by: Philip Xiu, MA, MB BChir (Cantab)
Most physician offices are still stocked with Harrisons’ Principles of Internal Medicine, perhaps a Bates’ Guide to the Physical Examination, and other venerated medical texts.
With the advent of smartphones and tablets, many of those texts are becoming more of a decoration than a resource as its far easier to refer to your tablet version of Harrisons‘ than the physical text. Knowledge of internal medicine is vital however the skills of clinical diagnosis are also an important aspect of any healthcare provider.
Coming from a strong lineage of medical texts including the venerable Oxford Handbook of Clinical Medicine, the Oxford Book of Clinical Diagnosis makes the jump to mobile in this app. In this review, we will be looking at the merits of the app for the Blackberry platform.
It is divided into 3 main sections (clinical signs/symptoms, laboratory tests and radiological signs), with lists of main differential diagnoses associated with particular patient symptoms, signs and abnormal investigative findings.
Focusing on the patient’s symptoms first, we use gastrointestinal systems as an example. It is extremely finely divided into exact symptoms i.e. dysphagia for solids which stick vs dysphagia for solids (which do not stick) > fluids.
For dysphagia, we can see that it lists the main differentials. It also gives the primary other symptoms expected alongside the main investigations required.
The other section in which this app excels in is the laboratory investigations and the interpretation thereof. For these, it includes initial simple management strategies.
The third and last segment that is crucial to the Blackberry app is the detailed radiology sections. The section on chest X-Rays was excellent, providing succinct descriptions and explanations for a range of chest film abnormalities. In fact, it has a range of other differentials for a whole host of radiological findings. However it should be noted that the app does not include actual images.
In real life context, for example, if someone came into the ER with diffuse hair loss, a quick search on the BlackBerry would reveal that he/she has the symptom spot on. Indeed the search function is very powerful.
Pricing and technicals:
- $49.99 for this app
- The app is actually more expensive than the book itself; however, the book in its physical format is rather unwieldy compared to the mobile portable format.
- The app advises you that the best way to use it would be to cover up the column of diagnoses on the left and to test yourself using the diagnostic lead and clinical history to formulate your own list of diagnoses
- The simple to use search engine combined with a whole raft of possible symptoms
- This unique handbook enables students to justify and systematically evaluate clinical symptoms to enable a logical diagnostic differential list
Dislikes/possible future updates:
- The OHCD app is based upon MedHand’s book reading system, which is a glorified ebook reader
- The OHCD has not been designed from the ground up as an app, (unlike Epocrates, or 5 Minute Clinical Consult), and the difference in ease of browsing shows
- The lack of diagrams in the whole ebook/app is very disappointing, even simple reference diagrams for the radiology section would be most invaluable
- This app lends itself to having a game based on the diagnostic side of things. An ideal update would feature the symptoms/clinical history and would let the user choose the most likely diagnosis from a list of 5. That would be value added entertainment, and would be a beacon of light in the medical student’s otherwise rather miserable revision schedule.
- The Oxford Handbook of Clinical Diagnosis was derived from the powerhouse of medical education that is the Oxford Handbook of Clinical Medicine
- The main reason that I recommend this app despite its disadvantages, is the fact that it is a very unique book/app.
- It doesn’t have close alterernatives on the market, in my opinion.
- It is also a very powerful diagnostic tool for the physician who seeks to generate a list of possibile diagnoses rapidly.
- The book would be a beneficial addition to any junior doctor and medical student’s bookshelf
- It offers a different perspective on learning medicine, and varies from the Oxford Handbook of Clinical Medicine