UpToDate or Dynamed?

5 07 2009

Guest author: Shamsha Damani (@shamsha) ;
Submission for the July Medlib’s Round

Doctors and other healthcare providers are busy folks. They often don’t have time to go through all the primary literature, find the best evidence, critique it and apply it to their patients in real-time. This is where point-of-care resources shine and make life a bit easier. There are several such tools out there, but the two that I use on a regular basis are UpToDate and DynaMed. There are others like InfoPoems, ACP’s PIER, MD Consult and BMJ’s Point of Care. I often get asked which ones are the best to use and why. The librarian answer to this question: depends on what you are looking for! Not a fair answer I admit, so I wanted to highlight some pros and cons of UpToDate and DynaMed to help you better determine what route to take the next time you find yourself in need of a quick answer to a clinical question.

UpToDate

Pros:

  • Comprehensive coverage
  • Easy-to-read writing style
  • The introduction of grading the evidence is certainly very welcome!

Cons:

  • Expensive
  • Conflict of interest policy a bit perplexing
  • Search feature could use a makeover
  • Remote access at a high premium
  • Not accessible via smart phones
  • They didn’t come to MLA’09 this year and medical librarians felt snubbed (ok, that is not a con, just an observation!)

DynaMed

Pros:

  • Bulleted format is easy to read
  • Remote access part of subscription
  • No conflict of interest with authors
  • A lot of the evidence is graded
  • Accessible on PDAs (iPhones and Blackberries included!)

Cons:

  • The user interface is a bit 1990s and could use a makeover
  • The coverage is not as extensive yet, though they keep adding more topics

A lot has been written about UpToDate and DynaMed, both in PubMed as well as on various blogs. Jacqueline also did a fabulous post of the evidence-based-ness of UpToDate not too long ago. I used to think that I should pick one and stick to it, but have recently found myself re-thinking this attitude. I think that we need to keep in mind that these are point-of-care tools and should not be utilized as one’s only source of information. Use the tool to get an idea about current evidence and combine it with your own clinical judgment when needed at point-of-care. If suspicious, look up the primary literature the good old way by using MEDLINE or other such databases. A point-of-care database will get you started; however, it is not meant to be a one-stop-shop.

I can almost hear people saying: so which one do you prefer anyways? That’s like asking me if I prefer Coke or Pepsi. My honest answer: both! (databases as well as beverages!). So what is a busy clinician to do? If you have access to both (or more), spend some time playing with them and see which one you like. Everyone has a different searching and learning style and it is sometimes a matter of preference. DynaMed’s concise structure may be appealing to newbies, whereas seasoned clinicians may prefer UpToDate’s narrative approach. Based on my very unscientific observation of Twitter conversations, it appears that clinicians in general prefer UpToDate whereas librarians prefer DynaMed. Could this be because UpToDate markets heavily to clinicians and snubs librarians? Or could it be the price? Or could it be the age-old debate on what is evidence? I don’t know the answer, partly because I find it all a bit too political. I’ve seen healthcare providers often use Google or Wikipedia for medical answers, which is quite sad. If you are using either UpToDate or DynaMed (or another similar product), you have already graduated to the big leagues and are a true EBM player! So relax and don’t feel like you have to pick a side. I find myself using both on a regular basis; the degree of success I have with each can be gauged by my daily Twitter feed!

Shamsha Damani


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11 responses

5 07 2009
Palmdoc

A small correction here:
UpToDate is accessible via smartphones – at least one can install the entire content on Windows Mobile and Palm PDA phones. Any smartphone with a decent browser can access UpToDate mobile at http://pda.uptodate.com

5 07 2009
DrRobH

I can quickly and easily access UTD on my iPhone via Safari. In fact, it’s only slightly slower than the web version. I do agree about the cost and questionable conflict of interest though.

6 07 2009
Shamsha Damani

You guys are right; UTD is accessible via PDAs. Thanks for the correction!

10 07 2009
danil sutil

hi did you look into detail about bmj’s point of care ? as I did a 30 day trial and I found it to be excellent as it appears to cover the real evidence (you can tell its totally evidence based) alongside the expert opinion, when the evidence is not available or weak according to the grade scores, but also the guidelines. i also like the way its totally sliced and gives very short info if you need it as I dont have time to read pages and pages of stuff when I am looking for a quick answer on the ward

31 07 2009
Shamsha Damani

Hi Danil, I just tested BMJ’s Point of Care and like you, was impressed with it as well. The one drawback for me was the lack of coverage in the field of oncology. However, they are adding new topics and are providing more graded evidence as well. I think that this product is one to watch closely in the next few months! Thanks.

5 08 2009
MedLib’s Round 1.5: the best of medical librarianship | Pharmamotion

[…] MedLibLog hosts Samsha Damani as guest writer, who makes an interesting comparison between UpToDate and Dynamed. She highlights the pros and cons of each product, with very sharp observations about cost, […]

31 12 2009
Jane Smith

Dynamed is a great product for Primary Care physicians but lacks many things that make UpToDate a superior product. Dynamed links out directly to the source documents but so does UpToDate. When faced with a patient whose presentation leaves a question (do I subscribe this Rx or do I order an MRI or is specialist consult required) it is difficult to answer those questions with Dynamed which reads more like an outline of general medicine. With UpToDate you can find answers, evidence and recommendations from field leaders in medicine. Dynamed may be helpful in the study of medicine but falls short when the practice and application of medicine is required and reads more like a bibliography.
I trust UpToDate, the content is consistent, topics are written by field leaders, are direct and useful in treating patients. I have it on my Blackberry and can pick it up on my hospital’s wifi broadcast plus I can get CME through UpToDate for free when I use it through my hospital’s physician intranet portal or our EMR system.
Concerning the issue of cost, our IT department pays for it. Compared to the other IT based resources like EMR and CPOE, UpToDate’s cost is relatively small.

8 08 2010
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[…] she is a prominent twitterer and has written quest posts at this blog on several occasions (here, here, here and […]

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[…] new look at certain topics (see for instance Grey literature time to make it systematic and  Uptodate versus Dynamed. The post were written by Shamsha, but I reviewed them before publication. Because after all, […]

13 10 2011
Evidence Based Point of Care Summaries [1] No “Best” Among the Bests? « Laika's MedLibLog

[…] UpToDate or Dynamed? (Shamsha Damani at laikaspoetnik.wordpress.com) […]

18 10 2011
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[…] UpToDate or Dynamed? (Shamsha Damani at laikaspoetnik.wordpress.com) […]

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