My recommended medical articles for today:
We organize and express our thoughts with words, verbal labels. As parameters of thought, those labels are both helpful and limiting.
At the repository of medical articles maintained by the National Library of Medicine, PubMed ( http://www.ncbi.nlm.nih.gov/pubmed), the medical literature is indexed using "Medical Subject Headings," sometimes referred to as "MeSH" headings or "mesh" terms. You can search for MeSH labels here http://www.ncbi.nlm.nih.gov/mesh. One of the ways to search for articles is to search for articles to which particular labels have been attached. If you find an article addressing a subject of interest, you can click on "related citations" to find similar articles.
Sadly, there is no MeSH label for "patient safety." By way of contrast, there are MeSH subject headings for:
Legal Liability http://www.ncbi.nlm.nih.gov/mesh?term=%22legal%20liability%22
Insurance Liability http://www.ncbi.nlm.nih.gov/mesh/68007351
Professional Misconduct http://www.ncbi.nlm.nih.gov/mesh/68028743
A search of Pubmed for "patient safety" as a phrase identifies articles dating back to 1960 containing the phrase in the title of an article. http://www.ncbi.nlm.nih.gov/pubmed/14411970. The phrase "patient safety" appears in the titles of over four thousand articles and identifies over ten thousand articles in the PubMed database. http://www.ncbi.nlm.nih.gov/pubmed?term=%22patient%20safety%22 Still, there is no MeSH subject heading. When you search the MeSH headings for "patient safety," the result is a heading for "Travel Medicine." http://www.ncbi.nlm.nih.gov/mesh?term=%22patient%20safety%22 According to the MeSH index, "Travel Medicine" is the:
Multidisciplinary field focusing on prevention of infectious diseases and patient safety during international TRAVEL.
This may be historically interesting, but it is less than helpful for those working on making care safer for patients.
Here are today's articles published on "patient safety." http://1.usa.gov/LeeTilsonPatientSafetyArticles819 None have "patient safety" as a MeSH label.
A search of PubMed for articles in which "patient safety" appears in the title generates over four thousand articles. http://www.ncbi.nlm.nih.gov/pubmed?term=%22patient%20safety%22%5Btitle%5D "Patient safety" might be important enough to include in the title, but not in the index.
The label "patient safety" is not used to index the medical literature. It is not a concept recognized by the National Library of Medicine. Our concepts govern how we think and how we organize information. The concepts determine the information we can find, or, as is true for so many, the information we cannot find perhaps because we don't think it exists.
According to the MeSH subject headings, "patient safety" is not a concept.
This is not an idle concern about indexing or the appropriate concepts labels that are used. The indexing structure used makes it easier, or more difficult, to find the information needed. Clearly, the goal of an indexing system should be to make finding literature easier. The MeSH labeling system fails to meet that goal.
It is so bad that even leading experts in the field who are preparing review articles have to devote enormous time and energy to locating relevant information. Karimi et. al (2010) explain the problem in the article's abstract:
The process of constructing a systematic review, a document that compiles the published evidence pertaining to a specified medical topic, is intensely time-consuming, often taking a team of researchers over a year,with the identification of relevant published research comprising a substantial portion of the effort. The standard paradigm for this information-seeking task is to use Boolean search; however, this leaves the user(s) the requirement of examining every returned result. Further, our experience is that effective Boolean queries for this specific task are extremely difficult to formulate and typically require multiple iterations of refinement before being finalized.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966450/pdf/1472-6947-10-58.pdf. If the experts who are asked to prepare review articles encounter so much difficulty, one can only guess how clinicians treating patients fare in their literature searches. The time devoted to such searches is an enormous waste of time that could be spent researching, writing, or treating patients. Making literature difficult to find does not benefit patients.
It seems strange that in our digital era, we continue organizing information in such a clumsy manner that it takes months before even experts can find the information they need. The sad irony is that people cannot find the information then need simply because the indexing system fails. The information is, as a practical matter, unavailable to them.
The current indexing system needs to be replaced with something that works.