Using smartphones in medicine; practical examples
I had the privilege of being one of the docs who chatted with Sam Soloman about the most useful smartphone medical apps available. Check out the Parkhurst Exchange’s Practice Management article, that’s little snippet makes me sound so much smarter and more concise than I really am!
My iPhone sits in my scrub pocket or in a leather holster on my belt every day. I rely on it for the usual phone and message features, to handle quick e-mails, and listen to music on a daily basis. If I’m at work, ePocrates, Skyscape’s Taber’s Dictionary and the thankfully free MedCalc seem to see regular action. UpToDate is fortunately built into our hospital’s EMRs so I don’t tend to access it via my smartphone’s small-compared-to-a-desktop’s screen. I use a few other apps when I have more time to dig deep. Skyscape’s RxDrugs has a lot more Canadian and over-the-counter medications in its catalogue; Netter’s Atlas helps when straining to remember long forgotten things like muscular insertion points; and Diagnosaurus helps broaden my differential when I feel like I’ve wandered down the garden path.
PDAs are changing the way we practice. Yesterday, we wrote an “open book” pharmacology/prescribing exam, where the test was about choosing appropriate medications and writing clear prescriptions. If we pass this and other measures, we are then recommended to the College as sound prescribers and will be issued the appropriate registration numbers and duplicate (narcotics) prescription pads.
The object of the exam was not to test our recall of doses or to probe the bounds of our prescribing accurately for rare disorders. Rather, it was a test to see that we could come up with a reasonable drug choice given the patient’s context, using the resources regularly available to us. The questions got at things like: What anti-hypertensive medication would you start first-line for a diabetic patient? What would you do if they were still hypertensive after weeks on that drug? What might be a better choice for someone managing their chronic pain with hundreds of T#3s a month?
We were told to bring our PDAs, since those (and the CPS!) are our main prescriber tools. I think the nature of the questions – testing application and synthesis of knowledge rather than rote memory – and the allowance of our Smartphones was a reflection on the fact that medicine has changed. I don’t know about endorsing one brand of software over another, but some medical schools are even integrating smartphones into their education model.
We are trained to be critical thinkers, and there’s too much medicine to remember; offloading some of the raw data from our brains, there’s now more space to think carefully about why we do what we do, and about how it should be done.