Exam Room Favorites

This article originally appeared online at DrPullen.com.

How can a physician have time to use the internet while seeing patients in the exam room. How is this possible when as a family physician I need to keep visits brief, and can’t spend time surfing the net. Actually I do go online to facilitate patient visits a few times every day. I find specific uses of the internet can be both efficient and helpful. I suspect some of these sites will also be useful to non-physicians too as reliable sources of information.

I find Dr. Google has a great memory. Certainly better than mine. Just yesterday I had a patient on Byetta, an injectible non-insulin medication for diabetes who was having side effects and I wanted to switch her to the newer drug in the same class. Google is great for this. I searched for “Injectible non-insulin diabetes medication” and the second item in the Google search has the names Byetta and Symlin right in the search bar summary. This took about 10 seconds, certainly less time than using my PDA would have taken, and far less than walking out of the room to look elsewhere. I don’t use search engines for much else though. It’s too slow. I need to go directly to a known site. In exam rooms where we use a Citrix thin client, keeping a list of favorites on a browser is problematic. Every room is different, and it would just take too much time.

The solution was one site to use as a homepage in our EMR that has all the good sites as links. I had my daughter make me a web site with most of my favorites on it to use as my in-office home page. We call it Exam Room Favorites. I find it extremely useful, and encourage any of you to use it too.

The most used sites for me include:

Epocrates: Now that I’ve switched from a regular PDA to an iPhone, the Epocrates app is somewhat slow unless I have a good Wi-Fi connection, so I use Epocrates online. It is fast, has the same great info as the PDA applications, and is very useful, mostly for cost information, but also for dosing and side effect information. Exam Room Favorites has an Epocrates search bar right on the page, saving a click or two.

Inner Body On-line: This used to be called Anatomy On-Line. I love this site. It lets me show a patient a picture much like the old CIBA monographs that give diagrammatic pictures of most body parts. I find patients love to see graphics that help me explain their issues to them.

Traveler’s Health CDC Site: Indispensible when I’m asked about international travel issues. Here you can find what immunizations are needed, what precautions to take, what type of malaria meds to prescribe, and other issues for any place in the world. I urge my patients to use this site prior to international travel.

Patient Handout sites: The AAFP Family Doctor.Org site and the Mayo Clinic patient information sites are the best. Here you can get printer friendly handouts for most types of problems. These are reliable places to tell patients they can look for information about whatever they have questions about.

Costco Drug Prices Site: Most pharmacies don’t publicize prices for their meds on-line, except for the discount pharmacies and their $4./ $10. generic lists at Target, Walmart and in our area Fred Meyer. I find the Costco site a great place to tell patients what they should have to pay for a medication, and many local pharmacies will match Costco pricing on generics.

New PAP smear guidelines: The new recommendations for management of abnormal PAP smears can be confusing and difficult to memorize. Why try when they are easily available on-line.

Lab Tests On-line: I occasionally have a consultant order a test I am not aware of, or need to know how to interpret in the case of a patient. This site has a good explanation of most of the common and obscure lab tests that may get done from time to time.

Ed Pullen, MD, is a board-certified family physician practicing in Puyallup, WA. He blogs at DrPullen.com — A Medical Bog for the Informed Patient.