors that favour implementation are: strong professional support, convincing evidence base, no more costs, implementation tracking, and professionals not isolated
Evidence based guidelines or collectively constructed “mindlines”? BMJ 2004;329:1013-16: Evidence based guidelines or collectively constructed “mindlines”? BMJ 2004;329:1013-16
Clinicians: informed by brief reading but mainly by own and their colleagues’ experience, their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives: Clinicians: informed by brief reading but mainly by own and their colleagues’ experience, their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives
An insoluble paradox exists between the desire for consistent evidence based guidelines and the unique requirements of an individual patient: An insoluble paradox exists between the desire for consistent evidence based guidelines and the unique requirements of an individual patient
Decision makers are often forced to provide a definitive answer in conditions of high uncertainty, and unthinking adherence to guidelines and protocols can be harmful: Decision makers are often forced to provide a definitive answer in conditions of high uncertainty, and unthinking adherence to guidelines and protocols can be harmful
Decision support systems are one attempt to impose simplicity upon complexity, providing clinicians with concise, evidence based, up to date, and—crucially—individualised information: Decision support systems are one attempt to impose simplicity upon complexity, providing clinicians with concise, evidence based, up to date, and—crucially—individualised information
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z : A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z : A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 1 1 0 1: 0 1 1 0 1 1 0 0 0 0 1 0 0 1 1 1 1 0 1
All of this, of course, raises serious questions about the existence of journals, once rated by the inscrutability of their language and the complexity of their subject matter : All of this, of course, raises serious questions about the existence of journals, once rated by the inscrutability of their language and the complexity of their subject matter
Those that survive the downturns in advertising revenue, subscriptions, and the threat of open access publishing will be the ones that, in the words of Einstein, make everything as simple as possible, but not simpler : Those that survive the downturns in advertising revenue, subscriptions, and the threat of open access publishing will be the ones that, in the words of Einstein, make everything as simple as possible, but not simpler
They will be more readable to compete with other entertainment media : They will be more readable to compete with other entertainment media
And the print and electronic versions, in their different ways, will be metaphoric gateways through which humans enter and navigate around : And the print and electronic versions, in their different ways, will be metaphoric gateways through which humans enter and navigate around
Simplicity concealing layer upon layer of complexity: Simplicity concealing layer upon layer of complexity
In our information rich and highly complex world, those suppliers of information, and doctors, who succeed will be the ones who make simple sense of our messy world while capturing its fuzziness: In our information rich and highly complex world, those suppliers of information, and doctors, who succeed will be the ones who make simple sense of our messy world while capturing its fuzziness