Great article in terms of a decision tree of what to read vs. what to skip.
It's also important to note that in articles that we read, really devoting the time to critical reading... Evaluating the nuances behind the methods and results, and the online supplement also.
And, if it's really compelling enough to change practice, cross referencing to the pre-registered trial protocol (e.g., ClinicalTrials.org) to ensure that the study published matches what was originally planned, both in terms of primary clinical outcomes and statistical analysis. Yes, it's an extra step, but it's good to know that what is being reported is what the study intended to examine, not a Plan B because Plan A didn't produce interestjng enough results.
The publishing ecosystem rewards novelty and interesting findings, and those are the ones that make the headlines and abstracts. But, the caveats often get buried deeper in the final scholarly product.
This is a useful breakdown, and the appraisal tiering by study type is the part I wish more people internalized.
The closing truism is the one that stuck with me: learning anchored to a real patient is what makes it stick. The flip side is that the same mechanism quietly sets your sampling frame. The literature you retain is the literature your panel happens to surface, so conditions you rarely encounter become invisible gaps in what you keep up on, not because you skipped the article but because nothing prompted you to go find it.
The retention trick and the blind spot share a cause.
Offering a comment from the Amtrak Acela train cruising at 160 mph! It would be interesting to survey how physicians’ professional reading practices evolve over the arc of our careers. My reading pattern and inclinations are much different than when I first started. In the early years of my subspecialty practice, I continued to read deeply on internal medicine across several journals. I gradually shifted over to devoting ~90% of my reading to gastroenterology. With family and other interests, there are only so many hours in the day and one can’t do it all, or do it all well. Now, in the autumn of my career, I am reading on gastroenterology exclusively, choosing subjects which iare directly relevant to my more narrowed practice. Today’s GI journals are filled with studies and articles on endoscopic wizardry and AI, which are fascinating, but are beyond my professional reach.
If you had the power to change the system on how medicine is taught, to improve the learning experience and the outcomes in patient care - what would the three things you would change be?
Great article, doc. Your main point and examples can be applied to any profession. I’m not a real doctor (just a lowly PhD), so when I start thinking about a blog, article, or book, I do a fair amount of research constantly thinking about what my subject and theme should be. Gradually, I narrow it down to a title and first few sentences or paragraphs. This, then, guides my further research and narrowing, which can include some considerable editing. It becomes an iterative process until I really get going and eventually produce a finished product. (My younger colleagues would sometimes ask me how I could write a book. My answer, perhaps a little simplistic, was “If you can write an article, you can write a book. It’s just a series of papers, with edits and transitions to make it whole.)
I am not a medical professional, but I spent my career as a librarian/information professional. May I suggest that one way to keep up with some of the literature is through the NLM's National Center for Biotechnology Information (NCBI). You can set up searches for whatever diseases, conditions, techniques, etc. you want and you'll receive a daily list of links to new articles, previews of articles to be published, and more that are newly referenced in PubMed. I've found the lists to be very focused and very helpful to me as a patient who is interested in new research in a specific area.
The possibility for an active clinician to remain truly up to date is, paradoxically, undermined by an excess of clinical practice itself — a workload so overwhelming that it leaves physicians exhausted and with little time even to “read about” their own patients.
In real life, “School-Based Medicine” easily drifts into “Experience-Based Medicine,” characterized by a hypertrophy of judgment grounded mainly in accumulated personal experience, later nuanced by the lectures of “key opinion leaders” at medical congresses and the “professional” guidance of pharmaceutical representatives.
This troubling reality is sustained by the enormous pedagogical void present in nearly 93% of current medical curricula, which fail to train physicians to efficiently search for evidence, critically appraise it, synthesize it, and integrate it in response to a patient’s question — the only genuine way to remain continuously updated.
Random reading of medical journals is little more than a euphemism for this deficiency.
Serious question… Do you ever read literature provided to you by a patient? I am not a physician, but I did medical research for 23 years. Given that research was my “specialty,” I may have read more peer-reviewed journals articles than most practicing physicians, especially the younger ones. I’ve gotten pretty good at separating wheat from chaff, and I would never give my doctor a paper with a commercial agenda or from a questionable source.
And yet, in the few instances (which I can count on one hand) that I’ve given my doctor a printout of a clinical trial or statistical study, I get the feeling it’s going straight into the trash as soon as my 10 minutes is up. Not once has anyone mentioned at a subsequent visit the material I’d provided. Have I offended the “expert” by suggesting there may be something he may not know? Is he just too busy to read or scan something provided by a patient? Or am I mistaken? Perhaps he did actually read it and considered its contents, but dismissed its value or had forgotten about it by the next visit.
Physicians are good at memorization, so many memorize guidelines and do not read the primary literature. In addition, Biostats & Epidemiology is not emphasized in medical school. A student could skip this subject while studying for the boards and still pass. Pharmaceutical companies know this and exploit physicians ignorance to push their medications. Many physicians just read the abstract, and more precisely, just the conclusion of the abstract. There is very little statistical literacy in the medical community.
When ones were p<0.05, few understand the journey it took to get there. Was it the original planned analysis? Or was it the 45th iteration of analysis that finally yielded something "significant" once the right post hoc covariates were added and subgroups defined?
None of these findings are worth anything if the statistics are compromised!
I definitely do, but not everything. The array of stuff I am given is broad. Something that applies to the specific patient's care, which is given to me in the office, I will always read. These days, many people share articles outside of clinic time, I can't keep up with these and generally ignore them.
As a physician, I am impressed when patients bring literature for me to read. I make a point to acknowledge their effort and initiative. I will always follow-up with them regarding my interpretation of the literature they shared. I can't say all physicians do this, but many of us will engage in discussion with patients around literature they provide. 😊
Firstly see if you can find who paid for the article. If it was the drug sponsor I usually discount it by about 30%. But good luck in searching for this because they try and hide it.
Never look at the RR. It’s the absolute risk reduction that is meaningful to your patients. If something is twice as good as nothing that worthwhile?
Skip the editorials. All they do is vomit back the
article. When’s the last time you gleaned any insight from an editorial. Rely on Sensible Medicine and others instead.
Most importantly always read the comments. In about 5 or 6 comments you’ll see a pearl no editorialist would see.
Skip JAMA. When’s the last time you saw anything meaningful in it? It’s all DEI, like the intros in NEJM. You like indoctrination? Better to read Pravda.
Great comments (although every now and then the editorials add something interesting).
One thing I like to do, regardless of pharma sponsor or not, is compare the published study with the pre-registered clinical trial (e.g. ClinicalTrials.gov). And that includes looking back at the history of changes to the protocol.
That's when shenanigans like outcome switching and unplanned subgroups analysis can come to light.
The point about cohort studies almost never changing practice is worth sitting with.
The hierarchy most clinicians operate by informally, RCTs change practice, observational studies inform priors breaks down in areas where RCTs are scarce or ethically impossible, which includes a significant share of what general practitioners actually encounter.
The other failure mode is the opposite: reading RCTs without tracking reversals, which means your practice updates positively but rarely updates downward.
I agree with all the above. In addition I find the editorial type articles that are included immediately following a study to be an efficient summary, as well as comparing outcomes, pointing out potential pitfalls and/or areas needing further study. They help put the article in context. Sometimes I will read them in place of the study itself.
In 2026, clinicians are more deficient in common sense than factual information. Reading the latest Elsevier, Wiley, Wolters, etc journals would contribute little to practical, useful, or actionable knowledge (Isn’t at least half of published research either wrong or outdated in a few years anyways)?
For 99% of practicing clinicians in the trenches, they’d be better off reading textbooks (yes, paper with no ads) to brush up their general knowledge, use AI tools like OpenEvidence, and read plenty of books on decision-making under uncertainty (ie Kahneman, Klein, Taleb, etc).
Great article in terms of a decision tree of what to read vs. what to skip.
It's also important to note that in articles that we read, really devoting the time to critical reading... Evaluating the nuances behind the methods and results, and the online supplement also.
And, if it's really compelling enough to change practice, cross referencing to the pre-registered trial protocol (e.g., ClinicalTrials.org) to ensure that the study published matches what was originally planned, both in terms of primary clinical outcomes and statistical analysis. Yes, it's an extra step, but it's good to know that what is being reported is what the study intended to examine, not a Plan B because Plan A didn't produce interestjng enough results.
The publishing ecosystem rewards novelty and interesting findings, and those are the ones that make the headlines and abstracts. But, the caveats often get buried deeper in the final scholarly product.
This is a useful breakdown, and the appraisal tiering by study type is the part I wish more people internalized.
The closing truism is the one that stuck with me: learning anchored to a real patient is what makes it stick. The flip side is that the same mechanism quietly sets your sampling frame. The literature you retain is the literature your panel happens to surface, so conditions you rarely encounter become invisible gaps in what you keep up on, not because you skipped the article but because nothing prompted you to go find it.
The retention trick and the blind spot share a cause.
would love if you go through my article https://arcpath.substack.com/p/mastering-the-bone-marrow-assessment?r=8153x6&utm_medium=ios
Offering a comment from the Amtrak Acela train cruising at 160 mph! It would be interesting to survey how physicians’ professional reading practices evolve over the arc of our careers. My reading pattern and inclinations are much different than when I first started. In the early years of my subspecialty practice, I continued to read deeply on internal medicine across several journals. I gradually shifted over to devoting ~90% of my reading to gastroenterology. With family and other interests, there are only so many hours in the day and one can’t do it all, or do it all well. Now, in the autumn of my career, I am reading on gastroenterology exclusively, choosing subjects which iare directly relevant to my more narrowed practice. Today’s GI journals are filled with studies and articles on endoscopic wizardry and AI, which are fascinating, but are beyond my professional reach.
In my case when I was practicing, mostly in the diabetes world, nothing could compare with the annual ADA meetings for keeping up to date.
Dr. Cifu,
If you had the power to change the system on how medicine is taught, to improve the learning experience and the outcomes in patient care - what would the three things you would change be?
Great article, doc. Your main point and examples can be applied to any profession. I’m not a real doctor (just a lowly PhD), so when I start thinking about a blog, article, or book, I do a fair amount of research constantly thinking about what my subject and theme should be. Gradually, I narrow it down to a title and first few sentences or paragraphs. This, then, guides my further research and narrowing, which can include some considerable editing. It becomes an iterative process until I really get going and eventually produce a finished product. (My younger colleagues would sometimes ask me how I could write a book. My answer, perhaps a little simplistic, was “If you can write an article, you can write a book. It’s just a series of papers, with edits and transitions to make it whole.)
Um. Correction. “If you can write a paper, you can write a book.” Picky, but . . . Academics don’t usually write articles.
This is very helpful. Thank you!
I am not a medical professional, but I spent my career as a librarian/information professional. May I suggest that one way to keep up with some of the literature is through the NLM's National Center for Biotechnology Information (NCBI). You can set up searches for whatever diseases, conditions, techniques, etc. you want and you'll receive a daily list of links to new articles, previews of articles to be published, and more that are newly referenced in PubMed. I've found the lists to be very focused and very helpful to me as a patient who is interested in new research in a specific area.
would love if you go through my article https://arcpath.substack.com/p/mastering-the-bone-marrow-assessment?r=8153x6&utm_medium=ios
Dr. Cifu,
The possibility for an active clinician to remain truly up to date is, paradoxically, undermined by an excess of clinical practice itself — a workload so overwhelming that it leaves physicians exhausted and with little time even to “read about” their own patients.
In real life, “School-Based Medicine” easily drifts into “Experience-Based Medicine,” characterized by a hypertrophy of judgment grounded mainly in accumulated personal experience, later nuanced by the lectures of “key opinion leaders” at medical congresses and the “professional” guidance of pharmaceutical representatives.
This troubling reality is sustained by the enormous pedagogical void present in nearly 93% of current medical curricula, which fail to train physicians to efficiently search for evidence, critically appraise it, synthesize it, and integrate it in response to a patient’s question — the only genuine way to remain continuously updated.
Random reading of medical journals is little more than a euphemism for this deficiency.
Serious question… Do you ever read literature provided to you by a patient? I am not a physician, but I did medical research for 23 years. Given that research was my “specialty,” I may have read more peer-reviewed journals articles than most practicing physicians, especially the younger ones. I’ve gotten pretty good at separating wheat from chaff, and I would never give my doctor a paper with a commercial agenda or from a questionable source.
And yet, in the few instances (which I can count on one hand) that I’ve given my doctor a printout of a clinical trial or statistical study, I get the feeling it’s going straight into the trash as soon as my 10 minutes is up. Not once has anyone mentioned at a subsequent visit the material I’d provided. Have I offended the “expert” by suggesting there may be something he may not know? Is he just too busy to read or scan something provided by a patient? Or am I mistaken? Perhaps he did actually read it and considered its contents, but dismissed its value or had forgotten about it by the next visit.
would love if you go through my article https://arcpath.substack.com/p/mastering-the-bone-marrow-assessment?r=8153x6&utm_medium=ios
Thanks! I left a quick reply on your post.
Physicians are good at memorization, so many memorize guidelines and do not read the primary literature. In addition, Biostats & Epidemiology is not emphasized in medical school. A student could skip this subject while studying for the boards and still pass. Pharmaceutical companies know this and exploit physicians ignorance to push their medications. Many physicians just read the abstract, and more precisely, just the conclusion of the abstract. There is very little statistical literacy in the medical community.
When ones were p<0.05, few understand the journey it took to get there. Was it the original planned analysis? Or was it the 45th iteration of analysis that finally yielded something "significant" once the right post hoc covariates were added and subgroups defined?
None of these findings are worth anything if the statistics are compromised!
I definitely do, but not everything. The array of stuff I am given is broad. Something that applies to the specific patient's care, which is given to me in the office, I will always read. These days, many people share articles outside of clinic time, I can't keep up with these and generally ignore them.
As a physician, I am impressed when patients bring literature for me to read. I make a point to acknowledge their effort and initiative. I will always follow-up with them regarding my interpretation of the literature they shared. I can't say all physicians do this, but many of us will engage in discussion with patients around literature they provide. 😊
A few simple thoughts for modern times.
Firstly see if you can find who paid for the article. If it was the drug sponsor I usually discount it by about 30%. But good luck in searching for this because they try and hide it.
Never look at the RR. It’s the absolute risk reduction that is meaningful to your patients. If something is twice as good as nothing that worthwhile?
Skip the editorials. All they do is vomit back the
article. When’s the last time you gleaned any insight from an editorial. Rely on Sensible Medicine and others instead.
Most importantly always read the comments. In about 5 or 6 comments you’ll see a pearl no editorialist would see.
Skip JAMA. When’s the last time you saw anything meaningful in it? It’s all DEI, like the intros in NEJM. You like indoctrination? Better to read Pravda.
Great comments (although every now and then the editorials add something interesting).
One thing I like to do, regardless of pharma sponsor or not, is compare the published study with the pre-registered clinical trial (e.g. ClinicalTrials.gov). And that includes looking back at the history of changes to the protocol.
That's when shenanigans like outcome switching and unplanned subgroups analysis can come to light.
The point about cohort studies almost never changing practice is worth sitting with.
The hierarchy most clinicians operate by informally, RCTs change practice, observational studies inform priors breaks down in areas where RCTs are scarce or ethically impossible, which includes a significant share of what general practitioners actually encounter.
The other failure mode is the opposite: reading RCTs without tracking reversals, which means your practice updates positively but rarely updates downward.
I agree with all the above. In addition I find the editorial type articles that are included immediately following a study to be an efficient summary, as well as comparing outcomes, pointing out potential pitfalls and/or areas needing further study. They help put the article in context. Sometimes I will read them in place of the study itself.
Excellent advice. That penultimate sentence is so true about learning from an actual patient.
In 2026, clinicians are more deficient in common sense than factual information. Reading the latest Elsevier, Wiley, Wolters, etc journals would contribute little to practical, useful, or actionable knowledge (Isn’t at least half of published research either wrong or outdated in a few years anyways)?
For 99% of practicing clinicians in the trenches, they’d be better off reading textbooks (yes, paper with no ads) to brush up their general knowledge, use AI tools like OpenEvidence, and read plenty of books on decision-making under uncertainty (ie Kahneman, Klein, Taleb, etc).