An analysis of causes and potential interventions and recommendations for clinicians to stay up to date.
As (primarily) clinicians of a certain age, when picking up copies of mainstream and premier psychiatric journals these days, we, and many of our friends and associates, have increasingly experienced disturbing physiological phenomena best described as Duh and Yawn responses. Duh responses occur in reaction to reading scientific articles and commentaries that deliver old “ho-hum” news; despite all the time invested, readers gather sorrowfully little new clinically useful information or perspective. Yawn responses occur when articles are unreadable, opaque, and impose such enormous cognitive loads that seriously tackling them would risk developing cognitive hernias. Faced with these issues brimming with such articles, many of our colleagues—frustrated subscribers with limited time for professional reading—simply let piles of journals accumulate unread.1
Not entirely jaded, and perhaps slightly privileged by our station to be blunt, professional duty demands that we call it as we see it. Decades ago, we recall looking forward to each new issue, anticipating it would likely contain at least several reasonably understandable, clinically relevant, informative articles. Not now. Paradoxically, although revenue sustaining these journals come in large part from pharmaceutical, medical device, and services advertising aimed at practitioners, the journals publish fewer and fewer clinically pertinent, readable articles. Overall, we feel we have not left the journals; the journals have left us.
Our impressions are regularly verified by colleagues and students. Many practitioners report they never read journals because they find them largely to be a waste of time since so many published articles fail the clinical relevance test.
We are not inclined to be anti-scientific nor whining complainers. In fact, understanding the multiple functions that journals serve in academic life, we appreciate the remarkable efforts and contributions of editors. Still, if these journals are to remain reasonably relevant to practicing psychiatrists, as they once were, we feel obligated to explore what has transpired and to suggest remedies.
To start, Duh responses (Table 1) are activated by a variety of article types, including but not limited to:
In contrast, Yawn responses (Table 2), undoubtedly more frequent when tired clinicians peruse journals at the end of busy days, are activated by a variety of article types, including but not limited to those containing:
What accounts for the flood of Duh- and Yawn-ogenic publications?
Editorial boards and publishers are conflicted in attempting to serve several masters concurrently. Consequently, their changing determinations regarding journals’ purposes, intended audiences, and “customers” contribute to increasing numbers of Duh- and Yawn-ogenic publications. Guarding their profession’s sacred knowledge, journals archive new discoveries. Obligated to keep financially afloat, journals accommodate governing boards and advertisers. Finally, possibly in last place, serving educational needs of professional organizations’ members-at-large, journals attempt to inform and teach to increase clinicians’ knowledge and skills.
Balancing these diverse agendas, editors have been particularly sensitive to several trends:
Potential cures for the duhs and yawns
Remedies must address 2 distinct considerations: First, what might journals do to better address the needs of clinician subscribers? Second, perhaps more important, how should today’s clinicians satisfy their needs to keep informed and current? Clearly, it is not just about journals.
What journals might do
Journal editors know they need to offer non-super-specialized, working clinicians enoughin each issue to keep them coming back (Table 3). Accordingly, they try to include clinically focused commentaries and, intermittently, clinical case-oriented discussions, explanatory podcasts, and occasional videocasts designed to translate highly technical papers into plain English. Still, these efforts usually constitute a small percentage of each issue’s material.
Journals could also
Although we believe that it is too early for clinicians to give up on journals, certain strategies might improve their overall reading experiences.9 As most clinicians already do, skim tables of contents to see, first, based on titles if any of the articles seem pertinent to their practice or interests; second, skim the abstracts to see if the article might be worth reading further; and third skim the article to see if it is readable.
But in fact, journals will be journals, only sometimes addressing the needs of working practitioners. Therefore, clinicians are obliged to use a wider array of sources for keeping up, forced to discriminate intelligently in order to “drink from the firehose” of information.10 The trick is to find trusted, newsworthy sources that package “True News” rather than “Fake News” (tons of which float around the medical-industrial arena). Granted, readers must always guard against insidious influences of biasing financial, intellectual, and other conflicts of interest; many readers summarily mistrust articles by authors with a large number of industry-related conflicts for good reason, beyond which dishonest disclosure is by no means rare.11
Several free-of-advertising authoritative knowledge scouts, compilers, digesters, synthesizers, and curators offer reader-friendly and useful newsletters, journals, and online services. Similar online functions are provided by several commercial medical communications companies. Professional newsletters publish often excellent, well-written state-of-the-art summaries. Similarly, constantly updated online textbooks offer point-of-care information.
Finally, increasing numbers of clinicians seem to live in a post-journal era, reducing their Duhs and Yawns through social media, podcasts, blogs, blurbs, and burps. The challenge for the field, however, is discerning which sources vying for clinicians’ attention via these media have integrity and tell the truth.
Dr Kay is Professor Emeritus and Past Chair of Psychiatry Wright State University Dayton, OH. He is an Editorial Board member of Psychiatric Times. Dr Yager is Professor of Psychiatry, University of Colorado, Denver, CO. He is an Associate Editor of Journal Watch for Psychiatry, a Section Editor for UpToDate, and Senior Advisor for FOCUS.
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2. Turner EH. Esketamine for treatment-resistant depression: seven concerns about efficacy and FDA approval. Lancet Psychiatry. 2019;6:977-979. doi: 10.1016/S2215-0366(19)30394-3.
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5. Topol EJ, Verghese A, Ofri D. AI may save some time, but it can’t listen to a patient. Medscape. August 22, 2019. Accessed July 8, 2020. https://www.medscape.com/viewarticle/916392
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9. Laine C, Weinberg DS. How can physicians keep up-to-date? Annu Rev Med. 1999;50:99-110.
10. Patil C, Seigel V. Drinking from the firehose of scientific publishing. Dis Model Mech. 2009;2:100-102.
11. Orenstein C. Public disclosure to physicians from industry. JAMA. 2017;317(17):1749-1750. ❒