BMJ Best Practice: time for learning and time for patients
Professor Sheona Macleod, Interim Medical Director, Health Education England
Dr Kieran Walsh, Clinical Director, BMJ
BMJ Best Practice is the clinical decision support tool of the BMJ. It offers continually updated, evidence-based and practical content that helps doctors and other healthcare professionals make better clinical decisions.
This is the third and final of a series of blogs on clinical decision support, healthcare professional education, and BMJ Best Practice by Sheona Macleod and Kieran Walsh. This third blog concentrates on the latest thinking on meeting healthcare professionals’ needs and how digital tools can give back time to spend on patient care.
BMJ Best Practice is freely available to all healthcare professionals who work for the NHS in England as a result of a national subscription from Health Education England. The purpose of this provision is to ensure that continually updated and evidence-based medical knowledge is constantly in the hands of healthcare staff.
BMJ Best Practice is built around the needs of healthcare professionals – and this has happened by talking to healthcare professionals and finding out what their concerns are.
This is key to how BMJ and Health Education England now work. Not listening to healthcare professionals and their needs will cause problems – everything from personal distress for individuals to public disputes with professions. No other sector would have its brightest and best who are full of ideas and not listen to them until they had been working for years or had completed their training. So we are committed to finding out healthcare professionals’ problems and then trying to solve them.
One definite need from healthcare professionals is to have learning materials and updated medical knowledge portrayed in new and innovative ways.
Junior doctors regularly ask for more multimedia content and infographics – they describe themselves as “visual learners”. However it is not just junior doctors who want and need this. Healthcare professionals at all levels of seniority are now familiar with sharing videos and images via social media and so expect this from medical knowledge providers also. In light of this, BMJ Best Practice has launched multimedia videos that cover common procedures that healthcare professionals need to learn about – such as how to do a chest aspiration or a lumbar puncture. The videos cover how to do the procedure as well as other important issues - for example how to explain it to patients and how to ensure that the patient has given informed consent.
Clinical decision support and the provision of healthcare professional education also have to be flexible so that they can meet the needs of people in a variety of contexts and environments. When healthcare professionals are in the community, the internet might not be available, and so access to the offline app will be essential. Such professionals might be nurses in community care settings – they will have learned about many different conditions during their training, so will want real time access to the latest evidence – so that they can be confident that they are saying the right things to patients. Allied health professionals including pharmacists are also amongst the growing user base of BMJ Best Practice. They especially appreciate the background to the knowledge and the fact that they can use that understanding to make decisions with patients. So they use the tool as well, focussing on a different part of what is offered. Advanced pharmacist practitioners increasingly make diagnostic and management decisions and want support in making these decisions. All professionals are short of time and so want to be able to access information within seconds whenever and wherever they are.
Another need is for continually updated information.
This has become even more striking in light of the Covid-19 pandemic. The Covid-19 topic on BMJ Best Practice has received a substantial update every day for the past six months. Today the topic has a thousand references. So the pace of change has been incredibly fast. This makes it impossible to analyse and assimilate all the information about the disease on a continuous basis. BMJ Best Practice is doing this work for healthcare professionals so that they can access knowledge in a rapidly changing global environment.
There are other challenges that have come about as a result of the pandemic. It can be more difficult to talk to patients and go through some clinical decisions when everyone is rigged up in personal protective equipment. Clinical decision support should be able to help in this circumstance as well. Healthcare professionals will not have to go away to look things up and will also be able to share the BMJ Best Practice images and videos and patient information leaflets with patients. This should help to address the issue of isolation: social distancing rules mean that patients often don’t have family and carers with them during consultations now and so patient leaflets will enable them to talk to their family about the condition and what was said as well as reading about it afterwards.
The key thing about digital tools and the key message from the Topol Review is that digital innovations should allow healthcare professionals the time to care. (1)
If they have a digital solution that provides reliable knowledge that they can be confident in, then this gives them back time to spend with patients. They can use that time for essential human care and communication with patients and to share decisions more effectively. The core purpose of digital innovation is to make the doctor-patient relationship better, with more time for communication and compassionate care which is really what people want. This kind of digital innovation gives healthcare professionals back the real reward of medicine, which is being there for the patient.
Funded by Health Education England, BMJ Best Practice is free to all NHS staff.
KW works for BMJ which produces BMJ Best Practice.