Medical libraries for country hospitals

Surgery

1. Introduction

This subject was raised in a Hospitals Department enquiry in South Australia late in 1973. The following report is a personal submission based on personal study. It is hoped that what follows here may be of general interest and help.
It is important that a library be regarded as an information service, and not as a collection of books and journals; following Ivan Illich, many better primary schools have changed their libraries to "resource rooms". (It is important that some books be lost and stolen occasionally, rather than secure and unused.) The magic words are "information" and "communication", but their implications are very down to earth.

2. Objectives

2.1. Information Service.

It is just over 200 years since Samuel Johnson noted that knowledge was of two kinds. Either we knew something, or we knew where to find out about it. This second kind of knowledge is conveniently got from printed records (including microfilm as well as conventional books), or from people, often by means of an S.T.D. phone call. The latter category, that of information-from-people, is not discussed further here, except to note that its most highly evolved form at the present time is the Poisons Information Centre in each State capital city. 2.1.1. Books.
These vary in usefulness for information retrieval. Careful selection is doubly important, the second reason being that badly laid out books will discourage users, and arm the ubiquitous "knockers" further. Basis for book selection is discussed in more detail in Section 3 below.

2.1.2. Journals.
These only justify the expense of purchase, handling and storage if they are read to an appreciable degree. Unless the local climate of thought in a hospital is favourable, journals should be severely limited, perhaps to one single title. Articles even a few months old cannot be found, usually, except with the help of a librarian, who can provide a photocopy cheaply (two to five cents a page). For choice of journals see below. Storage
of journals is also discussed. While journals are a great status-symbol they are also a great waste of money if unused.

2.1.3. Occasional Publications.
Review articles are cheap but valuable.
One example is the "Notes on Cardiovascular Diseases" put out by the National Heart Foundation. Others might include hard-covered article reprints on, say, management of venereal disease, and other rapidly changing areas of diagnosis and treatment, in which any one doctor's experience is likely to be limited. Such items must be found readily by using "pamphlet boxes", as for journals.

2.1.4. Audio Cassettes.

All libraries should have many more electric sockets than they seem to need. Cheap tape recorders and head-phones can play back cassettes of great value and impact from such sources as the Audiodigest Foundation, of California (about 80 dollars a year), the local College of General Practitioners (about 30 dollars a year), and even medical publishers, who are starting to offer these in current catalogues. It is unfortunate that University Departments don't seem to have heard of this area yet.

2.1.5. Videotape Cassettes.

Provision for these should be made for 1976. Currently the cost of a half-hour tape is 20 dollars and of course it can be replayed or re-used many times. They are now part of undergraduate teaching at the Dental School at the Royal Adelaide Hospital. (I believe the people concerned here are Dr. Bill Scallan Dr. Murray Barrett). Several American centres have useful catalogues. This whole question is too important and too wide to discuss further here.

2.2 Integration of Hospital Libraries with Other Services.

There is over-lap and possible competition and confusion with other hospital based activities, where co-operation
would be of much greater benefit all round.

2.2.1. Nursing School Libraries.

Free exchange here is of obvious benefit, and requires that a suitable climate be created. This is a question of handling personalities for mutual benefit, and hopefully would be carried out by a warm and happy-faced medical administrator.

2.2.2. Administration.

Books of hospital design and function can stand safe and unused in an office, or much more appropriately in the medical library. Someone might read them there.

2.2.3. Laboratories and Special Departments.

Some books are best kept in these, such as perhaps books on x-ray diagnosis, but they should be available, and their existence noted by dummy cards and reasonably prominent lists. Other books (pharmacy, pharmacology) are best duplicated and indeed in certain cases available in every ward of the hospital, on their own (to-be-created) reference mini-library shelf.

2.2.4. Post-graduate education.

Hopefully, one of the functions of regularly visiting educators would be to recommend library additions in their field, whether books, article reprints, lecture notes, or (Cont.) audio cassettes. One of the functions of a post-graduate foundation, in coordination with the Hospital Department would be to disseminate brochures and minor (in size) publications.

2.2.5. Liason with the related University Medical Library - Most Important.

This is based best on personal acquaintance with the librarian, who can provide services such as bibliographies, photostats, book loans, cassettes (when Universities get around to having these themselves) and microfilm material (by 1977). Microfilm, incidentally, can be seen on the first floor of the Kodak building in west North Terrace, a quick taxi-ride away from the government offices
in Rundle Street.

3. Choice of books

3.1. Books in Traditional Subjects.

The best choices in medicine, surgery, and so on, are the basic books for post-graduate study, provided the choice is readable, easy to retrieve from, and of proven success in experience elsewhere.
It is mistaken to take too simple and low-level a book, whatever its excellence for fourth year medical students unable to grasp concepts from meatier books. While "100 Topics" is excellent for beginning students of surgery, it has no relevance to graduates, for whom Bailey and Love would be very much better whatever
its faults.
Too academic a book is wrong. Some early parts of Llewelyn-Jones' book are an example, though the rest is excellent. Can one imagine a busy doctor who has a chronic mild tiredness picking up theoretical material in the library arm-chair (see below) and concentrating adequately?. It is important to cover the minor specialities; some of us who are strangers to eye or ENT surgery occasionally want information, and then we want it quickly, easily, and adequately.

3.2 Newer Subjects.

Things our teachers never taught us, at the present time, include areas like accident surgery ("Road Accidents and the Family Doctor", BMA, 1970, ten shillings sterling; "Road Injuries - Medical and Surgical Management" 1969, by the staff of St. Vincent's, Sydney), new laboratory tests, sexual problems of patients, the latest few dozen antibiotics (covered so well in the relevant Commonwealth publication), community health, problem-orientated medical records, and so on. Most of these have direct bearing on the problems of some patient any of us might see in the very next week.

3.2.1. Family Practice.

Consideration of these newer fields must give special emphasis to the interests of the family doctor, who despite many pious public words, is generally neglected in book and journal information compared with his specialist colleagues.

3.3. Emergencies.

There has to be adequate available cover of emergencies in medicine, surgery, obstetrics, anaesthesia (the patient has sudden malignant hyperpyrexia!), neonatal medicine, casualty work. If a hospital library is to be really basic, it should concentrate on this one area alone. Choice
of particular books is important, as outlined earlier.

3.4 Choice of Journals.

Hilaire Belloc (I think) hoped his epitaph would be "his sins were scarlet, but his books were read". Hardley any country doctor would read the Lancet
or the New England rather than the "Practitioner" or its Australian counterpart. Many issues of the Lancet will contain not a single item of relevant interest to either general practitioner or country specialist.

4. Library site, size, structure and relations

A library is of little use if it is awkward to reach or to enter. It should be off a frequently used thoroughfare, such as just inside the hospital building entrance, or by a tea room or dining room, or mail rack. For security of its contents, the entrance should be opposite a generally occupied site, such as a switchboard, enquiry desk, or casualty clerk. This checks unwanted intruders and may allow for "signing out" of borrowed books, discouraging unofficial "loans". Designating such a site will require high authority, as there would be much competition for such a centrally placed room from nursing and general administration, auxiliaries, and others.
The ambience of the library must be attractive, roomy, well-lit, and positively inviting to the intended user.

4.1 Physical Facilities.

An adequate study of these is more detailed exercise, but facilities must include handy illuminated shelfspace, pamphlet boxes for journals, with a display fixture for the most recent issues, comfortable chairs, tables, and perhaps a coffee-dispenser (adequately serviced) costing a bit over a hundred dollars. There should also be provision for a couple of study carrels for audio-tape, video-tape, and a teaching machine installation, as these may
be relatively cheap to buy in two or three years, and of proven use with adequate soft-ware by then. There should also be a desk for library work, filing cabinets, and bench space for a simple photo-copier. Room for reading, or working from microfilm should be allowed for. External noise should be low, and internal noise should be kept down with carpet and with curtains where suitable.

5. Library administration and procedure

5.1 Who runs the Library?

Generally the local medical society will nominate or elect an honorary librarian; sometimes a subcommittee is appropriate, so that it seems justice is being done. Ultimate control of the library is of course through its purse-strings. Maintenance is a reponsibility of the hospital administration, as explained in the next section.

5.2 Library procedure.

All new books and journals should be properly listed in an accession journal, catalogued on 3 by 5 inch standard library cards, stamped from a moist ink-pad and labelled on the spine with the Dewey decimal number. As cataloguing is a skilled task, it may be best served by sending a photostat of the book's title page to the "mother" library at the University, where hopefully the few catalogue cards needed could be made out.

Older journals should be transferred from their display rack to adequately labelled pamphlet boxes, unduly long borrowings must be policed, stock must be checked and replaced. These office procedures and the tidiness of the library, other than ordinary housekeeping, should be the responsibility of a clerk who is mostly doing other work within the hospital's offices. This "library assistant" must be someone reasonably capable and motivated, and supervised through the administration but in adequate contact with the honorary medical librarian. A few days' special training at the medical or local library would be most useful, and there should also be a deputy or replacement for the library assistant, in case of her absence.

References

Patkin M.(1971) Books as Machines. Med. J. Aust. 1,44
Patkin M (1972) Microfilming Medical Journals, Letter, ibid, 12 Feb.

1. Introduction
2. Objectives
3. Choice of books
4. Library site, size, structure and relations
5. Library administration and procedure

References

Contents in more detail

1. Introduction.
2. Objectives.
2.1 Information Service.
2.1.1. Books. 2.1.2. Journals. 2.1.3. Occasional publications.
2.1.4. Audio cassettes.
2.1.5. Videotape cassettes.
2.2 Integration of Hospital Libraries with other services. 2.2.1. Nursing School Libraries. 2.2.2. Administration. 2.2.3. Laboratories and special departments.
2.2.4. Post-graduate education.
2.2.5 Liaison with a related University
medical library.
3. Choice of Books.
3.1 Books in Traditional Subjects.
3.2 Newer Subjects.
3.2.1. Family practice. 3.3 Emergencies.
3.4 Choice of Journals.
4. Library Site, Size, Structure and Relations.
4.1 Physical facilities.
5. Library Administration and Procedures.
5.1 Who runs the Library?
5.2 Library Procedure and Staffing.
6. Conclusion. Is it worth it?
Prepared for the Deputy Director General, Medical Services, Hospitals Department, South Australia. 12 January 1974.

Medical libraries for country hospitals
- an appraisal

Michael Patkin FRACS
Honorary Surgeon, The Whyalla Hospital.
Prepared for the Deputy Director General,
Medical Services, Hospitals Department, South Australia.
12 January 1974.
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I have always been fascinated by books, notes, and information in general.

It was only late in life that I came across Henry Petrowski's book "The Bookshelf". Prepare to be amazed when you read it—if you are obsessed with books and information.

Petrowski was professor of engineering at Duke University and has written many other highly readable books including ones on the history of the pencil and of the paperclip.