Using Evidence-based Resources to Guide Patient Care in Residency and Beyond
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Happy Match Day and congratulations! The move from 4th-year medical student to intern is both exciting and stressful. Distilled sources of evidence like DynaMed Plus can be helpful in getting the quick access to scientific evidence that you need to care for patients during your internship and as your career progresses. Here are some examples from our physician editors on how they use evidence-based resources to guide patient care.
Michael Woods, MD, Deputy Editor, Consumer Health:
In pediatric practice, I use evidence-based sources in several ways. First, I use them to review current recommendations for evaluation and treatment if I am not sure of them. For example, some screening tests such as lipid screening are a moving target. I may need to go to the evidence when I am doing a routine visit to remind myself what the current recommendations are on whether, how and when to screen children for hyperlipidemia, and to refresh my understanding of the rationale for screening so I can discuss it with patients and parents. Recommendations for treatment may also change rapidly. I can use these sources to verify them or even to notify myself about any new guidelines or practice-changing studies that impact my practice.
Second, I use them for guidance on the diagnosis and treatment of less common conditions or syndromes. Rather than trying, and failing, to review all the literature and memorize diagnostic and treatment information, I find it more efficient to look up information as I need it. Those with eidetic memories may not need to look things up more than once, but for the rest of us, it’s a necessity.
Alan Ehrlich, MD, Executive Deputy Editor:
I often use resources like DynaMed Plus to double check what I think to be true. For example, I recently saw a patient with cellulitis who was allergic to penicillin and cephalosporin. I thought I should probably treat with clindamycin, but wanted to confirm first. My answer was found right at the top of the cellulitis page on DynaMed Plus in the Overview and Recommendations section, and my patient benefited from the efficiency with which I was able to access that information.
Ruth Hertzman-Miller, MD, Deputy Editor, Systematic Literature Surveillance:
I frequently use point-of-care tools during office visits with patients. Since the doctor-patient relationship is based on communication, I am sensitive to the fact that if I shift my attention to the computer screen without offering an explanation, I may be giving the patient a message that I don’t care about them as a person. To keep the patient engaged, I narrate what I am doing, and if possible, even turn the screen toward them so that they can observe the process.
For example, I might let them know that I am looking up a medication to confirm appropriate dosing or to check drug interactions. I might explain that I am using an evidence-based calculator: for instance, DynaMed Plus has a simple warfarin dose calculator that uses information about the patient’s target range and ratio (INR) to generate a recommendation on how to adjust the dose and when to recheck the INR. Alternatively, if the patient has come in asking about a specific treatment, I will look up the evidence for that treatment and share with them what I find. I have discovered that most patients are very appreciative of the fact that I am taking the extra time to consult the literature in order to provide them with the most effective treatment.
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