Mark Holthaus
Geriatrics Managing Editor

I suddenly realized just recently the extent that time for reading has been squeezed from my days and nights. While we at Geriatrics were considering possible illustrations for the July cover article on gout (Classical disease presents new face as population ages), I came across what turned out to be a fascinating book, Gout: The Patrician Malady, by Roy Porter and G.S. Rousseau.¹ Though at times difficult reading, it was riveting and I found myself fighting my schedule to make time to stick with it.

"Historically seen as a disease afflicting upper-class males of superior wit, genius, and creativity, gout has included among its sufferers Erasmus, the Medici, Samuel Johnson, Immanuel Kant and Robert Browning," the book says of its topic. "It has also been the subject of powerful medical folklore, viewed as a disease that protects its sufferers and assures long life. This book investigates the history of gout and through it offers a new perspective on medical and social history, sex, prejudice and class, and explains why gout was gender specific." To that I'll add that gout seems to have been around since the beginning, and the story of gout closely parallels the development of medicine--both the modern and not-so-modern kind.

The Patrician Malady's history lessons and its illustrations (including James Gillray cover art from the year 1799)² are what made the book so fascinating, to me at least. But I'm not a doctor and I knew a lot of what Porter and Rousseau had to say was going right over my head. What would a doctor be thinking while reading this, I kept wondering, and would a busy doctor even have the time to be reading a 393-page book on medicine's past, much less time to read something else entirely non-medical, say anything currently on one of The New York Times' best-seller lists?

During lunch at the recent AGS Scientific Meeting, the topic turned to how much time doctors spend reading various journals, and one doctor explained how he sets aside a certain amount of time each day just for reading medical journals. The thought of how he obviously relishes his reading time stuck with me, and that's the point on which this brief conversation turns.

Enough research has been done on the reading habits of doctors to allow the sweeping generalization that they read a ton of stuff in medical school and on through their residencies, and then as they become established many of them taper off to somewhere between 2 and 4 hours of reading a week, much of it in medical journals.

In one of the more "bookish" studies, J.K. Crellin³ repeats the lines of a medical student in the 1989 feature film Gross Anatomy, "This is our reading list, we have anatomy, biochemistry, histology, embryology and bacterial science and that's 3500 pages a week of reading, this week anyway, and that doesn't mention lectures and research." Crellin goes on to cite real-world numbers from the University of Southern California medical school circa 1992 of required reading for second-year courses of 10,997 pages (estimated reading time of 1712 hours) and another 7124 pages of recommended reading.

More recently, CJ Lai and colleagues⁴ found that: "As the availability and amount of rapidly evolving medical information increases, 'keeping up' becomes more challenging,^5,6 especially for primary care physicians, who may spend less time on medical reading than do hospital-based physicians.^6,7 Studies show a gradual decline in medical knowledge and quality of care after physicians leave the structured environment of residency.^8-12" A national survey in 1998 found that internists reported spending just over 4 hours a week reading medical journals and they said they only read abstracts for about two thirds of the articles.¹³ An earlier JAMA article put weekly reading by established physicians at 1.25 hours.¹⁴

A century ago, no less a source than Osler put the then-reading MDR at 30 minutes ("With half an hour's reading in bed every night as a steady practice, the busiest man can get a fair education before the plasma sets in the periganglionic spaces of his grey cortex"¹⁵), which nets out to either 2.5 or 3.5 hours a week, depending on how long your week was. (I wonder what Osler would have to say about doctors' reading habits in the digital age of advanced medicine.) Rather than scolding established doctors for the amount of reading they did, Osler was just setting the bar high for medical students and residents, I think, with many of his other pronouncements on reading, including, "It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it."¹⁶

Most of the preceding information is just on medical reading. "Beware of the man of one book," said Thomas Aquinas. Osler thought doctors should "read widely outside of medicine" and he suggested that every medical student have a bedside library consisting of the Old and New Testaments, Shakespeare, Montaigne, Plutarchs Lives, Marcus Aurelius, Epictetus, Religio Medici, Don Quixote, Emerson, and Oliver Wendell Holmes Breakfast Table series.¹⁷

So far, I haven't found many sources for the kinds and amounts of non-medical reading by doctors. Crellin's piece--which focuses on a collection of more than 290 medical books that was slowly built up as it passed through the hands of three different doctors from 1860 to 1970--offers some interesting leads, but he also wonders if the medical profession has become less bookish since a time when only lawyers could hold a candle to how much reading doctors did.

As someone with a vested interest in the amounts of reading done by doctors, especially in journals, I want to think the weekly reading figure is much higher for our audience, an audience also chockful of Renaissance women and men.

References

MORE GERI.BLOG:

Physicians acknowledge treating family, friends, and colleagues

Are you 1 of 150,000 doctors looking to cut back or quit?

It’s time to take stock of bailout’s effect on health care