To many medical students, the ability of consultants to recall the pathogenesis of a rare condition or the dosing schedules for a myriad of medications seems unattainable. This feeling is further emphasised when we are confronted with patient questions that can make us feel grossly underqualified. If only there was a way to carry our library of textbooks into the clinic for quick consultation! Enter Medscape: a free app for iPhone, iPad and Android devices. Medscape’s comprehensive features may be an invaluable tool, whether it is in the clinic, writing assignments, or as a study aid for exams.
The Medscape application has a number of features that make it unique compared to other medical apps (Table 1). Primarily, it is a free application. All information is peer-reviewed, and in an easy to read format that is available both on- and offline. Another advantage is that the Medscape app covers a broad range of topics, providing a range of detailed information for almost every clinical scenario (Figure 1). The categories covered include:
Drugs: A comprehensive list of pharmacotherapies, including prescription, over-the-counter, and alternative medications (Figure 2). For every medication listed, the app provides the generic and commercial names, dosage and indications, administration, adverse effects, warnings, pregnancy information, basic pharmacology and pharmacokinetics, images, and formulary.
Conditions: Medscape provides detailed information about a wide range of conditions, from allergic asthma to Zollinger-Ellison syndrome. Each condition is divided into the following sections: overview, clinical presentation, differential diagnosis, work-up, treatment and management, and follow-up (Figure 3). Over 1,000 conditions are included within the application, however it is important to note that this list is not exhaustive, as some rarer conditions are not covered. Overall, however, using this section for any disease is more than sufficient information for a medical student or junior doctor level.
Procedures: A list of many procedures listed by specialty as well as a large atlas of anatomy is included (Figure 4). Articles do however primarily use text to transmit information. Topics such as these may benefit more from greater use of visual adjuncts and illustrations.
Drug Interaction Checker: This tool allows the user to add up to 30 medications concurrently and view the subsequent potential interactions that may occur between these medications. This tool will prove useful when assessing older patients, or those with multiple co-morbidities who are often subject to polypharmacy, to check for interactions.
Pill Identifier: A tool that allows the user to input information about a medication’s appearance (shape, colour, etc.), and generate a list of possible medications that match the description. While in theory this could be a useful tool for patients who cannot remember the name of their medication, in practice it is not particularly accurate, and customised towards medications available in the USA. As such, this tool appears to have limited utility in an Australian setting. For example, searching for features of Panadol capsules leads one to a page of 500 possible medications, none of which are the drug in question.
Calculators: Over 150 medical calculators and clinical decision-making scores (e.g. Glasgow Coma Scale, Warfarin Bleeding Risk, Framingham Risk Score, etc.) are provided, arranged by specialty. This section is ideal for quick calculations when a computer is not available: for example, when calculating a patient’s renal function to see if they are contraindicated for a pharmacotherapy.
Formulary: The formulary tab on this app is designed to provide clinicians with a reference of which medications are subsidised at their hospital or state. However, as the app is designed to suit the USA market, this feature is not applicable in Australia.
Directory: This section provides a directory that lists nearby hospitals and specialists according to GPS location of the mobile device. However, this is another feature designed for the American market and thus has serious compatibility issues for Australian users.
Conclusion
The Medscape mobile application is not perfect. As of version 5.5 it remains U.S.-centric, rendering features such as the drug formulary, directory, and pill identifier almost useless for Australian medical students and clinicians, which is a major drawback. I have also found that suggested dosing regimes can differ from Australian standards, as per the Australian Therapeutic Guidelines. Finally, by extension, Australian names of commercial medications are not listed. Aside from this, the drug pharmacology section can be very brief, so it may be more suitable for a refresher rather than learning drugs primarily through the app.
Overall, however, I have found that this app can be a fantastic tool for a medical student to have in a clinical setting, or as a reference tool for studying, and acts as far more than just a medical encyclopaedia. It is especially suited to those who wish to brush up on conditions already learned, or to extend their learning. All features other than images and pill identification are available offline, which may be useful in areas where internet access is limited, such as the clinic. The app works smoothly, and is well laid out and easy to navigate. The app manages the delicate balance between not enough information and too much irrelevant information very well when compared to similar medical applications available on smart devices, making it indispensible to any student anticipating some difficult patient or consultant questions.
In the digital age, our patients expect the medical fraternity, and by extension, medical students, to be more knowledgeable than ever. As such, in the author’s opinion, this app is a fantastic way to provide additional information, and may help students and clinicians alike to provide better patient care.
Conflicts of interest: None declared.