iPad in Hand, Librarian Joins Rounds
Physicians often wish they could carry a medical library around with them when visiting hospitalized patients. Medicine is complex and ever advancing — each specialty has dozens of journals and publications devoted to improvements and refinements in treatment — and doctors say it would be wonderful if the questions that arise during medical teaching rounds could be researched on the spot. The cell phones and tablets many physicians carry can access such information online, but it can be tricky to find the right answers and do so quickly.
As Dennis Murphy, MD, FACP, puts the issue: “In the current medical world, entrenched as it is in evidence-based medicine, we are frequently needing to ask ourselves on ward rounds — ‘what exactly is the evidence for this treatment?’ — and in fact no one, from 3rd year students on up the chain, accepts explanations at face value any more.” Murphy is assistant professor of medicine at Georgetown University Medical Center (GUMC) and chief of the general internal medicine division at MedStar Georgetown University Hospital (MGUH).
Enter Jonathan Hartmann, MLS — a human search engine. On most days, Hartmann takes a spot in ever-changing teams on the hospital’s pediatrics and internal medicine units that include attending and resident physicians, medical students, a pharmacist, and usually a nurse or two as they move en masse from one bed to another.
He is the hospital informationist/librarian at Dahlgren Memorial Library, the health sciences library at Georgetown University — but he has morphed into a rounding librarian. His identifying feature is not a white coat, but a well-used iPad.
Some other medical centers also occasionally include a librarian in ward rounds, but Hartmann suspects he rounds much more frequently than most medical librarians.
“They use me when they have trouble finding something. It isn’t easy to find the right study to answer a complex question, and my searching skills are really good — it is what I do, it is my job,” says Hartmann, who came to Dahlgren four years ago.
One good example of that expertise occurred shortly before Thanksgiving, says Gabriel Hauser, MD, MBA, a professor of pediatrics at GUMC and vice chairman of the department of pediatrics at MGUH. Hauser was leading teaching rounds that came to a critically ill child admitted the day before who was suffering from several endocrine disorders — type 1 diabetes, celiac disease, and autoimmune thyroiditis. “We wanted to know right there and then about the importance of co-existence of these disorders,” Hauser says. In a flash, Hartmann pulled up two recent studies, both from Italy, that said that due to multiple immunologic abnormalities, type 1 diabetes can be linked to autoimmune disorders like celiac disease and the thyroiditis.
“In the past, one of us would go to the computer after rounds and search for articles, then circulate them to the team. Mr. Hartmann was able to provide us with those articles while we were rounding, so we could quickly read them and incorporate the information into our work in real time,” Hauser says. “Having him on our rounds for the last few months has been very helpful.”
On a recent teaching rounds in an internal medicine unit, the attending physician wanted to know if warfarin, an anticoagulant, should be used for stroke prevention in a patient with metastatic renal cell carcinoma. Hartmann pulled up journal articles that talked about how both cancer treatment and cancer spread can increase the risk of stroke.
Murphy says that the initiative to integrate the medical library services with clinical operations is a “strong win-win, especially in the academic hospital setting where everyone — including patients — expects cutting edge information.
“Every day on rounds a question is posed about some clinical interaction that may affect the outcome of the patient’s care: the best medication out of a wide variety to use in a specific patient, or the latest study revealing state-of-the-art treatment options,” he says. “This initiative, if refined and tailored properly to the wishes and needs of specific clinical teams, has great potential to stimulate deeper bedside discussions on care, make rounding more interactive and rewarding, and, most of all, lead to better service to our patients.”
In his 20 years working in the stacks and on reference desks, Hartmann finds it refreshing to actually see medicine off the page and in action. “It’s fun, very interesting, sometimes sad, and never boring,” he says. “It makes me feel good that I might have contributed, even a tiny bit, to the great job the medical teams at the hospital do.”
By Renee Twombly, GUMC Communications