EDITORIAL

The informationist—two years later

The participants generally agreed tion surprised me somewhat, be- or no formal clinical training. A
that the word was inelegant, but we cause I took the original Frank conceptual gap remains that re-
all kept using it anyway, as if the Davidoff and Valerie Florance edi- quires more exploration.
acknowledgment released us from torial to be neutral about the pos- This issue of education and train-
the search to find something better. sible backgrounds of individuals ing is critical, because it is the
As we bandied it about, one might filling the informationist role [2]. touchstone of concern among some
have thought it had been in general But while some of the presenters hospital and clinical medical librar-
parlance for years, rather than be- and some of the discussion touched ians. Michael Kronenfeld, in his
ing a recent coinage invented to try on the notion of entrants to the National Network article (which
to gather loosely together a set of field from other arenas, we always was referred to several times by
concepts for exploration. Now that came back quickly to librarians. participants), charged that the Dav-
the conference on ‘‘The Informa- As a member of the task force idoff and Florance editorial was a
tionist’’ is over, do we have a better that organized the conference, I re- direct attack on hospital librarians
idea of what the informationist is? call that in our early planning doc- [3]. While this was certainly not the
I think we do. At least, I think we uments we envisioned a very wide- intent (and Davidoff and Florance
have a better understanding of ranging attendance, with represen- reconfirmed that in their presenta-
some of the ideas involved. tatives from all across the health tions at the conference), it is also
This issue of the Journal of the care spectrum. And, in fact, a num- clear that many hospital librarians
Medical Library Association (JMLA) ber of individuals representing oth-
contains a brief overview of the saw the same red flags. The percep-
er professionals attended, and they tion among these concerned librar-
conference, which was sponsored had a great deal to contribute. Still,
by the Medical Library Association ians is that the editorial suggests
as we sat in NLM’s Lister Hill Cen-
(MLA) and held at the National Li- that they are not qualified to deliv-
ter auditorium, the audience was
brary of Medicine (NLM) in April er the sorts of services being de-
overwhelmingly librarians. We were
of 2002 [1]. I encourage you to scribed, and that this suggestion
among the true believers. Librarians
spend some time with the confer- implies that they need to be re-
and nonlibrarians alike, this was a
ence Website* as well. Many of the placed by the dreaded ‘‘informa-
group who did not need any con-
presentations have been posted vincing that we needed to do a bet- tionists.’’ The rejoinder from these
there, as well as a conference sum- ter job of managing information in librarians might be, ‘‘The services
mary and the transcript from the the health care and biomedical re- that are being described are pre-
online chat session that took place search arenas. The discussion fo- cisely those that we are already pro-
several weeks later. The MLA cused on whether or not ‘‘informa- viding. Rather than creating a new
Board of Directors has asked the tionists’’ represented the avenue to- profession, we need to focus on
task force to continue to work on ward making things better. providing better support for what
options for further developing the As I see it, the central notion of medical libraries are already do-
concept, and additional informa- the pro-informationist argument is ing.’’
tion will continue to be posted to that the effective management of One might respond to this in a
the Website. couple of ways. For one thing, in-
information resources requires an
I am sure that all of the partici- formationists are not the be-all and
individual who has formal training
pants came away with their own end-all of information services and
of some sort both in information
handful of highlights; here I intend need not be in competition with li-
management and in the particular
to offer just a few of my own. One brarians. In some cases, what li-
discipline—a true hybrid. Implicit
of the things that struck me early brarians do is what the informa-
in the first day was that we seemed in this is that one could come to
this role from a variety of areas. tionist would be called to do, but
to implicitly assume that we were
Some librarians bristled at the no- even if there were large numbers of
talking about potential extensions
tion that ‘‘retired clinicians’’ might well-trained and qualified infor-
of roles for librarians. This assump-
be easily trained to perform the in- mationists, that would not elimi-
formationist role. Yet it strikes me nate the need for professionals do-
* The conference Website may be viewed at that there is an incongruity be- ing all the other things that librar-
http://www.mlanet.org/research/ tween that reaction and the notion ians do. Not all hospital librarians
informationist/. that librarians can start participat- are or need to be clinical medical
ing effectively in rounds with little librarians (CMLs) in the ways in

J Med Libr Assoc 90(4) October 2002 367

Editorial

which we have understood the of time and energy and resources can find a way to fund a CML pro-
term over the past thirty years. are going to have a payoff in the gram, then we might do it. But be-
However, that begs the question areas that they care most deeply cause we never have enough fund-
in an important way, because a cen- about. In health care, the payoffs ing to do everything we would like
tral part of the informationist ar- are pretty clear—shorter length of to do, CML programs fall to the
gument is that what is needed is stay, fewer unnecessary tests, fewer bottom. At Vanderbilt, because it is
not, in fact, what is already being adverse effects, fewer medication a top priority, it gets funded at the
done. Without some degree of spe- errors, and the like. To move clini- top of the library budget. This no-
cialized training, such as is not typ- cal librarian or informationist, or tion is radical, because it upends
ically acquired by librarians, an in- whatever you want to call them, the standard models and requires
dividual is not qualified to provide services into the mainstream will considerable shifting of job assign-
the level of services described un- require demonstrating a closer con- ments within the library, but it is a
der the term ‘‘informationist.’’ nection between those services and beautifully simple approach to-
Moreover, until the funding and or- these desirable outcomes. ward solving the tangled problem
ganizational status of that individ- The Davidoff and Florance edi- of funding CML programs.
ual are changed and moved out of torial goes further than this, How much of this can be trans-
the library and into the clinical de- though. Implicit in their argument ferred to other institutions is still a
partments, even well-trained indi- is the notion that proving the value big question, however, as Nunzia
viduals will not be effective in the is not enough. Not only do librari- Giuse, the Vanderbilt library direc-
way the editorial envisions. This ans have to get out of the library tor, pointed out during one of the
proposition was not directly con- physically (as clinical medical li- question-and-answer periods. The
fronted during the conference, but brarians do now), but they have to institution must be culturally and
it hovered in the background dur- get out of the library organization- organizationally ready to embrace
ing all of our discussions. ally. They need to be employed by, such an approach. Other institu-
Start with the question, do cur- and responsible to, the clinical de- tions may not find such a rear-
rent CML programs effectively partments. Only then will the rangement of priorities to be feasi-
meet the information management funding and acceptance challenges ble.
needs of clinical care? One answer be successfully met. But partici- One of the things apparent from
to this might be, yes, they do, in the pants at the conference suggested the conference is that a great deal
institutions in which they are well that other ways to address these is- of innovative work is going on.
developed. If that is the case, then sues might exist that would retain There are many successful pro-
the next question becomes, why, in the base in the library. grams in hospitals and medical
thirty years, have they not become There were several references, for centers throughout the world. But
the norm? In his keynote remarks, example, to ongoing projects at the how many of these are document-
Davidoff put this question in the Eskind Biomedical Library at Van- ed? Two years ago, in the Bulletin
context of diffusion of innovation derbilt University. The work being of the Medical Library Association,
theory, discussing the patterns by done there is well documented† Carolyn Lipscomb traced the his-
which new ideas move through a and shows a commitment to train- tory of clinical medical librarian-
society. First, they are presented by ing and organizational ingenuity ship as reflected in the library lit-
the innovators themselves, then are that provides a useful point of erature [4]. At the conference, K.
picked up by the early adopters, comparison to other attempts to es- Ann McKibbon announced her in-
and gradually move into the main- tablish strong CML programs. I tention to write a systematic review
stream. With clinical medical li- think that perhaps the most signif- of these efforts. The systematic re-
brary services, we are still largely icant thing about the Vanderbilt view will be tremendously helpful,
in the early adopter stage, and the program is simply the radical no- but it will only identify what has
question remains, why have they tion that putting librarians into the so far been documented. There is a
not moved into the mainstream? clinics is the top priority. Too often, critical need to do more documen-
Part of what distinguishes early library directors have seen these tation and to encourage people pro-
adopters from the mainstream is programs as extras. If, after all our viding these services to do sound
the early adopters’ willingness to other priorities have been met, we evaluations and get them into print.
take innovations on faith. Some- This could be a valuable joint pro-
thing looks like it might be a good † See, for example: GIUSE NB, KAFANTARIS
ject for the Hospital Libraries and
thing, so the early adopters are SR, MILLER MD, WILDER KS, MARTIN SL, the Research Sections of MLA—to
willing to try it out. The main- SATHE NA, CAMPBELL JD. Clinical medical identify programs and to help the
stream requires more proof. They librarianship: the Vanderbilt experience. Bull people running those programs to
want evidence that the investments Med Libr Assoc 1998 Jul;86(3):412–6. evaluate and publish.

368 J Med Libr Assoc 90(4) October 2002

 Editorial

By the second day, as we contin- specialized information services in of the young doctor or nurse or
ued to struggle with concise defi- clinical and research settings can therapist who is trying to give her
nitions, we talked of the ‘‘thousand best be provided and what the key the right kind of care. I think of
flowers’’ approach—the notion that roles of librarians in that milieu their information needs, and I hope
loose definitions were fine and that should be. If the results of this are we are building systems of people,
we needed to support a multiplic- better training programs, improved machines, and networks that are
ity of methods and models for en- funding, and more effective orga- getting them exactly the informa-
hancing information services at the nizational models, we will all be tion they need as efficiently as pos-
point of need. (The phrase, by the better off. sible. In my professional heart, I
way, is most commonly attributed I was talking with my mother hope their information-providing
to Mao Zedong, who took it from the other day. She is in her early partners are called librarians, but
an ancient Chinese poem. He used seventies and in good health, but as my mother’s son, I simply want
the phrase supposedly to encour- she is at that age where she has to them to be called excellent.
age constructive dissent, although deal with the health care system on T. Scott Plutchak, Editor
some have suggested his real inten- a regular basis. It is frustrating, be- tscott@uab.edu
tion was to root out and eliminate cause what she needs most of all is University of Alabama at
the dissenters. I will refrain from information, and that can be diffi- Birmingham
commenting on whether this has cult to get. We discussed some of Birmingham, Alabama
any implications for the current the changes that are happening
discussion.) within the system, the increasing References
It was apparent that information- emphasis on problem-solving and 1. SHIPMAN JP, CUNNINGHAM DJ,
ists could operate in many different communication skills for medical HOLST R, WATSON LA. The informa-
ways in different settings, and con- students and the growing recogni- tionist conference: report [special re-
sensus seemed to be growing that tion that what physicians and other port]. J Med Libr Assoc 2002 Oct;90(4):
this could be a good thing. Rather health care workers need is to be 457–63.
2. DAVIDOFF F, FLORANCE V. The infor-
than trying to define the notion too able to find and process informa- mationist: a new health profession?
tightly, it might be better to sup- tion. The evening after finishing [editorial]. Ann Int Med 2000 Jun 20;
port a lot of different sorts of pro- this editorial, I will speak to a first- 132(12):996–8.
jects and see which ones are suc- semester library school class about 3. KRONENFELD M. ‘‘The Information-
cessful. (I remain somewhat con- medical librarianship. I am going ist: a new health profession?’’: so what
cerned, however, that employing to make the point that what makes are we? chopped liver? Natl Netw [In-
the term that loosely may result in our specialty different from all of ternet] 2000 Oct;25(2):1,15. [cited 28 Jun
2002]. ,http://www.hls.mlanet.org/
our using a word that actually has our librarian colleagues’ is that NatNet/OCTpage1.pdf..
relatively little useful meaning. If ours is literally a matter of life and 4. LIPSCOMB CE. Clinical librarianship.
‘‘informationist’’ can mean any- death. At the end of the day, this is Bull Med Libr Assoc 2000 Oct;88(4):
thing I want it to mean, how can I what ties us together as health sci- 393–6.
be sure that you and I are both ences librarians. 5. SHEARER BS, SEYMOUR A, CAPITANI
talking about the same thing when The symposium on the informa- C, EDS. Symposium: patient-centered li-
we use it?) tionist in the January 2002 issue of brarianship: the informationist and be-
yond: a symposium to honor the fifti-
The best outcome of the confer- the JMLA stressed the need to be eth anniversary of the Philadelphia Re-
ence, of course, is simply that it ‘‘patient-centered’’ [5]. These days, gional Chapter of the Medical Library
took place. We are now engaged in when I center on a particular pa- Association. J Med Libr Assoc 2002 Jan;
a national discussion about how tient, I think of my mother. I think 90(1):21–85.

J Med Libr Assoc 90(4) October 2002 369