Although I enjoy my job, there are things that make it hard to work in a non-academic setting. The first is that "access to information isn't free" and the second is that "honest feedback is hard to find". I recently learned that my access to the Dartmouth Biomedical Libraries has been turned off. Apparently, my work with The Dartmouth Institute and the SQUIRE project does not qualify me for access. Without the library, my ability to access information has turned into a patchwork quilt. I can get abstracts off the web and some articles through the on-line library to which APD subscribes, but trying to do a comprehensive literature search is next door to impossible. At best, I find this mildly annoying. At worst, I think that limiting access to information must adversely affect the spread of good practice. Even if I succeed in publishing my work, who will see it? Is it worth expending a tremendous amount of time and energy to create a paper that collects dust on some obscure virtual bookcase? I get a sense that we need other ways to disseminate good ideas and good projects - ways that are more egalitarian that the traditional journal and library system.
Which brings me to the second point. During my training, it was easy to get feedback on my work. Sometimes, I got feedback even when I did not want it or did not have the time to deal with it. Now, I live in a feedback free zone. Perhaps my colleagues are just too polite, but I can't remember the last time anyone said anything other than "nice job" in reference to my work. I don't mind hearing those words but a little constructive criticism now and then would be helpful. Because of the absence of meaningful feedback at home, I am compelled to put my work "out there" for all to see and critique so that I can continue to learn and grow.
This attempt to publish from a non-academic setting is daunting. The system isn't set up to support or reward this type of work. From the lack of an IRB to the limited library access to colleagues who have different priorities, everything conspires to make this hard. This really is not about me and one little paper about Urine Cultures and pregnant women, it is about structure. There are two different healthcare worlds out there and we are only hearing about the experiences of one of them. I can't help but wonder about what is lost in the process.