Medical Decisions

Nurses General Nursing

Published

  1. How do doctors make difficult medical decisions?

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      Rely on their own knowledge/intuition
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      Follow a clinical carepath (EHR based)
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      Consult with another doctor
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      Search a medical database - which ones?
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      Use a medical app - which ones?
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      Ask nursing staff for input

1 member has participated

Hi -

I'm new here and looking for some input on Medical Decision support systems.

Do any of you use medical decision apps? Other sources?

I've heard of UpToDate and Dynamed. Are these commonly used?

Thanks for any input!

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I don't understand your question. Medical decision making is the realm of the physician in my area of practice. While it's true that the physician's medical decision making can be heavily influenced by nursing input, the practice of nursing and the practice of medicine are complementary but not the same. What are you asking, exactly?

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Specializes in NICU.

I use UpToDate, but it's a resource for all healthcare professionals, not a "medical decision app."

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Specializes in ICU, LTACH, Internal Medicine.

One of the main differences between "nursing thinking" and "medical thinking" is that medical providers are able to utilize half a dozen options at once. It is ok for them to think like "the guy has afib, so he needs anticoagulation all right; the last guideline says Eliquis is a good option for his age and weight; but he is a butcher by trade so can cut himself and Eliquis is not reversible; he lives God knows where and has no insurance, so warfarin is not an option because he will not go to lab for INR every 2 weeks; and he has CAD and PVD as well, so ASA and pentoxiphylline to start and we add something as we go. Maybe he can do home health, and we add warfarin, if so". And h*** with those guidelines.

Nurses tend to go mych by policies/directions/guidelines, whether they work from position of common sense for the particular case or not. I do not say that one view is better than another; I'seen many instances when application of either in extreme form ended badly. But I was in both worlds, and that is just what I've seen.

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Specializes in Critical Care.

I think the OP was referring to medical references, which are used for both nursing "decisions" making as well as medical, maybe they just misspoke. Personally I prefer UpToDate, which is typically available as an app as well if your facility subscribes to UpToDate.

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@Anna Flaxis - thanks for helping me to clarify. I understand that medical decisions are in the realm of the physician, but physicians don't seem to talk much about that medical decision making processes. I spoke to one Chief that said 90% of the time he knows what to do based on his experience. THis seems surprising to me, especially in light of the ever changing nature of medicine and the requirement for personalization.

I'm interested in two things. #1 - what medical references do you (nurses) typically use? Do nurses use different references than doctors? Do they need to be different? From other posts, looks like UpToDate is common. If you don't use any, that's fine too. I was just curious b/c getting succinct medical information is a challenge.

#2 - As a nurse - what is your view of the medical decision making process? that is to say, what do you see doctors doing? Do they rely on their own intuition/experience? Do they use "care paths" as prompted by EHRs? Do they consult w/ other physicians? I'm mostly interested in understanding the process.

thanks for the input!!

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I think the OP was referring to medical references, which are used for both nursing "decisions" making as well as medical, maybe they just misspoke. Personally I prefer UpToDate, which is typically available as an app as well if your facility subscribes to UpToDate.

Yes, thanks for helping me to clarify the question. I've heard a few folks talk about UpToDate. I'm curious - do you use the web-based version (and is that accessed through the EHR?) or do you use an app on your phone?

I'm interested to know how these medical reference are utilized. Are you just checking for your own understanding? Are you sharing information with patients? Do you ever get conflicting information with what is prompted/suggested by EHR/doctors?

thanks!!

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Specializes in Reproductive & Public Health.

As an RN and CNM, I adore uptodate. I missed it so much that I got myself a subscription when I stopped working at a facility with an institutional subscription. I also belong to ACOG and ACNM and use their resources sometimes.

I use it to broaden my understanding of every day topics and to look up unfamiliar diagnoses etc. I definitely use it to guide my clinical/medical decision making.

And I also use it for fun... I've logged in to U2D to look something up quickly and found myself 2 hours later with 15 tabs open lol. Very very interesting stuff.

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Specializes in OB.

Can you tell us what your reason is for asking this?

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Can you tell us what your reason is for asking this?

Sure, my reason for asking is several fold. I'll go through it chronologically..

1. I'm a research scientist by training and so I am very methodical in my synthesizing of information and haven't personally seen the same systematic review of current literature/trials/guidelines by my own PCP. I'm looking for a new PCP so it got me thinking - is this just how it is in medicine? I know time is limited, but do doctors just do as they do? Do they ever double-check that what they're doing/diagnosing/reference is the latest and greatest? Apologies if that seems naive, but like I said, I come from a different industry, so I don't know if my expectations are too high.

2. My mother is a NICU nurse so I have an appreciation for nurses and their knowledge. I don't know that a lot of resources are tailored to people other than physicians. I asked my mom and she said she usually googles for information. I guess PubMed is used too. She is also a travel nurse and has told me how different things are in every hospital.

3. I'm also a parent. I've used WebMD, Google and other sources to look up rashes and other symptoms. I'm curious what the best sources of information are. that is to say, What do doctors and nurses use for their families?

4. Also curious if we're heading to a future where there are more Do-it-Yourself diagnosis tools for low risk scenarios (e.g. viruses) or will we remain in a paternalistic state of medicine indefinitely - that is, the Doctor decides. Sorry, a little more philosophical on this last point :)

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Thanks cayenne06. UpToDate comes up a lot, but it's pretty pricey - $495/yr for an individual subscription.

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Specializes in Critical Care.
Yes, thanks for helping me to clarify the question. I've heard a few folks talk about UpToDate. I'm curious - do you use the web-based version (and is that accessed through the EHR?) or do you use an app on your phone?

I'm interested to know how these medical reference are utilized. Are you just checking for your own understanding? Are you sharing information with patients? Do you ever get conflicting information with what is prompted/suggested by EHR/doctors?

thanks!!

I use the web-based version through work, our subscription includes smartphone access as well although I don't use that myself (my phone sucks).

I use UpToDate for a variety of things, part of what a nurse does is to help implement the medical plan of care, so in order to that I need to have a good understanding of it, it also includes specific nursing considerations, patient education, etc.

Some Doctors use these types of references more than others, same goes for nurses. Nothing is set in stone, what was the proper treatment for something when a doctor was in medical might have completely changed. To use an example, one of my responsibilities as a nurse (ICU) is to manage the ongoing treatment of hyponatremia. The Physician defines the treatment goals and I titrate a 3% saline infusion to stay within those parameters. But I'm also responsible for agreeing that those parameters are correct so for the last patient like this that I had I looked it up in UpToDate and the treatment parameters have completely changed in the past few months, which I pointed out the MD who changed the parameters accordingly. If we (nurses and doctors) aren't using these types of references then there's no way to ensure patients are getting the proper treatment.

It doesn't serve quite the same function as UpToDate, but Cochrane Collaboration is a good source for free comprehensive analysis of existing data on a given topic.

Cochrane | Trusted evidence. Informed decisions. Better health.

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