American College of Physicians: Internal Medicine — Doctors for Adults ®


No such thing as ‘one fits all’ for physicians and mobile devices

From the April ACP Internist, copyright 2012 by the American College of Physicians

With the push toward electronic health records and the explosion of the mobile marketplace, physicians are now more likely than ever to take advantage of technology in clinical practice. Smartphones and tablets can put medical information at a doctor's fingertips, making it easier to calculate drug dosages, look up symptoms or side effects, and explain complicated diseases to patients. But the best ways to integrate these tools can vary widely from practice to practice and physician to physician. Paula S. Katz surveys the current technological landscape and reports on what devices physicians are using and how.

In clinical news, anticoagulation is another area where things have been changing rapidly. Recent research on warfarin has suggested that international normalized ratios (INRs) may need to be monitored less frequently, and that some patients may be able to take a more proactive role in their treatment by checking their INR levels at home. In addition, recently approved alternatives to warfarin could make anticoagulation easier by doing away with monitoring, but they also have some significant disadvantages, including potentially increased bleeding risk and lack of an effective antidote. Charlotte Huff reviews the latest advances in the field and talks to experts about how to choose the best therapy strategy for individual patients.

The latest Gray Matters column from Jerome Groopman, MD, FACP, and Pamela Hartzband, MD, FACP, uses anticoagulation to demonstrate some of the complications in medical decision making. They discuss a case in which a cardiologist recommended anticoagulation as stroke prophylaxis for an elderly man with atrial fibrillation. Because the patient knew someone who'd hemorrhaged while on an anticoagulant, however, he was very worried about the associated bleeding risk. Drs. Groopman and Hartzband look at the mechanisms behind this type of “decisional conflict” and the ways in which patients and physicians tend to weigh associated risks and benefits of treatments.

Finally, later this month the College will hold its annual meeting, Internal Medicine 2012, in New Orleans. The ACP Internist staff will be on site to bring you the latest news via our blog and our Twitter feed, as well as our daily e-mail dispatches. If you'll be in New Orleans, please stop by our booth at the ACP Resource Center to say hello and share your ideas. We'd love to meet you in person. And as always, e-mail us any time.

Jennifer Kearney-Strouse, Editor


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