We All Make Choices…

September 30, 2013 at 9:31 am | Posted in Professional Development | 3 Comments

When I became a medical librarian nine years ago it was impressed upon me that our profession was threatened by tight finances, high cost of databases, and declining use. At that time however the buzz words were Web 2.0, hand held devices and increased visibility. Maybe our time could have been better spent? The notion was that if librarians increased their visibility and became technologically savvy they would demonstrate their value. Sadly, today the buzz word/phrase has morphed into “cost/value positioning”. In retrospect, our past trajectory might not have taken into account the silent, ideological and financial pressures the profession was facing. As George Eliot said; “The strongest principle of growth lies in the human choice”.
We don’t choose to ignore silent trends; rather, they just remain under our radar. There is a large body of literature demonstrating that the increase in cost of electronic databases unsustainable. Conversely, there is a second body of literature demonstrating that costs are justifiable because of improvements to patient safety and overall care. The loudest proponents of excessive cost are proprietors of cookbook medicine (CM). They promote their resource as the “be all and end all” tool knowing that users always choose the path of least resistance. They hire authors from major medical schools and infiltrate classrooms to promote their tool. Once their intended audience is hooked, their market is secured. Do we choose to make the same claims when speaking with our users about our services and our resources? I hope so, but I’m not sure. Maybe we have spent too much time promoting resources that make visiting a library and talking to a librarian a thing of the past.
Librarians are fighting a difficult battle, the battle between the value of the library and the value of CM and we are feeding our own worst enemy. We support tools that have led to the slow demise of research and scholarship in lieu of easy answers. As a profession we are stuck between a rock and a hard place. Keep CM resources and watch your department and resources dwindle or, cancel CM resources and at worst lose your job.
“Why do we need a librarian when we have CM”?
Vendors have developed a notion among their clientele that they cannot live without their resource. At best such words fall on deaf ears. However, if left unchecked, a debate might ensue about the financial value of one “be all and end all resource” over a library. Arguments in defense of CM ignore the rigid pricing structure, high yearly increases at renewal and their proven unsustainability. “Who cares how much it costs! They want it!” Well, they want it until it costs too much and then it’s back to relying on the library and librarian.
So, here we have the perfect storm, one that we helped to create and one that we feed….
Our patrons will always choose the path of least resistance. It’s easier to search one database than to practice true EBM. In our continued insistence to subscribe to CM, we are only hurting our users, their patients and our profession. The solution is both simple and challenging. We have a choice and I will leave it up to you to determine what that choice is….

Todd Allen Lane, MAT, MLS

Chief, Library & Multimedia Services

Bridgeport Hospital



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  1. This dilemma is very apropos in our library. We’ve signed a multi-year contract with one of these CMs, culminating in an astronomical final year fee. A proposed post-contract solution, not from a Southcoast librarian, but from a person in a decision-making position above mine, is to require the medical staff to pitch in large amounts to subsidize the astronomical cost of this resource they feel is irreplaceable.

  2. Providing quality information resources at the point of care is one of the greatest contributions librarians can make to improving healthcare. I firmly believe that clinicians need this information in the course of their day and usage statistics certainly reflect this. What medical librarians really need is some stiff competition from other vendors so we can offer our patrons a true alternative resource at a much more reasonable price.

  3. Two comments–
    It seems that it was not so many years ago that physicians were up in arms because they felt they were being asked to practice cookbook medicine. They saw it as an affront to their professionalism. Now, it’s difficult to get them NOT to do this.

    Secondly, our residents were unable to get access to the medical school’s electronic resources until they had been made faculty. (They will be teaching the 3rd & 4th year students.) The process took some time. More than one of them told me because they were unable, for a while, to use that extra-pricy resource, they used the alternative that we subscribe to here, and found it to be very useful. “I never would have known about this if I was able to use [that other thing.]”

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