“Thought doesn’t grow on trees. It grows in the library.” – Walter B. Shelley and E. Dorinda Shelley, Advanced Dermatologic Diagnosis, 1992
It’s no secret that long-form reading is on the decline. As of 2022, less than half of U.S. adults (48.5%) report reading at least one book a year (including electronically), though reading shorter material in other media formats, such as newsfeeds, social media, and blogs, has risen. This represents an 8% decline from 2017 and a more than 11% reduction from 2012.
The same is happening in medicine. Physicians traditionally rely on textbooks while training, but as our careers progress we turn to journal articles for more up-to-date knowledge. Medical knowledge is now doubling at least every 73 days and we are overwhelmed by trying to keep up. We may average one article every two days, though we read them rather quickly (averaging 22 minutes per article), and perhaps without taking enough time for critical evaluation or adequate reflection on study design, statistical analysis, and corollary literature review.
With all these articles to read and not enough time to read them, let alone to read actual books, how can clinicians retain the benefits — increased knowledge and enhanced memory, as well as stronger analytic skills — that book-reading provides? There are several possible solutions.
The first is narrative medicine, which is returning to our professional literature and resuming its role as a useful tool for practitioners. The publication of single case reports declined following World War II, but The Lancet reintroduced them a few decades ago. Developing diagnostic, empathic, and clinical reasoning skills through case review may provide more applicability than focusing on abstract principles. Clinical situations can be effectively synthesized through patients’ stories, helping us to improve our clinical judgment. As we shift from seeking information to developing knowledge, and from treating illnesses to treating patients, a refocus on carefully crafted short narratives helps clinicians adjust our attention from a “problem” to the patient in front of us.
Narrative has also been credited with assisting the delineation and characterization of multiple sclerosis by changing what clinical features could be associated with distinct anatomical and pathological features in the minds of both clinicians and researchers. Journals and the better medical textbooks are returning to this once discarded method. After all, many patients now have access to the same information we do. We may still be special “doers” but we are really no longer special “knowers.” Our true value must remain as seasoned problem-solvers who can collate disparate information into a coherent meaning (i.e., narrative) to help improve lives.
An important note: Though clinical vignettes can be persuasive and are recalled better and longer than individual research articles, they must still be structured to represent correlations of many cases, not single data points. They must also display reasoning through analogy and creative, imaginative understanding of important connections within synthesized clinical puzzles. These can be crafted to illustrate rare causes and atypical and infrequent presentations, among other confusing clinical dilemmas.
Ultimately, the inductive generalizations that can be made from clinical vignettes are limited by the numbers of cases they represent. With current trends in technology and the evolution of distributed knowledge, however, technology can now link open-source, open-access texts that are regularly updated as new cases and data are incorporated.
Another way clinicians can retain their analytical skills is through reading non-medical mysteries. Some educators have pioneered the use of detective stories to teach better clinical reasoning. Mysteries written for entertainment display a variety of reasoning methods that we clinicians should know, each better suited to a particular case. These include knowledge, observation, deduction, the use of counterfactuals, and the ability to spot inconsistencies. While the physician Arthur Conan Doyle’s Sherlock Holmes frequently referred to his use of “deduction,” he actually used multiple cognitive skills, most commonly abductive reasoning, the preferred method for physicians.
However, the best way to retain the benefits of reading is simply to … read an actual book. Reading medical textbooks throughout our careers leads to more mature thought processing, more accurate clinical understanding, and greater decision-making. And after reading a novel, increased connections develop to the left angular/supramarginal gyri and right posterior temporal gyri, which are associated with perspective and story comprehension. Even longer-term changes, that persist for days after reading narrative, have been observed in the bilateral somatosensory cortex associated with semantic understanding.
How we read may also make a difference. Visually addressing material though paper or eBooks allows for deeper comprehension and appreciation of meaning than does listening to an audiobook, especially with complex and abstract content. Visual approaches also offer the opportunity for rereading and highlighting, which can improve our later recall of the material. It may be best to match the format to one’s individual learning style, or to combine both visual and audio for the best benefits.
Some may feel they do not have time to read longer material, but the same might be said about many things in our lives, and we often do create time for what we value. Though I prefer text, I do listen to books while exercising, walking, and driving. Riding mass transit or any other passive mode of transportation is also a good time to open a book.
Reading books, technical and otherwise, needs to make a comeback. As more authors, editors, and publishers move toward reincorporating the value and gains from the narrative consideration of highly technical information, and practitioners return to reading well-crafted literature of all sorts, our patients will benefit from the changes this produces in our skills and practice. Books will improve our cognitive function, but only if we pick them up. Opening a book opens a brain.
What's the last great book you read (medical or non-medical)? Share in the comments!
Dr. Putman, in Austin, TX, is the author of “Rational Psychopharmacology: A Book of Clinical Skills,” “Encountering Treatment Resistance: Solutions Through Reconceptualization,” and “Thinking Again: Reducing Cognitive Error in Psychiatric Practice.” He blogs at drpaulputman.com. Dr. Putman was a 2024–2025 Doximity Op-Med Fellow, and continues as a 2025–2026 Doximity Op-Med Fellow.
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