www.nejm.com

The New England Journal of Medicine (NEJM) has a distinguished history going back to 1781 and grew up in Boston, Massachusetts, that somewhat conservative and rather traditional eastern coast of North America.

The journal's owner is the Massachusetts Medical Society (MMS), the oldest continuously operating medical society in the US. The MMS was incorporated as a professional association of physicians by the Commonwealth of Massachusetts in 1781, just days after the American Revolution's Battle of Yorktown. One of the key powers the state legislature gave the society was the effective ability to license physicians.

The NEJM is seen by many as the bastion of "integrated" internal medicine and hovers above any single specialty of medicine.

The articles published are mostly from highly academic and appropriately prestigious contributors. But despite that, it has rather graciously made some efforts at having regular review articles on a broad range of topics which are perhaps of more interest to GPs than to any particular specialty. And, the NEJM has been making a big push for new readers from the clinical "middle classes" over the last few years. Their distribution level must be enormous and would be anybody's guess.

They have also been enthusiasts for new ways of doing things - they have been providing a good selection of clinical practice article audio podcasts since 2006 (New Zealand Doctor, 12 March) and there is a large archive of previous years' articles available.

They have also been enthusiastic advocates of the "value-added" article. Often an article will be supplemented with not just the full text article in HTML and PDF but also with a power point - presumably for teaching purposes rather than the casual readership - and often an audio podcast. They have also added in the occasional video clips every week or two, such as real time echocardiography (see below).

Look and see offer

One of the reasons we picked the NEJM this month is they have been enthusiastically promoting their free 21 day full access "look and see" offer.

So, it is perhaps a good time to have a proper look around the site and to perhaps decide whether the US$100 annual e-subscription (no print copies, sorry) is value for money. Being a weekly publication one could argue it might even work out cheaper than a Time magazine subscription at US$2 an issue.

The section on videos in clinical medicine are aimed at review procedures or as teaching aids. Examples of some recent videos are examination of the larynx and pharynx, central venous (subclavian) catheterisation, abscess incision and drainage and chest tube insertion.

The journal is also archived into around 60 subgrouped specialties called collections - for example, healthcare delivery (528 articles) and health policy (723 articles) - just two examples of the tendency the journal has had in its strong focus on US healthcare systems over the last several decades.

While the full list of 60 specialties is fairly comprehensive it is noted there are no listed articles on primary care as such (nor for that matter family practice, family medicine, general practice - or even general medicine or paediatrics for that matter - whatever happened to that comprehensive "generalist"?).

The leading articles are not strictly editorials, they are rather appropriately called perspectives - after all a good leading article should really be there to give an overview rather than a clinically oriented state of the nation address.

The original articles are often rather ponderous but in other respects impeccably presented original research, mostly perhaps with minimal relevance to the GP clinician. They also have special articles, often covering aspects of the international medical globe. The review articles are in my view the main strength of the journal, usually focussing on some modestly contentious issues or new clinical approaches in modern medicine.

The never-ending case records of the Massachusetts General Hospital were always something that fascinated me as a medical student - clinically intensive brain-teasers not unlike those mostly fond memories of our own traditional CPC's (Clinico-Pathological Conferences) at Dunedin's memorable pathology lecture theatre.

Two of the other sections noted in the current issue were the images in clinical medicine section and also the clinical implications of basic research.

Clinical perpetuity

Overall, I still find the NEJM amazing for its clinical perpetuity. And, in 100 years from now it will doubtless have the same simple cover with the "seal" of the Massachusetts Medical Society on its frontispiece, whether it is to be sent via email or some other form of yet to be discovered transferable data format.

But, overall, I am perhaps not convinced the NEJM should be at the top of our must-have journal lists. After all, there is a range of free full text general practice journals supported by less than wealthy and somewhat more philanthropic publishers than the traditional big and powerful postgraduate societies.

Nevertheless, an excellent overview of what is available at NEJM Online can be found at www.nejm.org/features/features.html

For those technophiles with an insatiable curiosity for the latest of everything, try out the NEJM beta site at http://beta.nejm.org where they claim "to pursue new ideas in publishing and showcase innovative ways to present information for use in medical education, research, and clinical practice".

"The beta site is part of our commitment to physicians who never stop learning." On the beta site you might try out a new article interface, test out the audio summary with slides, play around with NEJM stuff with "google gadgets", drag and drop images to create power point slide shows and play around with search widgets.

NEJM Online also has a special link to its handheld service for PDAs (hand-held computers). Most of the articles in the archives are also available for PDAs, though, to be honest, it is difficult enough to read an article on a high definition LCD screen compared to the ease of sitting back with a printed article, let alone squinting and scrolling your way through a detailed article on a small handheld screen.

I got myself a full subscription to NEJM Online a year or so ago and found it to be very informative and intermittently inspirational. A temporary - perhaps just one year - subscription does also allow one to download any number of articles to keep for perusal at a later date and NEJM does also allow full free text access to some of its articles after a six-month stand-down.

OUT OF FIVE STARS
High quality content *****
Up to date *****
Good presentation  *****
Level of unfettered access *****
Useful patient information *
Interactive CME *****