A family practice article filing system.
Key words. Filing; efficiency; family physicians. (J Fam Pract 1995; 41:583-590)
At some point during medical school or residency, the stack of articles collected on rounds becomes overwhelming and begs to be organized. Most physicians consider starting an article filing system, but the task of doing so can seem staggering. Faced with this daunting task, some may wonder why they should even bother.
A library of classic textbooks is usually found in most physicians' offices. Unfortunately, this information quickly becomes outdated. Computerization has recently revolutionized the ability to rapidly access medical information. CD-ROMS are now available that contain the complete contents of many textbooks and journals. There is, however, no substitute for an article-filing system to keep track of the most recent studies as well as timeless "pearls" that are collected over the years. Once completed, an organized article file provides quick access to the vital information that busy clinicians need on a daily basis.
For an article-filing system to be functional, it must be simple to use. The user should not have to agonize over the process of filing and retrieving articles. The organization of the system should be intuitive.
Previous authors have suggested organizing an article-filing system by using chapter titles from major textbooks,[1-3] using the Medical Subject Headings (MeSH) from Index Medicus, or by using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) system.
Chapter titles and MeSH key words alone do not give clear organization to the broad range of topics that need to be included in a family physician's article files. If chapter titles are used for folder headings, a problem arises in deciding how to further organize them into related groups. Simple alphabetization and MeSH key words also do not keep related information together. MeSH key words can be difficult to use since most articles list a number of key words. There are approximately 16,000 MeSH key words; having a folder for each would simply not be practical. As with chapter titles, there is no overall organization to MeSH key words.
The ICD-9-CM is organized by organ system. This is not particularly intuitive since most physicians think in terms of specialties rather than organ systems. For example, the ICD-9-CM "Circulatory System" category includes stroke, myocardial infarction, Raynaud's phenomenon, aortic aneurysm, varicose veins, esophageal varices, and hemorrhoids. Examples of more intuitive headings for these respective topics are neurology, cardiology, rheumatology, vascular surgery (both aneurysm and varicose veins), gastroenterology, and colon and rectal surgery.
An article filing system based on medical specialties would be a logical approach for most physicians. When faced with filing or retrieving an article, the user simply decides what specialty the topic falls within. Some cases, for example, breast masses, may be ambiguous. The user must decide if he or she considers breast masses a "gynecologic" or "general surgery" topic. However, physicians' individual perspectives on such issues will determine where within their personal systems these articles most logically belong.
The author developed the following specialty-based filing system during residency and has used it for 1 0 years. This filing system enables him to locate most articles within 15 seconds.
The Master Index
The Master Index, which includes all major headings and subheadings, serves as the backbone of the filing system. Each medical specialty and subspecialty is represented as a major heading; topics that fall within the specialty's domain are listed as subheadings, each of which is represented by an individual folder. Additional major headings include professional organizations such as the American Academy of Family Physicians, and topics such as "Medicolegal," "Practice Management," and "Procedures." Other subjects of personal interest to the user can be added. Major headings and subheadings can be numbered using a decimal system, as shown in the Figure, although it is not critical to do so.
To develop the Master Index, the author first listed every subspecialty area of medicine as a major heading. Subheadings were initially "brainstormed" for each major heading. These were cross-referenced for completeness with subheading lists from Tyznik, an ICD-9-CM based system, and McMicken, a specialty-based emergency medicine system. Major textbook chapter titles and/or MeSH key words can also be used for crossreferencing.
This original Master Index was used to start filing existing articles that had piled up during medical school. It quickly became evident that some subheading folders needed subdivision, and others, which contained no articles at all, could be removed. The Master Index was thus revised and used for about 18 months before being replaced by the current Master Index. The filing system has now been used for 10 years and has undergone one major housecleaning session.
The author's complete Master Index is shown in the Appendix.(*) The index is stored in a manila folder atop the filing cabinet that contains the article filing system, where it is easily accessible as a quick reference of all the major headings and subheadings.
The File Folders
As originally suggested by Tyznik, letter-size three-tab (left, center, and right) manila folders are used in the e drawers. Each major heading is listed on the tab of a separate center-tab folder (Figure). A list of all the major heading's subheadings is placed below the tab, inside the folder. This allows quick reference of all the subheadings within the major heading. The major heading folders are left empty unless there are no subfolders within the major heading.
Each subheading is listed on the tab of a separate folder. All subfolders in the first major heading are right-tab folders. The next major heading's subfolders are all left tabs. Alternating between left and right by major headings allows for quick access to each major heading and its subfolder index.
More left- and right-tab folders will be needed than center-tab folders. Office supply stores stock boxes of 100 three-tab folders that have roughly equal numbers of each of the three tabs, and also stock separate left and right-tab folders. To fully use the author's system, 700 folders should be purchased. Two hundred should be a three-tab assortment, and the balance either left or right tab. A left-tab folder can be converted to right-tab simply by folding in the opposite direction and visa-versa.
Clinicians who wish to start an article-fifing system on a smaller scale could begin with only the 62 center-tab folders. Then, as individual major heading folders become stuffed over time, subfolders can be added.
In organizing a "black and white" filing system, the portion of the practice of medicine that falls in the "gray zone" can be a problem. For example, where do you file an article on suturing? Should it go in "Acute Care/ER," "Plastic Surgery," or "Procedures"? The author chooses to put articles on this topic in "Plastic Surgery." However, in both "Acute Care/ER" and the "Minor Skin Surgery" subheading of "Procedures," there is a "dummy" heading with a reference back to "Plastic Surgery" where the suturing articles are filed. The dummy heading is listed in the Master Index and marked with a star, but no subfolder exists for the dummy cross-reference.
Since some topics belong within two specialties, it may be appropriate to separate each specialty's individual perspective. For example, the author puts the topic of breast-feeding in both "Nutrition" and "Obstetrics." In the "Obstetrics" subfolder entitled "Breast-feeding/mastitis," there are articles on both the process of and problems associated with breast-feeding. The "Nutrition" subfolder entitled "Infant Feeding-Breast" is more about the nutritional aspects of breastfeeding. Cross-references between these two related topics are placed on both folder labels in parentheses after the subfolder heading.
Sorting out undifferentiated symptoms is part of the joy of family practice. Many good articles are written on the differential diagnosis of presenting symptoms such as dizziness, chest pain, abdominal pain, etc. A major heading of "Symptoms" is included for these articles.
The author started out with folders labeled in pencil until he had used the system for a while. Over time, users of this filing system will discover the need for new folders, stuffed subfolders that need subdividing, and subfolders that remain empty despite the initial impression that the topic would grow quickly in content. Clinicians who use this system will develop customized Master Indices through this longitudinal process.
Once the system has been personally customized to suit the users' purposes, the folders can be labeled more formally, ie, using computer-printed self-stick labels. Double printing the labels will allow for placement of a subfolder list on each major-heading folder.
Using the Filing System
Before becoming buried in the details of any filing system, clinicians should decide what sort of articles and information will be saved. Philosophically, the article file should contain important but infrequently used information that must be quickly retrieved and used to enhance quality patient care. The author finds his system most useful for saving information on recent medical advances, up-to-date review articles, and timeless pearls for clinical practice.
Some clinicians may read every word of an article before filing it. Others will scan an article for relevance and file it with the intent to fully_ read it when patient circumstances dictate. The author does a little of both.
Once established, the filing system should require only moments to use. When an article is to be filed or retrieved, the user simply decides which specialty the topic is associated with and locates that main heading's center-tab folder. On this folder, the listing of all the main heading's subfolders will guide the user to the folder where an article on the desired topic can be either filed or found.
The user should not agonize over where to file an article. If the placement is not obvious, the article should be filed under the "first gut reaction" subheading and then cross-referenced to the other subheadings. Thinking in terms of "Where would I look for this later? " may help focus the filing process.
When an article is removed from a folder, it is advisable to pencil the folder number on it to speed refiling. However, the author does not routinely code each article as it is initially filed. Nor is there a comprehensive list kept of every article filed within the system.
The following guidelines will ease the process of clipping and filing articles. Articles are easier to tear out of journals if the binding is broken first. This frees the binding edge so the article can be removed more cleanly. The first page of each article should be turned face up. As many of the ads as possible should be removed. Resist the temptation to throw out the references at the end of the article since they are a guide to further articles on the topic. If two articles from the same journal share a sheet of paper first page of one article on back of the last page of the other), copy the last page of the first article and keep the original first page with the second article. Never staple articles together on initial filing as staples tend to catch on each other and also take up too much room in the folder. However, a retrieved article that will be out of its file for a time or loaned out probably should be stapled.
File everything of relevance short of textbooks in the article filing system, including review articles, original articles, abstracts, monographs, lecture handouts, booklets, patient education materials, etc. Keeping these all together in one place greatly improves the quality and breadth of information in the files.
The filing system also may be used for organizing patient education materials. Such materials are best filed in the subfolder for the individual topic, rather than in a large, random file of patient education materials. Consistently placing patient education materials in either the front or back of each subfolder facilitates speedy retrieval. Some clinicians may find that a separate patient education file maintained by office nurses is more convenient. Use of the major headings may help in organizing this type of file.
To keep the article file up to date, the user must make a commitment to file everything as soon as possible. If new articles pile up, they will be difficult to find in the random stack. A few minutes spent filing every week can keep all articles immediately accessible. Ideally, the user should personally do the filing to ensure that the intuitive nature of the system is maintained. However, some busy practitioners may train an office staff member to maintain the files.
Periodic reviews of the files may show empty and/or stuffed subfolders. The former should be removed, and the latter should be subdivided into new subfolders if they contain more than 30 articles.
Given the rapidly changing knowledge base of modern medicine, it is necessary to periodically "clean house" in the filing system. Ideally, this should be done every few years. This task may be particularly advantageous if performed in the year prior to board recertification. Going through each subfolder to discard old articles will refresh the user's recollection of everything in the filing system. Many of the articles may bolster the user's understanding of less commonly seen problems that may be asked about during recertification.
When cleaning house, only currently relevant articles, up-to-date reviews, landmark studies, timeless "pearls," and useful patient education materials should be kept. Occasionally, a subfolder will no longer be needed. A good rule of thumb is that if an article has not been used or missed in the last 3 to 5 years, it should be discarded. Keeping and relying on such outdated information can lead to inappropriate patient care.
An intuitive, specialty-based article filing system has been presented. The author finds that it can save time and improve access to vital medical information, including patient education materials.
The author sincerely thanks his wife Diana for many thankless hours of helping make order out of an enormous stack of articles, Jef Dirig of Dirig Medical Art and Design, Jamestown, Indiana, for the Figure illustration, and Diane Stone and her dedicated library staff at Mercy Hospital Anderson, Cincinnati, OH, for assistance with references.
(*) A list of family practice major headings and subheadings arranged apbanumerically is available at no costfrom the author for use as a starting points in setting up the article-filing system. It is formatted in Microsoft Word for Mac (Version 5.1). Most word processing programs will translate this file. It can be edited to suit the user's needs, printed on commercially available self-stick label paper, and then cut apart and used as individual file folder labels. To obtain the texfile, send a formatted (IBM or Mac) 3.5-in. floppy disk and a stamped, Self-addressed mailer to Ronald D. Reymolds, MD, 1050 US 52, New Richmond, OH 45157. Subscribers to America Online can obtain the file by e-mail: RDReynolds@aol.com
 Fuller EA. A system for filing medical literature, based on a method developed by Dr Maxwell Wintrobe. Ann Initern Med 1968; 68: 684-93.  Singer K. Where did I see that article? JAMA 1979; 241:1492-3.  Karofsky PS. How to create and maintain an article file. JAMA 1992; 268:2450.  DeAlarcon R. A personal medical reference index. Lancet 1969; 1:301-5.  Tyznik JW. Taming the medical literature "monster." Postgrad Med 1983; 74:77-80.  McMicken D. Emcergency medicine filing system. Ann Emerg Med 1980; 9:471-5.  Haynes RB, McKibbon KA, Fitzgerald D, et al. How to keep up with the medical literature: VI. How to store and retrieve articles worth keeping. Ann Intern Med 1986; 105:978 - 84.
Submitted revised, July 5, 1995.
From New Richmond Family Practice, New Richmond, Ohio. Requests for reprints should be addressed to Ronald D. Reynolds, MD, 1050 Old US 52, New Richmond, OH 45157. E-mail:RDReynolds@aol.com
|Printer friendly Cite/link Email Feedback|
|Author:||Reynolds, Ronald D.|
|Publication:||Journal of Family Practice|
|Date:||Dec 1, 1995|
|Previous Article:||Office laboratory diagnosis of vaginitis: clinician-performed tests compared with a rapid nucleic acid hybridization test.|
|Next Article:||Nefazodone and venlafaxine: two new agents for the treatment of depression.|