Here we review the 5-Minute Clinical Consult (5MCC) iPhone medical app from LWW (and powered by Skyscape), a reference hailed as a “comprehensive clinical resource” with rapid-access, up-to-date information on diagnosis, treatment, medications, follow-up, and associated conditions of 715 of the most common medical conditions.
Powered by Skyscape, 5MCC is published by LWW (Lippincott Williams & Wilkins). If you follow our website, you are probably already aware that we trust LWW, a productive and highly regarded publisher of healthcare content. The editor-in-chief of 5MCC is Frank J. Domino, MD, an Associate Professor at the University of Massachusetts Medical School. The 5MCC program is also available online and in print form, and has been around since 1994.
Here we review it in its latest incarnation as a member of the Skyscape suite of medical resources.
As for the app itself, the home screen is, by default, a Main Index of all the various topics and medications contained in the 5MCC reference (seen below).
Alternatively, from the drop-down arrow at the top of the home screen, the app’s home screen can also present other indices: ICD-9-CM, SNOMED, Signs & Symptoms, Calculator, Algorithm, or Medication Indices. Moreover, the user can set the home screen as a Table of Contents (shown below), but this function only sorts topics by alphabetic letter, and is of rather limited utility.
Of the various alternative home screens, the most intriguing one appears to be the Signs & Symptoms Index (the separate Calculator, Algorithm, and Medication Indices could be potentially useful, but their functions are all completely encompassed by the Main Index).
This Signs and Symptoms Index (shown below) allows for the selection of symptoms from a comprehensive checklist to generate a list of matching diagnoses, an intriguing tool to call on when needing help to expand your differential diagnosis. The index pulls up a long list of potential symptoms, from which the user can select as many as applicable, and then click “Go!” to generate a differential diagnosis sorted by how many of the symptoms fit.
For example, let’s say you’re a third-year medical student rotating on inpatient medicine. On your call night, a middle-aged man is admitted to your team for fever and what appear to be recurrent infections, fatigue, and generalized pain. On your thorough physical exam, you palpate an enlarged spleen, notice widespread bruising on his skin, and even appreciate some lymphadenopathy. Inexperienced and puzzled, you use the Signs & Symptoms Index to put in what you found above, and click “Go!” (shown below).
You see that your differential diagnosis should include acute lymphoblastic leukemia (ALL) near the top, along with other conditions like CLL, myelodysplastic syndromes, insect bites, and a few assorted autoimmune and infectious causes, to consider. Obviously, this presentation represents a straightforward example, but there’s no denying that this Index can also be a useful tool, when utilized appropriately, for residents and beyond.
To provide an example of the content of the 5MCC, clicking on a topic from the aforementioned differential diagnosis, such as rheumatoid arthritis, opens a trove of useful information on the selected topic. Here, the “Diagnosis” section begins with the ACR diagnostic criteria for RA (shown below).
Clicking on the “Treatment” tab for RA (along the right side of the topic screen above) displays the first-line medications (and important considerations) for the treatment of RA before moving onto second-line medications and more invasive procedures and surgery (shown below).
In summary, the Main Index offers easy access to what appears to be a comprehensive bank of medical information and evidence-based recommendations. Moreover, the Signs & Symptoms Index represents a useful instrument to generate prioritized differential diagnoses based on your history and physical. Also of note, this version also features over 130 dermatologic images and over 200 common pediatric conditions.
Pricing: The basic Skyscape app is free, and it is via this app that one can access and purchase from the Skyscape collection of over 500 medical titles, including the 5MCC app, which are then installed into the Skyscape Medical Resources environment. 5MCC costs $79.95 (for comparison’s sake, the 5MCC hardcover costs a similar $79.96 on Amazon). Alternatively, a subscription payment of $71.95 gives one-year access with free “edition” upgrades (“content” upgrades are included in the standard purchase) but requires renewal at the end of the term for continued use.
Likes:
- Ability to sync device (via desktop or wirelessly) to update with the latest trial results and journal summaries, and breaking drug alerts (these regular quarterly updates, however, are only free for 1 years’ duration or during your subscription term, depending on your purchase choice)
- Emphasis on evidence-based recommendations throughout this reference
- Subscription also includes web access to 5MCC (which features medical procedure videos, as well as MEDLINE search privileges and over 1,000 patient handouts from the AAFP)
Dislikes/Future Updates I’d Love to See:
- The Signs and Symptoms index, while an interesting tool, does not appear to always prioritize diagnoses appropriately (certain symptoms that should intuitively definitely push a certain diagnosis to the forefront of the list do not always do so), so be wary (as always)
- If the application is exited mid-stream, wherever you were (reading a certain topic, or inputting signs & symptoms) is lost upon re-starting the Skyscape app
Conclusion: The 5-Minute Clinical Consult app offers a rapid-access, seemingly comprehensive bank of quarterly-updated medical information. Definitely a powerful and user-friendly clinical reference tool, we offer it our full endorsement for use on the wards or in clinics for medical students, residents, and attendings alike.
[itunes]
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