Its 3 AM and you are the new intern on call covering far more than your share of patients for multiple services. Your pager goes off. Mrs. Smith is seizing and Mr. Jones is vomiting large amounts of blood and is hypokalemic. What do you do?
MD on Call ($5.99) hopes to provide these answers. The app is developed by MDMarkee Publishing and is a new addition to the App Store. It is a simple application with sometimes basic but vital information, especially useful at those early morning call hours. This review will focus on the information provided and my experience using this application while being on call.
What is it?
MD on Call is a simple repository of 17 typical, bread-and-butter issues that can arise on call, quick advice on how to evaluate the problems and quick management suggestions. The app also contains sections devoted to abnormal lab findings, ECG pathologies, and ‘hardware’ (discussing common problems with central lines, NG tubes, etc.).
From an ergonomic standpoint, the application is extremely easy to use. Each section is alphabetically organized and searchable by keyword (although the search feature does not handle synonyms or phrases well). The sections on ECG and laboratory findings are particularly complete for any acute abnormality that required immediate action.
If, for example, your patient is hypocalcemic, the application reminds you to double check the patient’s Phosphate and consider other confounding factors, tells you what physical exam findings are commonly seen, and ways to correct the serum Calcium based on the severity. The information is correct and mostly complete: striking a good balance with its easy to read bullet points without being too verbose.
The application states the obvious, but also assumes at least a respectable level of medical knowledge as well. In the above hypocalcemic example, the application states that Chvostek’s and Trousseau’s signs are traditional physical exam findings without wasting space stating how they can be elicited. In the management section, it provides sound medication and dosing advice as well.
My first reaction to the 17 issues discussed by the application was doubt. Only 17? Surely that could not cover the wide variety and sheer quantity of ‘On-call’ issues that can arise. Once I put this put this assumption to the test, however, it was clear that I was wrong. This application is only meant to be a guide for when a patient has an acute change in status; most calls are patient specific medication changes or order related and are not meant for an application such as this.
The Not So Good
As I stated before, the issues covered are ‘bread-and-butter.’ As a result, the application is not perpetually useful. Either you already know what to do when you receive a call, or you quickly learn how to handle the situation and cease to need the application for reference. House officers or residents with substantial experience will not find this application very useful.
I did note a few instances where the information provided by MD On Call was lacking, but these tended to be very specific and minor. For example, the discussion of ‘Fever’ did not include any advice for a patient who was neutropenic, and the app did not offer any advice when documenting a patient’s cause of death and instead focused on the interaction with family when pronouncing death.
A few minor complaints about the interface should be noted as well. The font is very small and can be hard on the eyes when viewing on the run or after long hours on call and the application does not support the iPhone’s position sensor and will not rotate (no landscape mode).
In the field with this application, the section dealing with abnormal lab values has proven to be the most useful while on call and is much faster than trying to locate or sift through dense Up-to-Date chapters or case files.
This is a simple application that contains accurate and concise information for students and new interns. Seasoned residents with more experience will not find a huge benefit with this app. However, if you have ever needed a quick reference to learn on the fly or been stumped by a late night call while cross-covering and you are willing to spend a few dollars to avoid that feeling, you should consider this app.