Home Forums Discussions General Discussion UpToDate and eMedicine

Does anyone else feel the way that I do as to UpToDate. I used to love UpToDate as searches would tend to bring up disease I searched for. It broke it down into different categories of the disease. Now, it brings up around 10 different articles/reviews on various topics that somewhat relate to the search if at all.

I keep it only for the CME. Searching for homocysteinemia, a specific clinical disease, will show the disease under the search box, but all you get are articles on peripheral artery disease (yes it can cause thromboembolic events and stroke, and folic acid and B12 deficiency (the reason I tested the patient to begin with -- yes it can be caused by homocysteinemia). But, there is not "hit" for the disease itself.

Years ago, that would be what would come up with sub hits of epidemiology and pathophysiology, clinical presentation, diagnosis, etc.

eMedicine used to be great. Actually, so great I subscribed to it. Now that it is combined with Medscape, you get another list of articles. For whatever reason, they seem to be more relevant than the above. But, there are so many ads, it is hard to read.

I use Google, and mostly Wikipedia.
Too many ads on all the commercial sites, and uptodate and similar paid sites aren't nearly as good as Wikipedia most of the time.

So true. Google brings me right to NIH, Mayo, and many other good studies and reviews. Not a big fan of the box containing the questions, which just quote the articles.

I subscribe to the full Epocrates suite, and have never used the PDR. Built into this is the Dx section and a lab section. I think the Dx comes from 5-min Clinical Consult. It's nice for determining your DDx and ordering workup panels. For instance: do you remember the full workup for Hyperparathyroidism?

Calcium lab -> Interpretation -> High: ->

familial hypocalciuria (you can read a full description of each disease with an article thatis brief and concise)
hyperparathyroidism -> PTH -> lab, interpretation, etc
hyperthyroidism -> TSH
immobilization ->
malignancy -> lymphomas, leukemia, MM, SCC, metastatic dz
milk-alkali -> renal us, BUN, PO4, PTH, Cr, pH, venous
Paget -> etc
sarcoid -> etc
meds (a dozone listed)

This is excellent for Point of Care. UTD is great for studying and getting CME, but it's too bulky for point of care. I've used it since med school, however.

I still prefer Up To Date as my main resource for educating myself, and at the point of care the many patient handouts, and I usually prefer the Beyond Basics handouts for most common problems. I like the epocrates for medication info, and the Good Rx app for cheapest prices around town for meds, and Calculate by Qx MD, all free except the Up To Date, but I get more than enough CME each year to qualify myself 10x over usually with Up To Date so more than justifies the cost, which I buy 3 years at a time as it is a little cheaper that way. I use Up To Date on my computer the rest on my phone at point of care, and Calculate has a great dermatome map and CHADS 2 vasc score/ yearly bleeding risk calculator I use a lot.
I have noticed as time progresses there are more options with searches in Up To Date, so if I want a patient handout I click on patient, if I want information for myself I click on adult. That narrows it a bit.

Remember when UpToDate had the 30-day guest pass?

I do need to put together or use something like what Chris was talking about to generate differential diagnoses and labs. I can't even find time to put a template together in AC for DDx or labs for something like abdominal pain.

Does anyone use some type of AI software for entering signs, symptoms and/or exam findings to generate a differential?

So, I looked at this. Is it only available as an app for a phone? Or can you get it online?

I mostly use Uptodate. It's nice that my professional liability insurance carrier "MagMutual" provides it for "free." Seems like one of those "Win Win" situations. Sometimes uptodate is a little irritating when the expert author of a section says stuff like "then the condition is treated in the usual way." (when I am looking up to confirm what the usual way is)

I remember when UpToDate simply provided CME that you just printed out. I guess they got in trouble with that method, because now we have to go through each CME and mark if it helped with clinical decision making or diagnosis, or differential or whatever they are. I pretty much go with one answer with a few of the others sprinkled in.