Medical Librarians: A Story from Region 7

Show Notes

Transcript

00;00;03;12 - 00;00;33;29
Yamila El-Khayat
This is NNLM Discovery, a podcast from the network of the National Library of Medicine. I'm librarian Yamila El-Khayat and I'll be guiding you through this podcast series that explores how the NNLM is engaging with communities to provide access to trusted information for the purpose of improving the public's health. Today's episode is “Medical Librarians,” a story from Region Seven. Education and Outreach Coordinator, Margot Malachowski, from Region Seven will be joining us today.

00;00;34;15 - 00;00;35;05
Yamila El-Khayat
Hi, Margot.

00;00;35;14 - 00;00;36;09
Margot Malachowski
Hi, Yamila.

00;00;36;16 - 00;00;40;10
Yamila El-Khayat
Margot, tell us about the story you're sharing today from Region Seven.

00;00;40;22 - 00;00;53;17
Margot Malachowski
Well Yamila, you're a medical librarian and I'm a medical librarian. Be honest, when you go to a cocktail party and talk to others about your profession, how often do you need to explain to them what a medical librarian is?

00;00;54;14 - 00;00;57;00
Yamila El-Khayat
Good point there. Almost every time.

00;00;57;12 - 00;01;06;24
Margot Malachowski
Well, Hollywood left us out. Our job is not portrayed in the media. Today, we're going to change all that with a podcast all about medical librarians.

00;01;06;25 - 00;01;18;17
Yamila El-Khayat
You're right, Margot. I would have totally appreciated at least one “E.R.” episode or “Grey's Anatomy,” where the medical librarian comes in to save the day with information. Set up our story for today.

00;01;19;01 - 00;01;49;17
Margot Malachowski
So, I work in Region Seven of NNLM. Region seven provides programs, services and dedicated support for members in Connecticut, Massachusetts, Maine, New Hampshire, New York, Rhode Island and Vermont. Today, we are featuring interviews from four medical librarians at very different locations and hospitals in our region. We interviewed Jill Tarabula, who is a solo librarian at Champlain Valley Physicians Hospital in rural upstate New York.

00;01;50;05 - 00;02;11;00
Margot Malachowski
Tim Kenny, who works with a team of librarians at Maine Medical Center, the largest health care organization in the state of Maine. Anne Romano from Silver Hill Hospital, which is a small psychiatric hospital in Connecticut. And Chloe Rotman, who works at the Internationally acclaimed Boston Children's Hospital in Massachusetts.

00;02;11;11 - 00;02;16;25
Yamila El-Khayat
And I'm pretty sure each role is also different based on the size of a hospital and community, right?

00;02;17;01 - 00;02;38;27
Margot Malachowski
That's right. For example, Anne at the Silver Hill Psychiatric Hospital manages traditional library services for the patients, as well as serving as the medical librarian for the staff. But really, no matter what their differences are, they provide the same core services. So let's help those friends at that cocktail party that have no idea what a medical librarian is.

00;02;39;05 - 00;02;46;14
Margot Malachowski
Here is my first question to Anne Romano. For someone who has no idea what is a medical librarian?

00;02;47;01 - 00;03;27;29
Anne Romano
When I attended graduate school at the University of Alabama, I did not realize that there were so many distinct types of librarians. Some of my classmates knew that they wanted to be academic librarians, public librarians, school librarians, special librarians serving in business or legal sectors. I was the only one of 100 students who knew that they wanted to specialize in medical librarianship. Medical librarians are knowledge specialists who know how to locate quality medical information that can support patient care, medical research. They can work in various settings such as academic settings, hospitals, clinics, and even insurance companies.

00;03;28;07 - 00;03;29;29
Margot Malachowski
Let's hear from Chloe Rotman.

00;03;30;25 - 00;03;50;11
Chloe Rotman
I think in many ways, libraries are always libraries. It's just that my patrons are the staff of Boston Children's Hospital, so that’s doctors, nurses, admins, research assistants. I'm providing books and journals and information to everyone who works at the hospital.

00;03;51;03 - 00;03;52;17
Margot Malachowski
Jill Tarabula.

00;03;52;17 - 00;04;20;05
Jill Tarabula
In a nutshell, I'm an information navigator for medical information. I help the doctors and nurses find the best information and the best evidence to guide patient care, whether it's document delivery, literature searching, I provide instruction. It might be helping them with technology here in the library. I am here to help them with whatever they need to provide the best patient care to our patients.

00;04;20;19 - 00;04;22;07
Margot Malachowski
And lastly, Tim Kenny.

00;04;22;27 - 00;04;54;27
Tim Kenny
There's a really simple aspect for what we do in our world and is that we save people who are actively active clinicians in seeing patients and doing patient care. We save them time. They may very well be perfectly capable of doing a search for PubMed articles, but it's finding time in the day for that. Nurses, they know they can send us a request. We know they don't want to see 50 pages of results. So we really try to repackage things in a way that they can review it and use or request more follow up.

00;04;55;10 - 00;05;14;19
Margot Malachowski
Tim makes a good point here. Medical librarians are saving the hospital staff valuable time, but there's this sticky perception that all biomedical information is easily available and you can get it yourself, right. So I ask these medical librarians to elaborate. Here's Chloe, from the Boston Children's Hospital.

00;05;15;24 - 00;05;39;07
Chloe Rotman
I think that a medical librarian is a translator of all of that information a distiller of that information. Just because, information is so widely accessible, doesn't mean that it's understandable. And in many ways, maybe even primarily, it's our job to be able to help users discern what is actually useful to them and what they're searching and where that lives.

00;05;39;25 - 00;05;53;22
Chloe Rotman
I think that we could even think of ourselves if there is a big rushing river of information coming off the Internet, we're sort of a dam in the middle of it that helps to keep trash and logs behind the dam and only let the good information through.

00;05;54;05 - 00;05;59;23
Margot Malachowski
Jill, the solo librarian from Champlain Valley Physicians Hospital, also makes a good point.

00;06;00;15 - 00;06;30;05
Jill Tarabula
Because the quality of the information that's available online is quite variable and not everything is truly, fully, freely available online as some might think. We have a very healthy and generous budget here at the hospital where I work. At least I feel that is the case and the resources that I subscribe to for the patrons that I serve are handpicked based on very close evaluation of usage in demand.

00;06;31;01 - 00;07;00;05
Jill Tarabula
You cannot get these resources through Google. You cannot go to Wikipedia and get this information. Evidence based practice, standards, things of that nature are not free. And so I am very selective and very careful as to what I subscribe to and make sure that we have available and only hospital librarian or someone with that background is going to be able to have that knowledge and provide that service and do it well.

00;07;00;24 - 00;07;15;09
Margot Malachowski
Folks might not understand that many library resources are subscription based and these subscriptions are expensive. Tim Kenny, with the Maine Medical Center, talked about how Maine Medical manages resources across a large hospital system.

00;07;15;13 - 00;08;01;05
Tim Kenny
In a perfect world, we'd have all of our resources be exactly the same across the entire health system. But it's a big health system and depending on the resources sometimes the licensing of those things can get pretty hefty as far as bills go if you offer everything to everybody. We are able to offer a lot of core resources across the board, but what we've done is we have a separate portal for them, looks very similar. Each portal looks very similar, but we make sure to highlight the resources available to them and we try to keep the resources that are at each location relevant to what they're doing. So if they're more outpatient, maybe we have some different tools highlighted. We'd like to get to a unified, everybody's got everything, but right now it works really well and we're able for those that maybe don't have something they'd like, we're still able to supplement support them.

00;08;02;10 - 00;08;11;04
Margot Malachowski
The National Library of Medicine is committed to helping medical librarians get information into the hands of health care professionals no matter where they work.

00;08;11;04 - 00;08;21;24
Yamila El-Khayat
That's right, Margot. The National Library of Medicine is the world's largest biomedical library, and it provides a variety of online resources to help librarians, medical staff and of course, the general public.

00;08;21;29 - 00;08;28;14
Margot Malachowski
I asked our librarians which National Library of Medicine resource was the most useful. Here's Chloe Rotman.

00;08;28;21 - 00;08;46;23
Chloe Rotman
The Boston Children's Library uses DOCLINE every single day, and DOCLINE is a network of libraries across the country where if you're, if you need an article or if you need a book chapter and you don't personally own it, you can make a request to another library who does own that resource, and they send it to you.

00;08;47;03 - 00;09;09;24
Chloe Rotman
And the next day they request something from you and you send it back. And so all day, every day, all of these libraries across the country are just sending each other articles that their patients need. And that is a resource that we rely very, very heavily on to add to and supplement our own subscriptions and make sure that even if we don't personally own something, we're never telling a patron that we can't get it for them.

00;09;10;03 - 00;09;11;24
Margot Malachowski
Jill Tarabula.

00;09;11;24 - 00;09;39;16
Jill Tarabula
I use PubMed daily. PubMed and DOCLINE, I live in both of those pretty much daily. I love MedLine Plus. That has always been one that I push in my teachings, in my interactions with people to make sure they know it’s out there. But it's definitely a more of a consumer health resource, obviously. But I make sure the providers and the nurses are aware of it so they can share it with patients as they're talking with them to help them find information.

00;09;39;25 - 00;09;41;23
Margot Malachowski
Lastly, Anne and Tim.

00;09;42;16 - 00;09;55;23
Anne Romano
Well, I use MedLine Plus every single day and I run groups with the patients and I provide handouts to them. It is my go to number one for an example of a credible source.

00;09;56;15 - 00;10;17;22
Tim Kenny
PubMed probably by quite a bit. It's it's also nice that even if I was completely removed from my network, I could at least still go search PubMed if I had to. Pretty much anywhere with a Internet connection. But if I really need to run a search or I wanted to find information on my own or direct someone to find good information, I can direct anyone PubMed.

00;10;18;01 - 00;10;22;17
Margot Malachowski
Yamila, do you have a story of how you made an impact as a medical librarian?

00;10;23;24 - 00;10;45;11
Yamila El-Khayat
I have a ton of stories, Margot. A few years ago, I worked on a project with community health workers or Promotores de salud which our community members that serve as liaisons to the Spanish speaking community, helping them navigate our very complex health care system. During the program, I was able to introduce them to resources from the National Library of Medicine, focusing in on social determinants of health.

00;10;45;25 - 00;10;54;27
Yamila El-Khayat
This allowed Promotores to go back to their own communities, empowering them with knowledge to ask more questions during their doctor's visits.

00;10;55;13 - 00;11;13;10
Margot Malachowski
What a great project. I love hearing stories like that. As librarians, we rarely get told about how our work makes a difference. Our job is to support the staff and not to collect accolades. But occasionally we do hear about big impacts. Here's Jill talking about the work she's done with the hospital pharmacy.

00;11;13;29 - 00;11;46;18
Jill Tarabula
I can tell you, I've worked very closely with our pharmacy here and helping them to determine best ways to save money while serving patients and making sure they have the best outcomes while being mindful of budget. And I was made aware of several literature searches that I had provided that changed practice, changed formulary, and in one instance, they actually saved $500,000 a year by making the changes that were introduced in the literature that I had located for them.

00;11;47;12 - 00;12;06;02
Margot Malachowski
Tim shared a story from a previous job where he rounded with the health care team at the hospital. This is a story about researching a rare condition ovarian ectopic pregnancy with complicating factors. An ectopic pregnancy is when the fertilized egg grows outside the uterus.

00;12;06;13 - 00;13;06;13
Tim Kenny
One of the docs pulled it, pulled, in this case, me aside and said, Hey, I've got this weird case. Can I send it to you and see if you can find anything on it? I have searched high and low and think there's much out there on it and there wasn't a whole lot. It was for a odd type of ectopic pregnancy, like a 1% occurrence type of thing. Did some looking very sparse on this particular aspect of it. And it turns out there was a case study slash review article in a Canadian journal, and they developed a flowchart for dealing with this particular case. So I found that sent along in fairly short order because this was an active patient care situation and they used that flow chart as as one to support the decision making process and two to guide their decision making process. They were able to use that to help treat the patient and they acknowledged that, and I think we got a kudos from the upper admin.

00;13;06;22 - 00;13;15;24
Margot Malachowski
Lastly, I want to share Chloe's story about providing research to a nurse practitioner who was training community health workers in a refugee camp.

00;13;16;10 - 00;13;45;11
Chloe Rotman
There is an NP at the hospital who was working in Myanmar and she reached out for a literature search, which is a very normal service that we provide. And she was asking about just training for community health workers in developing countries. And so I sat down, I spent maybe an hour or two on it, and I sent her 15-20 articles and she wrote back to me and she explained that she is working in a refugee camp.

00;13;45;11 - 00;14;07;14
Chloe Rotman
She is organizing volunteer community health workers from the community and using the articles that I sent her, she was able to create and implement a training curriculum that would allow the health workers to respond to natural disasters. So before that, you know, when there was an earthquake, when there were floods, there wasn't any set plan. People were standing around panicking.

00;14;08;00 - 00;14;30;03
Chloe Rotman
And now using the information that I gave her, they were so excited to learn. They were so excited to have action steps for when these natural disasters hit. And thanks to my work, allegedly, the refugee camp was now a safer place for everyone, but especially for the children who were there. And that was such a moving and shocking email to receive.

00;14;31;05 - 00;14;47;25
Chloe Rotman
I think in this work you don't often see the full effect of your labor, you know, and you hand things over and what happens happens and you have no idea what it is. I just felt like she was so generous in telling me what she used my work for and how it really impacted people.

00;14;49;03 - 00;15;09;16
Margot Malachowski
I really hope everyone listening will understand the role that medical librarians play in delivering quality health care. Maybe the creators of the next medical show will hear this podcast and develop a character at the hospital who has this role. But on a serious note. Medical librarianship is a profession that's been dwindling over the last 20 years.

00;15;09;23 - 00;15;22;24
Yamila El-Khayat
You're right Margot, here in Tucson, we had two hospitals each with their own library and their teams of librarians. And with budget cuts, they now are down to only one librarian to serve both hospitals.

00;15;22;25 - 00;15;46;29
Margot Malachowski
Yeah, unfortunately, that's a common story. When hospital budgets are slashed, we tend to be one of the first out the door. In fact, the week I was prepping for these interviews, I got one of those Facebook memories that six years ago my previous employer was poised to eliminate 300 jobs, and they had made this big announcement that they were looking at the need to have jobs and the good to have jobs and the nice to have jobs.

00;15;47;10 - 00;15;54;11
Margot Malachowski
And that they were likely to cut the nice to have and Yamila, I ended up being a nice to have. And I lost my job a few weeks later.

00;15;54;11 - 00;16;03;17
Yamila El-Khayat
That's terrible, Margot. I thought all librarians were need to have. But then again, I'm biased. All things happen for a reason, though. Now you're with NNLM.

00;16;04;03 - 00;16;23;25
Margot Malachowski
Yeah, and I get to take the knowledge and the skills that I developed as a medical librarian, and I support the work of medical librarians. And those of us in the field still believe that medical librarianship will stay relevant into the next century. So let's end on the upbeat with two interview clips from Jill and then Chloe.

00;16;24;20 - 00;16;54;17
Jill Tarabula
So in my opinion, medical information will continue to get more complex to navigate. There will be more and more information on the Internet freely available. There will be more information resources introduced that are subscription available. Helping our patrons to understand where to find what is going to be key to them being successful and making good decisions and providing that best patient care.

00;16;54;29 - 00;17;16;09
Jill Tarabula
Also efficiency. Being here and ensuring that the doctors and nurses are at the bedside and taking care of patients, and I tell them that. If you're spending more than a few minutes looking for something, you're taking too long and you're taking my work away, which is a bit of a joke with them. And they laugh. We laugh about it, but ultimately that is my expertise.

00;17;16;09 - 00;17;24;03
Jill Tarabula
Let me do that for you, so that you can go and do what you do well, and that is to take care of our patients so that they can go home with their families.

00;17;24;29 - 00;17;55;21
Chloe Rotman
I think that as long as there is medicine and as long and as long as there is research, medical librarians are an incredibly necessary and valuable part of that ecosystem, especially as we move towards workplaces that are more remote and less centralized. I think that it becomes more and more valuable that there is a central location and a central department where people can come to ask questions, get information, learn how to do, research themselves.

00;17;56;14 - 00;18;00;08
Chloe Rotman
I think that it only becomes more important as time goes on.

00;18;01;05 - 00;18;09;08
Yamila El-Khayat
I do want to thank you, Margot and of course, Chloe, Jill, Anne, and Tim for sharing your stories and humanizing what being a medical librarian really is.

00;18;09;12 - 00;18;10;03
Margot Malachowski
You're welcome.

00;18;11;06 - 00;18;40;02
Yamila El-Khayat
We'll be featuring other profiles, grants and interesting information from all of our regions during this season of NNLM Discovery. Subscribe, rate, comment and share our episodes to help us grow our audience. For more information about NNLM, the NLM, and supporting information about this story, check out the links within this episode's description. The NNLM offers free training, partnerships and many resources that help to improve health and wellness.

00;18;40;14 - 00;18;44;27
Yamila El-Khayat
Membership is free. Learn more at NNLM.gov.