What is the go-to resource for doctors to decide how to treat?

[achamess]

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Hi all,

So I've just started on the wards and I'm having a great time. One of my tasks, of course, is to do H&Ps and SOAP notes, and to come up with and assessment and plan. So my question is, what is the go-to resource that docs (residents, attendings) use to find out what the best treatments are for certain diseases? I know treatments are always changing, and for some diseases, there is 'standard of care'. Where do you learn these things? I can come up with general treatments based on what I've been taught - "If someone comes in with crushing retrosternal pain, give some nitroglycerin and aspirin and O2". But what about the specifics? Timing, doses, supplemetary things? Where do docs find this stuff out and stay current? Uptodate? First Consult?

From what I can gather on the wards, the reason I haven't found 'the' resource for treatment options is because so much of treatment is institution, department or even attending-specific. Experience is as much a determining factor as the available evidence. But that's just my impression so far. Any help here would be great.

 

[DrBowtie]

Mass Gen Medicine Handbook ("Green Book" or "Red Book") is a good place to start.

 

[OveractiveBrain]

Hi all,

So I've just started on the wards and I'm having a great time. One of my tasks, of course, is to do H&Ps and SOAP notes, and to come up with and assessment and plan. So my question is, what is the go-to resource that docs (residents, attendings) use to find out what the best treatments are for certain diseases? I know treatments are always changing, and for some diseases, there is 'standard of care'. Where do you learn these things? I can come up with general treatments based on what I've been taught - "If someone comes in with crushing retrosternal pain, give some nitroglycerin and aspirin and O2". But what about the specifics? Timing, doses, supplemetary things? Where do docs find this stuff out and stay current? Uptodate? First Consult?

From what I can gather on the wards, the reason I haven't found 'the' resource for treatment options is because so much of treatment is institution, department or even attending-specific. Experience is as much a determining factor as the available evidence. But that's just my impression so far. Any help here would be great.

Where SHOULD you go to find these things out? NEJM. Review Articles. Textbooks. These are, anyway, in descending order.

For a medical student in their 3rd year, you need only to find the rudimentary basics, not all the details of every disease. Thus, people use review books (First Aid, Step-Up, Case Files) oriented at their level of education.

For interns doing medicine, Current Medical Diagnosis and Treatment is a good starting point. Harrison's exists also.

As a medical student without any foundation, reading primarily literature or even NEJM review articles will be overwhelming and disappointing. Getting a decent review book targeted at Step 2 or the clerkship shelf will give you enough foundation without overwhelming. Then, adding a bridge, like the Mass Gen Book to evidence from review sources gets you at least thinking in terms of evidence based. Eventually, you will reach a point where the review sources don't cut it any more, and you'll move up into the literature. That point is likely not to occur any time soon.

The reason why MDs will never be replaced is because to accumulate the wealth of knowledge to answer the question your are asking takes the processing power of the human brain and is more integrated and thought provoking than any one source.

In summary:
- To start, get Step Up / First Aid / NMS / whatever
- To bridge, get Mass Gen Hand Book
- To expand, get Current (use this towards the end of 4th year start of intern year)
- To mature, go to journal articles

 

[osumc2014]

uptodate.com

 

[Frozen]

I think that AAFP/Archives of medcine does a great job of review articles on common diseases and how to treat them. They are well within the med student range for understanding and are more educational than just flipping open the redbook.

I don't like up to date for Plans. I find it too fragmented and I miss important aspects of treatment/workup plans.

 

[The Angriest Bird]

Hands down uptodate.com

My life wouldn't exist today if I didn't subscribe to that website. I know it's $230 if you have to pay out of your own pocket, but it's money truly well spent.

 

[C5toC9]

most institutions have a membership to uptodate

 

[Doctor4Life1769]

I don't like to Up To Date, and neither did most of the residents I worked under in med school. References are too old to be of any use to anyone. Emedicine is less user-friendly, but IMO more "up to date" than Up To Date.

👍

 

[werd]

at some point, your clinical experience will fill in a lot of the blanks about treatment options and the best one for your particular patient. the best sources of learning this information are you supervising physicians (attendings +/- residents depending on your level), journal articles, textbooks, and online sources like uptodate and micromedex.

as a med student, i would focus on reading about the treatment options and approach to a disease and asking your resident (and then attending) about what they think; acumen will come with experience and becoming familiar with the literature in your particular field.

 

[olemissbabydoc]

+1 for uptodate

Even our attending likes it

 

[coldweatherblue]

up-to-date, emedicine, and, if the question is too specific for those, wikipedia..

for a REALLY specific clinical question that doesn't have established guidelines, never underestimate the value of typing your question into Google and reading the first couple pub-med abstracts that pop-up..

if you're lucky a resident you work with will give you (via flashdrive, dropbox..) a couple hundred relevant journal review articles covering the vast majority of common clinical problems.

 

[dienekes88]

I don't know about real doctors, but for medical students on Medicine a good strategy is:
Green Book
UpToDate
National body recommendations, e.g. AHA/ADA/ACCF consensus statements re: diabetes mgmt, AHA guidelines on treatment of valvular heart disease, etc.

 

[isoquin]

agree with uptodate. You will find a few random attendings who insist you never use it, but I have yet to actually get a reason as to why.

 

[rbnsafsadgf]

agree with uptodate. You will find a few random attendings who insist you never use it, but I have yet to actually get a reason as to why.

Up-To-Date isn't as clear as to the quality of evidence as other sites are. It is a more traditional editorial and review.

I prefer Dynamed. It has better evidence based summaries and is *very* succinct. However, it requires a reader to have slightly better reading skills with respect to the types of evidence.

 

[J ROD]

uptodate.com

this......love it...😍

 

[Zuerst]

wiki