Dr Conor Malone is a Registrar in Informatics at St James’s Hospital in Dublin. Dr Malone is also the current National Healthcare Wikipedian-in-residence for the Health Service Executive in Ireland. We spoke to Dr Malone to find out how and why he uses BMJ Best Practice.
Why do you use BMJ Best Practice?
I’ve worked in ophthalmology and I’m currently working in emergency medicine. In both settings I’ve used BMJ Best Practice.
In ophthalmology, we often see patients presenting with an eye problem, but it’s actually a consequence of a systemic disease. When treating these patients, BMJ Best Practice is useful for looking for guidance on the ophthalmic issue, but also for things affecting the patient outside of my specialty.
In emergency settings and acute care, we’re increasingly seeing patients admitted with an acute condition, but who also have a chronic or lifelong condition. BMJ Best Practice enables me to get an overview of the patients’ acute condition, but also the interplay between treating the acute condition, medications they’re taking and the impact on their chronic condition.
Regardless of the area I’m working in, BMJ Best Practice helps me to structure my approach to a patient’s problem – the history-taking, the examination and diagnostics. The tool is like a living text, one that is constantly updated and contains the latest evidence and guidelines. Using the links to further reading, I can review in more detail information and data from Ireland, the UK, Europe, and the rest of the world. To have all this information summarised in one place is very useful.
BMJ Best Practice encourages the good practice of reviewing and refreshing knowledge. Through doing this I can see if there’s a new guideline, a new treatment, or a new way of managing a condition. By using the tool in this way it enables me as a clinician to keep my own knowledge up-to-date and accurate.
Please share an example when you used BMJ Best Practice to treat patients?
There are many occasions when BMJ Best Practice changed how I approached a patient. Recently I’ve gone back to seeing patients after a break from clinical practice when I was working on other projects during the COVID-19 pandemic. On my return to clinical practice, I saw a patient who had a respiratory infection and was becoming unwell, so I used BMJ Best Practice to look at the best approach to blood gases.
Using BMJ Best Practice as a reference, I was able to work through a number of questions. Was a venous blood gas enough? Did I need to do an arterial blood gas? What imaging should I get for the patient?
The situation was further complicated because it was during a time when the hospital was dealing with a cyber-attack and many of the computers were down. Everything was delayed and everyone was overstretched. It was quite likely I’d have had to wait to speak to a senior doctor, but thankfully, I had BMJ Best Practice on my phone and it helped me to speed up decision-making.
BMJ Best Practice enabled me to do the right things and not over-order or request the incorrect diagnostics for the patient. If I didn’t have access to BMJ Best Practice, I may not have made such clear decisions so quickly, which helped the patient receive care in a timely manner, despite the challenging circumstances.
Do you use the BMJ Best Practice Comorbidities Manager?
In treating complex patients, including those living with multiple comorbidities, BMJ Best Practice comorbidities manager provides valuable support and guidance.
Inpatient care has become more challenging, and even the management of relatively common conditions has become more complicated. Diabetes is a good example of this. Diabetes is a universal condition in that whatever speciality, or subspecialty you practice, certainly in a hospital setting, you’ll see patients who have diabetes.
Certainly, for patients with diabetes, who also have a second, third, or even fourth chronic condition, I found the comorbidities tool particularly useful. I think there’s probably no clinician in any speciality, who can avoid managing conditions that impact, or interact with diabetes and diabetes medication.
When caring for patients with diabetes, the comorbidities manager really does help you to make better decisions. One patient required steroids for COPD and also had diabetes. They previously had a problem taking oral steroids for another condition and it affected their diabetes and their blood sugars. The patient also had kidney failure as a result of the diabetes. I was able to use the comorbidities manager to navigate the interactions. This is not an unusual case, there are many patients who have two, three or four clinical conditions that you need to think through, and not treat as one single condition, or one single organ or system.
Do you use the BMJ Best Practice app?
I mostly access BMJ Best Practice on my phone using the app. It’s my most used medical app, and the calculators are one of its best features.
Using the calculators on BMJ Best Practice provides confidence we are using an accurate and evidence-based tool. It has also meant that I no longer have to Google websites to search for risk calculators, or other calculator tools.
Who would you recommend BMJ Best Practice to?
Having used BMJ Best Practice for ophthalmology clinics, ophthalmology emergency departments and in a general emergency department, I firmly believe it’s useful for everyone, whatever stage of your career, whatever type of care you are providing. For medical students, or trainees at the start of their career, it’s invaluable, especially when on call and seeing something new.
BMJ Best Practice is especially useful for people who are trying to make decisions out of hours, or in a time-sensitive setting, or are caring for acutely unwell patients. Ultimately it’s a really good decision support tool that enables all healthcare professionals to provide patients with the best and most appropriate care.