UpToDate, Harrison’s Cecil’s and PubMed---what are their respective roles?

The Clinical Cases and Images Blog recently cited a study on how house officers utilize on line information resources at the point of care, comparing PubMed and UpToDate. It turns out that searchers found the answer to their clinical question 83% of the time via UpToDate and 63% of the time using PubMed. UpToDate searches took an average of about 4 minutes while PubMed searches took almost a minute longer.

What does this all mean? Is UpToDate better than PubMed? It depends on what you value in a resource. Given that virtually all of UpToDate’s content is based on PubMed indexed articles, searchers, theoretically, should be able to find everything in PubMed that is available in UpToDate. That, of course, would expand the time differential for most users, who are relatively unskilled in PubMed searching. PubMed training with the on line tutorial and a little practice greatly enhances speed and closes this time gap, but there are still the steps of critical appraisal and synthesis.

When all is said and done PubMed is more rigorous and precise. Unlike UpToDate with PubMed you, the searcher, control the search and know the exact strategy used. That precision is essential if you’re researching for a presentation or a systematic review. It may be less important in searching clinical questions for patient care.

According to the Clinical Cases and Images Blog UpToDate, at least in the minds of some, is becoming the “universal textbook of medicine.” They pose the question:

Do you remember the last time you opened Harrison's to consult about a clinical topic? Was that in 1997 or 2001?

Well, just the other day as a matter of fact. A traditional textbook like Harrison’s or Cecil’s is better suited for background reading. If you want, for example, a general overview of carcinoid syndrome encompassing clinical features, pathophysiology, diagnosis and treatment the traditional textbook is a better resource. This is the reading you’ll do for general learning, relaxing at home. UpToDate is designed more for focused questions, so that reading for background learning may require navigating through seemingly endless cross links. (By the way, Harrison’s now has a companion product, Harrison’s Practice, which is being marketed as an on demand point of care look up reference).

If UpToDate has one consistent advantage it’s time efficiency. Even four minutes can seem long for a busy practitioner at the point of care. The biggest barrier to widespread implementation of evidence based medicine is time. As I illustrated once before, the constraints of busy practice don’t usually allow time for all the steps in the traditional EBM drill: formulating the focused question, searching, appraisal and synthesis. As the field of EBM matures it appears that physicians are more and more willing to pay large sums of money to have someone else carry out those steps for them. Increasingly often that someone else is UpToDate.