UpToDate as a common language among medical professionals
In terms of information sharing among medical professionals, how do you use the system?
Dr. Yano: Between doctors and pharmacists, Lexicomp is still often used from the perspective of drug interactions. For example, Lexicomp provides information that the Japanese package insert alone lacks, such as ranking contraindications and concomitant precautions. As a pharmacist, I also use it to check the effects of new drugs when I add them to the list of medications that patients bring with them when they are hospitalized. There are references in the information, as well as PubMed IDs, so I think the fact that I can read the linked information immediately leads to a comprehensive search for information.
In the past, it was common for doctors to issue prescriptions and for pharmacists to check them, but now pharmacists are routinely stationed in hospital wards, and they make recommendations to doctors from the stage of prescribing. Nowadays, pharmacists are routinely stationed in the wards, so they make recommendations to the doctors from the stage of prescribing. The current style is for pharmacists to be involved from the stage of making prescriptions, and for different professions to cooperate with each other. It is the physician who decides on the drug, but the pharmacist’s role is to check the dosage, interactions and contraindications of the drug.
Dr. Minami: For example, just the other day, when I was considering a prescription for a patient with a pre-existing condition, I asked the pharmacist to suggest a prescription.
Some drugs can cause a serious arrhythmia called QT prolongation. At that time, the drug I tried to prescribe was listed as having the potential to cause QT prolongation. Even if I tried to choose a different drug, it would be difficult to find out more during the outpatient clinic. However, if a pharmacist is present, he or she can provide information such as the name of the disease and the patient’s medical history and suggest an appropriate drug.
Dr. Yano: Isn’t it also an advantage that doctors and pharmacists can talk in a common language from the same source?
Dr. Minami: Doctors are provided with a lot of information by the medical information officers of pharmaceutical companies, but there is also the question of how far impartiality is maintained. Physicians should also get information about new treatments and drugs from science-based UpToDate and many papers and make decisions based on evidence-based information. It is important for pharmacists and doctors to get information from the same sources.
Do you find that you can learn things that you didn’t know before?
Dr. Sakaguchi: I often have more questions and interests after reading the information in UpToDate. It’s like I can’t stop, or I get more and more deeply involved once I start researching. With electronic media, it is difficult to know how much information is available beyond that. For example, when you read a textbook or a medical journal, you have a book in front of you, so there is a limit. However, when it comes to electronic media, there is a contrary concern that the research will spread as much as possible. If you don’t stop somewhere, you will end up spending so much time only searching in UpToDate.
Dr. Yano: Pharmacists oversee patients in the wards and check evidence such as guidelines to verify whether the actual treatment is standard or not. We also present this information to the doctors, saying, “This kind of information is also available.”
For example, let’s say a pharmacist meets with a patient and gets information about a possible side effect. If the doctor has already diagnosed the problem, but there is a concern about side effects, we may suggest another drug to the doctor using UpToDate and Lexicomp. Whenever I have a question, I do my own research and make a suggestion to the doctor, which is a great learning experience for me as a pharmacist.
Nowadays, UpToDate content is also available on smartphones!
Dr. Minami: I think you can use it to do some research and organize your knowledge whenever you have time, even when you are on the move. However, the text is too detailed, so I find it easier to read on a larger screen.