Throughout the other sections of Think Like A Doctor, I've given you little or no proof that what I've said is even close to being medically correct. I thought about pointing you to other, more authoritative sources of information, a process that is sometimes called citing references, but I haven't for two reasons:

1. most readers wouldn't know how to access the sources of information, and, even if they could,

2. it is often difficult to understand what these sources of information say.

In this section, my goal is to convince you that you can, by and large, access authoritative sources of medical information and that you can understand a great deal of it. If I'm right, you can learn more about your own medical conditions or concerns on your own, enabling you to better understand your own health and relate more effectively to your physician.

How does one know that something is medically correct, or, said another way, how does one learn about medical topics? One could suppose that if a doctor says something, it is medically correct, and you should generally assume that it is, but doctors make mistakes like the rest of us, and what a doctor says in one situation may not apply to yours. One could assume that if a magazine or a well-known website or a TV show says something, that it is medically accurate. But often the authors of such content are not doctors and can misinterpret medical facts. Further, the media often attempt to simplify medical facts so much so that, in many situations, they are just plain wrong. So to really learn about a medical condition or determine whether something is medically correct, you can do two things:

1. Ask one or more physicians who have taken your history and examined you, or

2. read the medical literature.

What the heck is medical literature? Broadly defined, medical literature is information written by and for doctors. I would divide medical literature into text books and journal articles. As far as text books go, I would recommend two: Cecil's Textbook of Medicine and Harrison's Principles of Internal Medicine. They're expensive, in the hundreds of dollars range, but they cover most medical conditions that you'll encounter, with the exception of surgical topics such as orthopedics. The Merck Manual is another textbook that has gotten some press, but I don't like it as much and find it too terse and confusing in many cases. Aside from text books, doctors also read and write journal articles. Journal articles are articles that appear in trade magazines to which most MDs subscribe. The good thing is that it is very difficult to write an article and get it published in one of these journals. To get an article accepted, the author or his hospital must generally be of some repute in the medical community and the content must be near flawless. A committee of doctors or scientists reads all article submissions to a particular journal and generally turns down most potential articles because they are not good enough. This process is known as peer-review, and is an excellent screen against crappy articles being published. So, the point here is that articles in medical journals are generally highly accurate, and over time dictate how medicine is practiced.

To find medical journal articles, go to the search engine known as MEDLINE, also called PUBMED. The link is www.ncbi.nlm.nih.gov/PubMed, but MEDLINE is easily found by typing PUBMED in any large search engine. On the PUBMED site, read the instructions on how to use it. There is information there designed for non-medical people, but you can also access the same information that any physician would access. You type in a term or terms and the titles of relevant articles come up. You can select the ones that are of interest to you and then view the abstracts of the articles. Abstracts are summaries of a paragraph or less that describe what the article is about and its conclusions. Sometimes the abstract is all you need. Other times, you will want to read the whole article. Many articles are free online, and are indicated as such on PUBMED. Those that aren't free online, you'll have to find at your local medical school library, if there is one around. There also may be some web-based article ordering services that charge you for getting the article, copying it, and mailing it to you.

In PUBMED, you'll find articles that describe experiments or treatments on animals or cells or on things in test tubes. In general, though, you'll be interested in those articles that describe the results of medical interventions in people. Also, PUBMED will tell you if an article is a review, which is a summary of other articles. I mention this only because it is important to describe an article as a review if you are talking to a medical professional. For instance, if you make a claim that one particular medical intervention is better than another, then it is always better to reference the original article, not the review, because all the details supporting that claim will not be present in the review. Also, in terms of the quality of the article, remember that the greater number of patients studied (like hundreds), the better. Remember that clinical studies that have groups that are treated with placebos (sugar pills), so-called placebo-controlled trials, are better. Remember that trials that randomly assign patients to placebo or treatment groups, so-called randomized trials, are better. Remember that studies are better if they blind the patients and the investigators to the kind of drug (placebo or treatment) each patient has, a process called double-blinded trials. For example, a good article will tell you that the authors have performed a randomized, double-blind, placebo-controlled trial. Finally, the more patients tested, the better. I mean hundreds or thousands, not 25 or 50. In fact, studies that test fewer than 100 patients are often only suggestive of something.

Also, when speaking with medical professionals about an article, they will take more stock in the article if it is published in a journal that they recognize. Most journals are minor and relatively unheard of. The ones that grab attention and respect from medical professionals are the New England Journal of Medicine and the Journal of the American Medical Association (JAMA). Others include the British Medical Journal, Lancet, Circulation, and Annals of Internal Medicine. One of the worst things you can do is to demand something from your doctor based on an article from a journal that they have never heard of, but I'll get to that later.

Now, to understand text books and medical journals, you'll benefit from a medical dictionary. Don't get me wrong - there will be plenty you won't understand even then. Heck, I went to medical school and I don't understand it all. To have a better grasp of what is going on, you'd have to take courses in anatomy, physiology, pharmacology, microbiology, and other courses in addition to spending years treating patients with experienced physicians. But that's OK. You can likely get a pretty good idea of what the author is trying to say.

So at this point, you can learn more about diseases or therapies. You can evaluate some medical piece of advice that you hear. You can see if there is any reason for doing what you do to be healthier. Let's take a real example. I received an email once that purported a link between breast cancer and aluminum-containing antiperspirants. Just for the fun of it, I typed in "breast cancer" and "aluminum" or "antiperspirants" in MEDLINE. The result? See for yourself. Here's another example: Does eating organic food make you live longer? Look it up on MEDLINE or in medical textbooks. Be skeptical. Empower yourself and make your own decisions about your health based on the billions of published papers that millions of scientists have devoted their lives to writing.

One last thought. You may recall, from the Think Like A Doctor Introduction, the patient who brought hundreds of pages of medical information from the Internet to her doctors and insisted that she had some rare medical condition. Don't do this. The resources in this chapter are for your benefit, not your doctor's. The whole point of this site is that you should communicate with your physician, not control or influence her.

MEDLINE: THE REAL SOURCE FOR LATE-BREAKING MEDICAL INFORMATION

MEDLINE, accessed via PUBMED (just type PUBMED into your favorite search engine, can be used to access the latest in medical articles. Use textbooks or accredited websites for common medical information, such as "What is a hernia?" or "How to I repair my torn knee tendon?", but use MEDLINE for the latest research on prevention or treatments, such as "Does antiperspirant use cause breast cancer?" or "What are the newest or experimental drugs to treat my disease?" See more about MEDLINE here.

MEDICAL TEXTBOOKS AS A SOURCE OF INFORMAION

The textbook shown above is an old (and well-worn) version of Harrison's Principles of Internal Medicine, an example of a medical textbook that may be of use to you in finding out more about a certain medical condition, especially as it relates to what causes disease and general guidelines for treatment. Medline is a better source of information for new treatments or new data on prevention or causes of disease. A medical dictionary may help you better understand what's written in either place, but don't worry if you don't get all the details. So, if you have a couple of hundred of bucks to spend or have access to a medical library, a medical textbook is a good place to start as a general backgrounder on a medical condition of interest to you. More is mentioned above.

You have the power to learn more about medical conditions by reading the medical literature, which includes published papers and textbooks. Papers can be accessed by all for free via MEDLINE. A medical dictionary will help you understand, but don't worry about getting every last detail. Information on large, randomized, blinded, placebo-controlled trials published in leading peer-reviewed medical journals is best. Challenge what hear from non-medical sources.

Experiences, Comments, or Tips of your Own?