N.B. I received a free copy of this software in order to review it.
I did this review for iMedicalApps.com – check out their extensive collection of reviews and other iPhone medical-related posts
Software: STATworkUP version 1.04Manufacturer: IatroCom (statworkup.com)
Cost: 24.99$ USD Availability: iTunes Store
Basic Connectivity: no subscription or Internet required once installed
Best for: Clinicians who want to broaden their differentials, residents and medical students who need a quick reference for obscure tests
Program Layout:
The layout is straightforward but I would not say that the workings of the program are equally as obvious. The bottom menu bar provides the ability to search Symptoms, Studies, Diagnoses, and Treatments. To start, one can use the menu bar to navigate to Symptoms, select a few symptoms from the list, press ‘Findings’ to review the choices, and the proceed to ‘Differential’ to get the goods. The Symptoms section is the only one in which multiple entries can be selected.
Under Studies, Diagnoses, and Treatments, each entry, once highlighted, will reveal more information about that subject. Then, it can be correlated with a subset of Problems/Disorders/Tests/and Remedies which are alternate names for the Symptoms/Studies/Diagnoses/ and Treatments contents.
What I liked:
Overall, there is a lot of information below the surface in this program. Contained within the information section of each symptom, lab, or diagnoses there are encyclopedic, point-form descriptions. Also, it is fast. Using the search bar will quickly yield the item you seek. If you want more detailed information, there are integrated web searches, accessed easily with the “info” button which appears with each entry.
Where it really shines, I think, if you are interested in one ‘hallmark’ symptom. There aren’t a lot of references that correlate symptoms to disease so this can be very handy for helping recall that condition that goes with Adie’s pupil or Fetor Hepaticus!
As I found it difficult to get success with my symptom correlations (see below), I think the program is best used in what I might call ‘reverse.’ It’s easiest to view the disorders or lab tests first, read more about their details, and then correlate backwards with the associate symptoms. The treatment section is particularly good in that, unlike a classic drug guide, it provides a more exhaustive list of indications including off-label uses.
Whether intended or not, the App isn’t without humour. Select Cannibalism, Annoys People (Deliberately), and Condom Nonuse (Failure) from the symptoms and try to correlate them. The result? Kuru!
What I didn’t like:
Their caveat is true – this really cannot replace a clinician, and of course it isn’t expected to. There may be 10, 000 entries, but some basic things like Dehydration or Hypovolemia are absent (instead there is “mucosal dryness” – not intuitive!). Less common ‘signs’ (like splinter hemorrhages, Janeway lesions, Osler’s nodes, Sister-Mary Joseph’s nodule, etc.) are lacking also.
The lines between symptom/labs/diagnosis are quite blurry. You have to know where to look; there are lots of things that can be both signs/symptoms and diagnoses unto themselves such as hemorrhoids. For these, you just have to look through the different sections until you find them. Obviously a lot of work has gone into making the associations thorough but unless you are in the mind of the designer, you will struggle to chose correlations which yield the expected results.
For example, I often see elderly patients with falls, confusion, and dehydration (“mucosal dryness” in the terms of this App). When I correlate these features, I get a differential which is extensive but still misses the mark. Common things that present this way such as urinary tract infections (UTIs) and hypercalcemia do not appear. Instead “Wallenberg Syndrom” and “vestibular neuronitis” are listed as most likely. Expand the differential and things like “Plague,” “Insulinoma,” and “Shy-Drager Syndrome” appear. Common things are conspicuously absent. Though this isn’t what I expected, the bizarre results are good in that they will challenge you to consider unusual diagnoses and keep a wide view of the differential.
Some entries are obviously not comprehensive. It wasn’t 2 seconds before I had stumbled across entries in the treatment section that had no information about them and had very sparse correlations (despite my knowledge otherwise).
Conclusion:
This program probably works a dream in the hands of its creators, but in mine, it’s a bit cumbersome. I do applaud the effort at what I think is the beginning of a great clinical decision making tool, but it’s not quite ‘fleshed out’ enough yet. I can’t help but think of neural networks when looking at this App; in this case, the front end is clean and easy, and the underlying framework is established, but more data must be entered and associations formed before it can comprehensively perform the task.
Maybe I’m using it incorrectly, or I’ve missed the mark, but I’m what I think is an average user – someone with a bit of programming experience, who regularly uses medical Apps, and who knows about clinical presentations and diagnostics. If it needs a tutorial to walk you through its use, maybe it wasn’t meant for the user-friendly iPhone. I don’t think the claim on the website – that “the operation is intuitive” is fair.
Set your expectations carefully; this isn’t a wizard to replace your clinical reasoning. However, it may help expand your differentials and serve as a reference for a wide range of clinical considerations. There’s lots of room for improvement with future iterations.
Tagged: app, clinical, decision, diagnostic, IatroCom, iphone, medical, stat, STATworkUP, tool, workup
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Sign in nowOn migranes, it doesn’t really count as a medicine, and it doesn’t involve taking anything, but have you tried cutting out caffiene? I’ve heard that cutting it out from your diet can help eliminate migranes.
For many people that is a great tip! I wish it applied to me! I hardly ever have caffeine; sometimes it helps with my headaches and migraines when they do occur.
Jessica, do not walk…run to the Mac store. I made the switch 2 yrs. ago and my e-life has been SO much simpler and better!
Hi Jessica,
Thank you for your efforts to review STATworkUP for IatroCom at drottematic.wordpress.com and at imedicalapps.com.
I found the review to be an honest and impartial appraisal of our work.
You made several observations that will help us improve the app in the future.
(A custom version is being designed and built for the iPad presently.) STATworkUP works on the iPad like it does on the iPhone now.
As you noted, the app has been designed as a fast, relational, and fairly comprehensive database to facilitate recall and link to detailed info for most medical workup entities.
The app was released prior to fully completing the database to be first to market, with the idea that the frequent monthly free updates will make it better very soon.
Regarding the things that you didn’t like … let me clarify:
Dehydration and Hypovolemia are not absent from the database…
These terms are included, but they are listed as Diagnoses entities, appearing on the full Diagnosis List.
(Simply tap the Diagnosis (Dx) tab item and search for them on the resulting full Dx list.)
Another way to find them is to locate their Symptom (Sx) “mucosal dryness” on the Full symptom list and drill down. (You don’t have to check it as a finding.)
In the Info view for the Sx open the correlation panel and then select the Disorders button.
When you do this you will see that a number of related diagnoses appear that can include the symptom “mucosal dryness”.
As I write this, I have added Dehydration to the list of correlated disorders (Diagnoses), that also includes Hypovolemia.
(Again, this is an evolving work … I do promise that incomplete relationships will be resolved quickly.)
The common things that are conspicuously absent will be included within the next few versions.
We do intend for the results to be good and to challenge how providers consider unusual diagnoses, by getting a wide view of the differential (or allow them to narrow it)
In my experience much of the high cost of medicine, and medical errors, occur because of the blurring the distinction between Symptoms and Diagnoses.
Hemorrhoid is a Diagnosis and not a symptom.
The Problems (Symptoms) of Hemorrhoid can be seen by selecting Hemorrhoid on the Diagnosis list.
Then you can drill down to its info view, tap the Correlate button, and then tap the Problems button to see Problems (Symptoms) for Hemorroid.
Problems for the Diagnosis of Hemorrhoid are listed:
DX: Hemorrhoid
SX: (Problems)
Bleeding
Constipation
Hematochezia
Pain (Abdominal)
Pain (Rectal)
Pruritus
Rectal Bleeding
Tenesmus
You will also see that any listed Problem (Symptom) can also be checked into a Finding, lending its weight to Differential computations.
If you check each problem they will appear on the findings list.
(You can see the Findings by tapping the finding button.)
If you uncheck a finding it is removed from the Finding list. (Each finding lends various weight to various Diagnoses on the Differential List)
Symptoms, can be selected as finding from the full list or from any Problem correlations.
All of the findings can be Cleared in the Findings view or individual findings can be Deleted from the list by back-swiping a table item and tapping Delete.
Additionally, you can build lists of Problems for any Selected Symptom by tapping the correlation panel in the info view for the symptom.
These are many other problems to consider during the workup, for all of the database Diagnoses that can include the selected Symptom.
For instance:
Drill down on Annoys People (Deliberately) and Correlate its Problems
You will see:
Other related symptoms to investigate.
If you check a number of those into Findings and then tap the Differential button you will see related Diagnoses that can be prioritized or listed alphabetically.
You can also expand or constrain the list by adjusting the sliding likelihood meter to less likely or more likely respectively.
Cannibalism Needs some info built to go into the drill down view like: (Associations) – Kuru … Then you will be able to correlate it too.
I did like the anecdote…
There is a tutorial to walk you through its use, on line and in the Help section of the app.
I think these are brief and straight forward explanation of how STATworkUP works.
If you tap the Navigation Bar (i) button in the Home view, the view flips around to get Help.
Also you can go to the web site: http://www.STATworkUP.com and tap:
Product Support & Help Tutorial (Click Here)
That link also is present at iTunes where you buy the app.
Again, we really appreciate your help with this Doctor Otte.
Best regards Jessica,
Sincerely,
Steve
Stephen Mlawsky, MD, CMM, FAAFP
CEO, Director, Founder, IatroCom
(916) 849 6178
PO Box 2537
Mill Valley, CA 94942
http://www.iatrocom.org
[...] REVIEW: Procedures in Family Practice « Dr. Ottematic [...]
I’d did have a Dr pepper’s one day during my OR session and say, “What’s the worst that could happen?”
It turns out quite a LOT can actually go wrong…
[...] Superstition in Medicine 5:35 am “Hey Dr. Otte, tonight has been very q—–” “Do NOT SAY THE ‘Q’ word! In fact, don’t even say the letter ‘Q’” “Oh shit, I said it! I said ‘Q’! Oh heckkkkkk!” “We’re screwed.” . . . [...]
I didn’t know about that one… does it make you extra, uh, spicey?
Dr. Pepper is seldom available in vending machines around here, and certainly not in the hospital cafeteria; it’s the kind of drink that has to be specifically sought out at the grocery store, so it won’t be hard to avoid!
Here’s a superstition that turns out to have some basis in fact – there is a saying “Married in May, Rue the Day” that seems more popular in Europe than in North America. Apparently, it is considered very bad luck to marry in May as the bride could die within the year.
As it turns out, in pre-industrial times, this had actual merit. Brides who married in May and got pregnant quickly (as brides sometimes do…) would end up giving birth during some of the coldest, harshest weather of the year.
Kind of interesting, I think.
I will warn my patients!
haha
but yes, I could see that making sense 200 years ago.
Congratulations on making that decision!
It must not have been an easy one.
true dat!
thanks Jenn – hopefully I’m on the right track.
mersyndol works great for my migraines. Don’t even need an RX , not that that is ever a problem in a hospital.
oh….could you please try these 2 remedies I read about ( I question both, but if you have a migraine, you try anything!):
1. Lidocaine squirted into the nostrils and let it drain upward (in other words, stand on your head I guess)
2. Get a slurpee and get a brain freeze while having a migraine.
If they work, get back to me!
Just sitting here “post call” feeling sorry for myself and decided to surf… Thank you for this. Emily was truly a gem to all that knew her or knew of her.
i have tried the brain freeze – doesn’t work though! just causes another kind of pain
I never prescribe narcotics for headaches because of the commonness of rebound headache but they do work for some people. A few of the triptans have worked for me, fortunately.
Good choice: If you’re interest in medicine is to be as much of as total a physician as possible, then hospitalist is as close as you can get, unless you never forget anything and master everything the first time around (then you can be a family practitioner). I’m an FP and hospitalist was not an option years ago. I liked FP to be able to practice all of medicine but dilution of diagnoses and patient steeling leads to less and less exposure to the complex and interesting cases. Ever lower compensation causes specialists often to refer the patients they get from FP’s to their own PA’s or NP’s to keep them busy. And patients often go to the specialists as first line so the FP sees too much of the simple stuff and less and less the more complex that makes it easy for those skills to fade, unless the fp is in the boondocks and all on his own.
The con’s you listed are not all that significant, from my perspective. Good Luck.
I am so saddened by this. Like you I watched that show over and over and it was Emily as well as others that inspired me to leave my Corporate job and go after my true dream of medicine, albeit veterinary medicine. Periodically I look on the internet to see where their lives had taken them and it was this search that led me to your site and this terrible news.
There was also one other MedStudent, Alyson Brodeur, that passed away in October 2009.
Such vibrant, young, incredible individuals that had their whole lives ahead of them. I’m so sad to read this and hope that she has found some peace.
Thanks for sharing. Odd how that little TV show meant so much.
I know that this post was placed over a year ago however I just found this site and am enjoying reading through all your posts.
With respect to NDs, I’ll be honest, I absolutely LOVE my naturopath. My regular M.D ended up pumping me full of pills based on one symptom after another in hopes of getting rid of my chronic pain. Of course I was put through all the tests imaginable and when everything came back ‘normal’ the only other option was ‘pain management’.
I was frustrated to believe that this was going to be my life, a young person with many years ahead of her popping pills that only barely touched the pain and foggy mind. I visited the Naturopath and was put on a strict diet. After a lot of foods being omitted and then reintroduced I found out that my body just doesn’t agree with gluten and dairy. When I eat them all my symptoms come back.
As much as I really respect my M.D seeing my Naturopath was just another avenue that I needed to take. Once my M.D and I exhausted all the testing we could it was time for me to look in another direction. My M.D could not do what my Naturopath did and my Naturopath could not do what my M.D did. They compliment each other.
As much as I love my Naturopath I do not believe that she has any credibility or the knowledge to effectively and safely prescribe medication. This is not her ‘field’ and not her area of expertise.
So I’m definitely with you. I want the person prescribing me medication to have ALL the information and schooling required to do so. Going to a Naturopath for prescription drugs is like going to the hardware store for milk, it just doesn’t fit.
It comes down to a matter of definitions. A text without a context is a pretext, and pretext can be used to rational anything. So for me, I would expect “related procedures” in a consent form to be consenting to procedures that are conducted in the same context/method as the main procedure is. Therefore, if the main procedure is conducted through an incision in the abdomen, when I signed the form I would expect that all other “related procedures” would also be conducted through that incision in the abdomen. I would not be expecting fingers (or any other object for that matter) to be shoved up my vagina, unless I was specifically told, and I would expect to have to give specific consent.
I think everyone, in their own way, is looking for the end of the world because everyone dies. The Apocalypse is real, and it happens to all of us, right?
Do you believe in Zombies? A post-apocalypse fantasy, movies & video-games, and why I care….
I found your entry interesting do I’ve added a Trackback to it on my weblog
…
I …. don’t know!
Everyone dies, yes.
[...] Pelvic Exams Done Without Consent « Dr. Ottematic [...]
Try wearing a fur coat all the time. I am one hot dog.
Jump in the lake! or the ocean! or just jump!
I’ll be here waiting for new posts.
~R
Sandra’s comment is not only infuriating, but horribly biased and opinionated. Sorry that her childhood was “sacrificed” to the military, but I know many families that have appreciated their military background.
My husband is a Doctor in the CF. I was in the military, bit now practice Nutrition privately. We have three wickedly bright, charismatic daughters, the oldest of which is heading to University this fall.
There is no culture of drink and debauchery. Like all neighborhoods, one has the choice of whom they socialize with. It sounds as if your father, perhaps, didn’t make the best choices in that arena. Unfortunate, but that is not unique to the military experience.
I am definitely not “pro war”, nor is my husband. We have many military friends of like mind who openly discuss their positions. It is not a requirement of the service that one forfeits their intellect, contrary to the implications of your comment.
We make a concerted effort to socialize outside of any base we ate posted to just as we would if we lived in a small community. A feeling that a base is insular demonstrates a lack of extension into outside activities and interests.
I certainly don’t think that living in a military community offers benefits over civilian life, but characterizing it with such generalities and sweeping prejudice does a disservice to the many happy, functional families that live within it.
Hello Jessica,
Your article is very interesting and I think it is great that it is great that you are trying to look at all the angles. Kudos to you for that!
I just finished my contract with the military (through the MOTP program) and also grew up in a military family so I have a lot of perspective about what it means to be a doctor in the Canadian Forces.
To cut to the chase I need to tell you what I think is your best option… DO NOT join the Canadian Forces as a physician. I know that may seem blunt but I have much basis for such a blunt and straightforward statement.
Firstly, you must keep in mind that the Canadian Forces is nothing but an American pawn at the current time. It is clear that Al-Qaeda was clearly crushed in Afghanistan in 2002, but yet the war kept on going despite no justification to do so. At the same time the US declared war on Iraq and diverted all their resources to that war instead. Now Afghanistan is even worse than before, and there is no way that keeping the war going there will help to make anything better. Anyone currently in the CF has to be prepared to turn a blind eye to this madness otherwise how else could they sleep at night. This is by far the biggest deterrent to being a CF physician (at least for me).
Secondly, as a physician in the CF, you can expect to do very little medicine, and plenty of administration. From my experience, at least two thirds of your job is admin.
Thirdly, expect very little respect for you as a professional once you are in the CF. Medicine and good patient care are always placed far secondary to the mission in the CF. Just look at what has happened at Guantanamo and how they have ordered physicians to force feed prisoners with the consequences of being charged if they do not do so (check out the article called `Physician First, Last, Always by George Annas for some more details on that). I know that you would expect that it would be different in Canada, but that is nothing but a false hope. Ultimately, the CF will try to crush anyone who expresses doubts about the mission, and that includes a physician. In the end, professional autonomy is thrown out the window in the CF.
Fourthly, from a financial perspective, is is clearly hugely disadvantageous to be in the CF once you are outside of residency. Now that I am out of the CF, I make about twice as much as what I did when I was in the military. Definitely, if you are thinking of joining the CF for financial reasons, that would be a huge mistake.
I know I may seem hugely one sided in my argument, but that is because I have been there and I know how bad being a physician in the CF truly.
I would be more than willing to answer any questions you have. Please email me if you have any questions.
All the best,
Jason
wow, thanks for the considered response
i’m pretty sure I won’t join
do wonder about doing the reserves/contract thing still though. is that something you would ever consider doing? lots of our Intensivists go overseas to be trauma junkies. I imagine I’d work better in a German hospital treating the recovering as opposed to a field trauma enviro, but I’d certainly learn more in the latter.
Hello Jessica,
I do know a few people who have joined as reservists and I must admit their is a lot more flexibility as a reservist. That is definitely true. I’m pretty sure you get to pick and choose your deployments, but you will want to ensure that is truly the case before you sign anything.
I just warn you to keep in mind though that once you decide to deploy with a unit, even as a reservist, you will fall underneath that unit’s chain of command. This means that you will be subject to the Code of Service Discipline, and when it comes to many units, particularly within the army, they can be very liberal in their application of this code. Something that you do would be viewed as good patient care by any rationale physician could be misconstrued as interfering with the mission by the Commanding Officer, who is often not a physician. I have a physician friend who was almost charged with insubordination in such a situation. This is a serious charge in the military. Even if your chain of command is purely medical, it happens quite often that you end up getting some physician-turned-administrator who hasn’t really seen a patient in several years “supervising” your medical care. This can become quite problematic, particularly if that individual starts interfering with your medical care, which they are more than entitled to do if they are a more senior medical officer to you (in terms of rank or seniority in the medical chain). Seniority in civilian medicine is determined usually by things like level of training and experience, and passing exams, but in the CF seniority is really determined by rank, which has nothing to do with your actual skill, level of training, or amount of experience as a doctor. This whole odd dilemma can become very problematic when you have a supervising physician of a higher rank who doesn’t realize how out of touch they are with clinical medicine. I know this happens in civilian medicine too, but it is taken to a whole new level in the CF. Following the chain of command and the “mission first” mentality always take precedence over everything else. This is definitely something to keep in mind and that you have to be comfortable with before joining the CF.
This does not even touch on the whole issue of whether supporting our current Canadian Forces (which is really just a US puppet at this point) as a physician is really morally correct or not from a more global perspective. I know that by the Geneva Convention you are obliged to treat everyone, but really your primary focus overseas is the Canadian troops. It all comes down once again to the “mission first” mentality. My belief is that being a physician in the CF currently is providing direct support to the US “War on Terror”, and you have to be comfortable with supporting that cause. I don’t know if you believe whether the current wars in Iraq and Afghanistan are truly helping to reduce the world burden of “terror”, and helping to establish true democracy in the war-torn nations in which these wars are being conducted, but I think you have to believe in that cause in order to sleep well at night wearing the CF uniform. I personally think that the current War in Afghanistan is actually making things far worse in terms of global terror and as well as in terms of peace and democracy for the Afghan people. Even if the American government had no hidden agenda with the War in Afghanistan (which is highly doubtful to me, but I am trying to be hypothetical here), the aim of “creating democracy” in a short time frame that a war takes place in (usually anywhere from 2-8 years say) in a country like Afghanistan that is populated in the large part by Pashtuns, who have followed for hundreds of years their own cultural form of government that is quite unique, but quite different from the Western idea of democracy, as well as highly influenced by the Islamic faith, is just not possible. Changing a culture takes decades. If the Americans expect to evoke such quick change in Afghanistan, they either have a hidden agenda, or they are foolishly optimistic, or just plain foolish.
As for other more “humanitarian” parts of the CF, even the DART, which everyone thinks is this great humanitarian aid vehicle, is nothing but a “huge political tool” (this is a direct quote from my ex-CO); aid could be delivered much “more quickly, effectively, and cheaply through NGO’s than through DART” (once again a direct quote from my ex-CO, paraphrased but the same essence of what he said).
I personally think if you look at being in the CF from a more global political and ethical perspective, it evokes a lot of soul searching, especially for a physician. In the Hippocratic oath it says,”In every house where I come I will enter only for the good of my patients”; however, that is often not the reality in the life of a CF doctor, especially during deployed operations. Yes you may learn a lot about trauma care doing field trauma (as you would also if you did a trauma fellowship or emerg rotation in any southern US city), but I just want to encourage you to look at the bigger picture. I didn’t do that when I joined, and I truly regret no doing so. Just something to keep in mind.
Once again, if you have any questions, please do not hesitate to ask.
Sincerely,
Jason
Hi, I just found your blog and I am enjoying your style of writing.
In reply to the “apocalypse” post, I think it’s simple really. Your drive or need or even desire puts you into the spotlight, keeps you in control, and makes you a hero or savior (whichever you prefer). Not to mention the constant verge of emergent action. I think almost everyone who chooses medicine for their career possesses some version of this fantasy at our very core.
What about ‘doctors’ who don’t really own a doctoral degree? I am nor referring to MD (which is not an actual doctoral degree, anyway — amazingly lawyers are more honest about this with their JD degrees) but to chiropractors, dentists, vets, etc. Even worse all those above plus physicians in countries like the UK and Australia where you received a Bachelor degree.
I always find hilarious when I go to the GP and she insists on calling me Mr even though I am a Professor with a PhD in engineering, which is well ahead of her education of a Bachelor.