Fall 2003 Contents • Automne 2003 Table des matières

A PDA user's diary

Barrie McCombs, MD, CCFP, CCFP(EM)

CJRM 2003;8(4):270-1

0800 — Drug dosage
Patient: Billy Smith
Diagnosis: recurrent otitis media

With his last episode, Billy responded poorly to ampicillin, so I decided to try him on Clavulin. I didn't remember the dose per kilogram, so I looked it up in my Lexi-Drugs program. His mother asked about side effects, so I showed her the information right on the PDA. I like Lexi-Drugs because it has a large drug list and gives Canadian drug names (for example, in the USA, Clavulin is known as Augmentin). The data is updated several times per year.

0900 — Drug interaction
Patient: Mary Jones
Diagnosis: diarrhea

A specialist recently started Mary on "Nousatol." She forgot to tell him about the "Nogudatol" that I gave her last week. I entered the names of all her medications into my Lexi-Interact program and discovered that diarrhea is a common side effect of "Nousatol," particularly in patients taking "Nogudatol." The recommended treatment is to reduce the dose of both drugs.

1000 — Medical reference
Patient: William Dogood
Diagnosis: malaria

Bill has just returned from 2 years as a volunteer in the Far East. He had developed acute malaria and was treated with quinidine, which is usually used for cardiac arrhythmias. I had never heard of this treatment, but I looked up malaria in my "Five Minute Clinical Consult" (5MCC) and found quinidine listed as a treatment option. I'm sure glad that I have a memory expansion card on my PDA so that I can store all these different programs.

1100 — Medical calculator
Patient: Hees Tufaht
Diagnosis: smoker, obesity

Until today, I've had no success in convincing Hees to stop smoking, reduce weight, follow his diabetic diet and take his hypertension medication regularly. On this visit, I used the Framingham calculator on my PDA to show him that, with all his risk factors, he has a 75% chance of having a heart attack within 10 years. He immediately asked for a prescription to help him stop smoking, and agreed to start working on his other risk factors.

1115 — Date Book
I called the Canadian Pharmacists Association to see if they have a PDA version of the Compendium of Pharmaceuticals and Specialties (CPS). They will have one available in early 2004. They had not decided on a price yet, so I made a note in my PDA's "Date Book" to call them again in January.

1130 — Alarm
Patient: Barrie McCombs
Diagnosis: poor memory

My PDA's alarm rang to remind me of the 1200 CME meeting at the hospital. I got there just in time to grab the last sandwich and hear Dr. Ray Bhid describe the first case of West Nile virus in our community. He gave a really good review of what physicians could do to reduce their patients' risk of contracting the disease.

1245 — Beaming
At the end of the rounds, Dr. Bhid had exhausted his supply of printed handouts, but he had a copy of the information on his PDA, so he copied it to my device using infra-red beaming. It only took a couple of seconds!

1300 — Address Book
Patient: Marcus Wobbly
Diagnosis: old age

Marcus is a 95-year-old physician. Just this year, he finally saved up enough money to be able to retire. He asked to have his prescriptions refilled at a new pharmacy that just opened in his neighbourhood. The store isn't listed in the phone book yet, but I had saved their phone number from a previous call. I pressed the "Address Book" button on my PDA and looked in my list of local pharmacies.

1310 — To Do List
I'm on telephone hold, waiting to talk to the pharmacist. While waiting, I pressed the "To Do List" button on my PDA. My wedding anniversary is in 2 days, and my wife has never forgiven me for forgetting it for the past 3 years. So I made a "high priority" note to call a florist tomorrow.

1500 — Calculator
Patient: Christie McDonald
Diagnosis: recurrent otitis media

I decided to try Clavulin on Christie as well. I remembered the dose per kilogram from the previous patient, but used the calculator on my PDA to determine the correct daily dose for her particular weight.

1515 — Memo Pad
A patient cancelled, so I used the time to read the notes on West Nile virus that the speaker had given me. I made a "To Do" note to create a patient handout about mosquito repellants. Just then, my partner dropped in. She had missed the meeting, so I beamed a copy of the notes to her PDA.

1545 — Note Pad
A patient came in with a sprained ankle. He wanted an x-ray, but I used "Note Pad" on my PDA to draw an ankle diagram and explain that, according to the Ottawa Ankle Rules, he was at low risk of a fracture. It was a good diagram, so I saved it to use again.

1600 — Find
I couldn't remember the diagnostic code for Ulcerative Colitis, so I used the "Find" feature of my PDA to look it up in my list of ICD-9 codes. While searching all the data on my PDA, it also found the notes I had written about the disease at a recent CME meeting,

1615 — Camera
My last patient had a very strange rash. I took a quick picture of it with the built-in camera on my PDA. I'll email the picture to a dermatologist in the city to ask if I should refer the patient.

1630 — Email
I'm stuck on telephone hold again. I used the time to write an email message to Mary Smith's specialist, to tell him that I reduced her drug dosage.

1800 — Music
I'm finishing up my charts for the day. To help me relax, I listen to my favourite music, using my PDA's built-in MP3 player.

1900 — Synchronization
When I get home, I connect my PDA to my desktop computer and run the synchronization program. When I came back after supper, they had updated each other, including sending the email message that I had written, and downloading 2 full-text articles from the CMAJ.

2330 — Good Night
I'm exhausted, and so is my PDA's battery. We are both going to crawl into our cradles and recharge.

Web Sites:

Lexi-Drugs: www.lexi.com
Lexi-Interact: www.lexi.com
5MCC: www.skyscape.com
Risk Calculator: www.statcoder.com
CPS: www.pharmacists.ca
CMAJ: www.cmaj.ca

Competing interests: None declared.

Correspondence to: Dr. Barrie McCombs, Director, University of Calgary Medical Information Service, 3330 Hospital Dr. NW, Calgary AB T2N 4N1; bmccombs@ucalgary.ca; www.ruralnet.ab.ca/medinfo/

© 2003 Society of Rural Physicians of Canada