The text below is a comment on an interesting post by Dr. RW: Are you UpToDate dependent?It looks like UpToDate is gradually becoming "the universal textbook of medicine." Do you remember the last time you opened Harrison's to consult about a clinical topic? Was that in 1997 or 2001? By the time Harrison's is on the shelf, it is often 5-10 years out of date. And this is where UpToDate steps in -- "up-to-date", what a catchy promising name.
UpToDate is useful and easy to use. We have it installed on every computer at the Cleveland Clinic and residents read it all the time. How many times I have not found the answer to a clinical question in UpToDate? Many. Then I try Pubmed and the plain Google search which both have almost always been helpful.
I don't think anybody should be dependent on a single source. If one cannot practice medicine without UpToDate, may be one should not practice at all.
There is an old proverb: beware the man of a single book (homo unius libri). It describes people with limited knowledge. The current version of the Internet has billions of scientific journal pages and the answer to your questions must be somewhere out there. Do not be the man of one book only.
References:
Are you UpToDate dependent? Notes from Dr. RW, 07/2007.
Image source: UpToDate.
Related reading:
CME thought police alert! Notes from Dr. RW, 01/2008.
Thought Questions
Small association between use of UpToDate and reduced patient length of stay, lower mortality (study sponsored by UTD) http://goo.gl/zSG8R
95% of junior doctors consider electronic textbooks the most effective source of knowledge. 70% of junior doctors read the medical literature in response to a specific patient encounter. BMJ, 2011. http://goo.gl/QZyJE
Most up-to-date point-of-care medical resource? Sorry, UpToDate, Dynamed is way faster - BMJ http://goo.gl/4GC5l and http://goo.gl/QQcOh
How Current Are Leading Evidence-Based Medical Textbooks? An Analytic Survey of 4 Online Textbooks (including UpToDate) http://buff.ly/X2kUKw
What about eMedicine, which is free (when you register)? I don't know how useful eMedicine would be for residents, but for me, as a lowly MS2, it's a great source of information. So is the Merck Manual on my PDA. I've also heard from MS3's that 5-Minute Clinical Consult (also for the PDA) is essential. I haven't tried UpToDate yet, so maybe I just don't know what I'm missing.
ReplyDeleteNot to advertise .. (I have no connection with the company) .. but Dynamed (dynamicmedical.com) is more comprehensive, more evidence-based, and more UP TO DATE than up-to-date.
ReplyDeleteUTD is a fine resource, but dynamed is better.
Many doctors are "addicted" to UpToDate and it is problematic because there are other very good competitors that offer home access with subscription (UTD does not) and are working towards integration within the EMR (UTD has no plans towards this and does not work with an EMR).
ReplyDeleteFirstConsult works with Epic (used at CCF) yet the doctors at CCF prefer UTD which doesn't work with Epic. So their choice point of care resource isn't really at the point of care (within the EMR). Not very forward thinking in my book.
I am biased... but just so you know what you are getting with Dynamed, it is written by almost all AAFP physicians, even residents (see their authors list). As for "Best Evidence", can someone who is not a specialist really determine what the "Best Evidence" is AND put together a treatment plan based soley on "that evidence"??? I'll take someone who KNOWS what the evidence means AND (to steal from Cicso) incorporates the HUMAN ELEMENT into the process. Also, UTD is all PEER REVIEWED, and the ENTIRE database is reviewed and updated every 4 months. How often is that done with Dynamed? Everyday??? Sure it is...
ReplyDeleteBy the way, UTD is working with EMR's... you guys spend to much time talking with the wrong reps...
i have www.clinicalevidence.com which does the job for me over uptodate, much shorter info that you can really use at the point of care, rather than sifting through pages and pages from uptodate (sometimes over 20 pages for 1 topic). I just dont have the time to read all that when I just want a quick answer at the point of care. bmj clinical evidence does this for me, plus you know its 100% based on evidence, I am not sure uptodate is
ReplyDeletebmj now launched their new decision support tool which looks great i just asked for trial to analyze more, its at bestpractice.bmj.com
ReplyDeleteI am currently using:
ReplyDeleteMDConsult (majorly for Mandell's Infectious Diseases and Robbins Pathology)
Access Medicine's Harrison Online
Uptodate
I have left today feedback on UPD and got an answer from two editors in one afternoon.
I have tried bestpractice but won't subscribe. Medscape - with its new layout - can be a quick free alternative for fast consultations.
Have you tried Epocrates Diseases? It's quick, intuitive interface, focused on diagnosis/treatment. Based on BMJ Evidence. Free online access after registration.
ReplyDelete