How Reliable Are Medical Textbooks?

Medical textbooks are considered by many to be the definitive sources of medical information. These textbooks are published and updated periodically with the goal of providing readers with the most current information. They contain detailed analyses of medical topics by experts of the particular fields covered in the book. These books often are the main source of information for medical students and residents, and these readers usually believe the information found there is indisputable. For example, during a patient's visit, a resident told us that the length of the esophageal tumor was an unresectability criterion for esophageal cancer. We asked where he or she had read this information. The resident said this is “textbook” information (unchangeable, indisputable, and sacred knowledge).Here we raise a question whether medical textbooks are, in fact, free of major errors. Recently, we encountered a flow chart in a surgical textbook1 that summarized the approach to esophageal cancer. According to this chart, tumors bigger than 9 cm warrant palliation. In the same section it stated that tumors greater than 8 cm exclude curative resection. This is surprising because none of the current guidelines (as of 2016)2 mention tumor size as a prognosticator. We also found that the article linked to published findings dating back to 1997.3Textbooks are crucial tools of medical education, especially when used as a source of learning by medical students and residents. Young doctors must be taught to critically evaluate the information found in these books, as this information is not immune to errors.It is the sole responsibility of the authors and editors of medical textbooks to keep these textbooks updated with current, accurate information. Based on our assessment of textbooks in surgery, we recommend open-access, open-source textbooks that enable corrections by knowledgeable members of the medical community.