To what extent are medical databases useful?

I’m interested to what degree medical databases such as UpToDate, FirstConsult/MDConsult, and InfoRetriever are useful to

A) The layperson
B) The medical student
C) The practicing physician

Are they considered suitably authoritative for practical, actionable information, or do one of the above classes of people consider them inferior to some other source, and if so, what? Do they cover the material in enough depth? Too much depth? Insufficient depth? If you’re a med student, would you answer an exam question based on information in them? If you’re a physician, would you diagnose/prescribe based on them, especially if they went against your general (non-specialist) knowledge?

(Yeah, my med school’s library finally got them, and I’m wondering how useful they are in real life.)

To give you some background about my perspective, I work at a hospital in a department called a “Community Health Education Center”. One of our jobs is to make medical info both more understandable and accessible to the general public. Among the things we do to this end is maintain a public library of medical reference materials (a kind of junior league medical library) incluging public access internet terminals – even with free printing so people can print out anything useful they find and take it home with them. We also host the physicans’ peer review and case study meetings. I’m not a health care provider, but I’m their main media technology and computer guy. I feel semi-qualified to provide some useful opinion on this.

“Useful” to the layperson? The programs are leased under restrictive licenses, and the general public has no access.

Useful to medical students? Absolutely, for several reasons, not least of which is that their teachers will be tossing out assignments and asking questions that require the type of research that is MUCH easier in a cross-referenced-by-link database. Residents in particular need something like one of them. They are so often coming across cases that are novel to them, and they don’t want to appear ignorant to the supervising physicians. Or a patient presents conflicting smptoms and a resident is tasked to research for similar histories.

It’s way harder to answer this question about the people further up the health care food chain. A large number of physicians, I would guess an actual majority (but I’ve not seen any estinate), are really uncomfortable with technology, particularly computers, and have staff to handle computer things. And since just about every damn thing has a computer in it these days, lots of doctors hardly or never touch their patients. We have several groups: general surgeons, a pediatric group, a perinatal group, cardiologists, orthopedists, and a “tumor” group of radiologists and pathologists. They range in size from 8-40 docs, none of them have more than 1 or 2 people willing to touch a piece of hardware, and THOSE are invariably the youngest faces in the room. When the’re not doing their own case reviews, they’re bringing in outside guest docs to lecture and give them CME credits. Even most of the visitors are quite proud of just being able to boot their own laptops and open up a powerpoint file.

About a year ago a group of 8 physicians wanted to participate in a monthly videoconference, and contacted me about arranging it. I could arrange for them to have the equipment, and train someone in its use, but I couldn’t guarantee then one of our staff sit sit in on the meeting and operate the equipment for them. Since none of them are willing to learn to turn on and operate the gear, even though it was as simple as pulling a microphone off a shelf, turning a computer on, and maybe hitting a couple more switches if they wanted to display something through a document camera. It could all be taught in about 15 minutes. They’re finally going to start this in September – it took then that long for then to get a staff person assigned to learn and operate the equipment for them.

But that is changing. The very first docs that have a pretty high comfort-level with computers are just now and for the last few years coming out of their residencies.

Generally, the physicians need to see test result numbers and occasionally images to make their recommendations. And the older docs eally have it over the younger ones in many ways. They ARE databases, and they generally have a pretty clear understanding of what various combinations of results means. Among a room full of doctors, they can pull out an amazing amount of information.

Our hospital is evaluating several bids on wireless, encrypted, battery-powered computers built into service carts for use in the in-patient areas, for use by the nursing staff. I’m quite sure there will be some underlying database to help with patient safety issues like reducing detrimental drug interactions and verifying a patient’s ID, & prescription data to reduce mis-medication. Can’t tell you for sure what we’ll end up using.

I’ve been tangentially involved in a couple of projects to do with bringing IT into hospitals and the doctors I’ve met with seem to be all universally enthusastic about computer technology and how it can benifit medicine. The groups I’ve met with were mainly radiologists and cancer specialists but they all seemed to love having digital scans which they can manipulate and they want to get heavily into video conferencing for remote diagnostics.

I’ve never really associated doctors with being IT phobic. Is this generally the case?

I don’t know if it’s generally the case or not. But it seems to me if you’re seeing enthusiastic docs at your product demos, maybe you’re NOT seeing a lot of unenthusuastic docs who don’t come. I agree they all like the pretty pictures they end up with, but they want someone else operating the gear, in my experience.

I could be wrong about this – maybe this is as much about status and docs not wanting to “dirty their hands” on equipment that we have lower class technicians (like me) to run. But the result is the same – they don’t learn the equipment and are dependent on others. This is great for me – they really LOVE me, and this is the most bullet-proof job I’ve ever had.

I just can’t emphasize how age-dependent this attitude is. Somewhere around 35-40 is where the split is – ironically, the younger they are the more experience they have with electronics and computers.

I’m straying too far into the zone of opinion rather then fact, but I don’t think the OP can be answered in an entirely factual manner.