⚖Evidence Based SmartPhrases (Archive #4)
We can all use a bit more of this in our life. So can our patients.
Note: The original tweetorial on this topic happened 10/11/22. If you saw it live, bear with me. I’m giving #EpicShortCuts a permanent home here before we start branching out.
The original tweet describes how to bring evidence into our daily practice. Check it out:
How do you know you need this in your life? If you ever googled, or PubMed searched something for reference in the course of clinical care, why do that ever again? You can help your future self by turning that reference into a SmartPhrase.
Let’s explore some examples.
Guidelines
When the American Urological Association came out with new microhematuria guidelines, I wanted to follow them. But (as my wife can surely attest) I don’t have the most amazing memory. So I used the snipping tool (in windows) and made this SmartPhrase.
Are you a Mac user? It’s Command-Control-Shift-4. Phew! I need a SmartPhrase just to remember how to snip an image on a Mac.
One more caveat- if you find you can’t paste images into SmartPhrases, it might not be your fault. Each EPIC build is different, and at your institution, someone may have decided to block that capability. Why? I haven’t the slightest clue. Control? Fear?
Folllowup
Doing the “right thing” at follow-up is hard. You’re in a rush, your clinic is busy, and you’re behind. Who can remember all of the latest recommendations?
Nobody. Least of not, yours truly.
I made this SmartPhrase “DCFUCYSTECTOMY” (It’s nice to be consistent with prefixes, as in <your initials> <FU> for follow-up and <something memorable>.
Check it out below. Now I don’t have to remember any of these guidelines. When I dump it in the chart, I can read and review it and then decide on the best (most evidence-based) way forward.
New data, lots of peer-to-peer calls
Insurance company guidelines lag behind best practices. I’m sure that’s news to none of you. When practice-changing data emerges, we all face an uphill climb of frequent peer-to-peer phone calls. Raise your hand if you love peer-to-peer phone calls.
I’m waiting.
So here’s what I did. In 2018, I made a SmartPhrase hot off the NEJM Precision trial about MRI in biopsy naive patients. Did it save me peer-to-peer phone calls? Probably not.
But it was a refresher, helped me frame patient discussions at the point of care, and made me feel better about the care I was providing.
The actual SmartPhrase is pictured:
Read something, and implement it immediately.
Here’s a very recent example. I read a great AUA News article by Ben Ristau describing what to do with negative prostate MRIs in patients with elevated PSA. I remind myself I’d like to explain this to patients in real-time, and I use the data to color my decisions. Maybe some of you out there can do this from memory. I cannot.
Here was the source article.
Here’s my SmartPhrase (you might notice some SmartLinks like @LName@ sprinkled in there. That’s fodder for another newsletter down the line.
I should point out here, you DO indeed have to remember to actually use the SmartPhrases you create. I can’t help you there.
Risk stratification
Here’s a scenario where clinical care gets complex. I need to force myself to risk stratify every patient, and then act accordingly. Guidelines are constantly in flux. As soon as a new one emerges, making a SmartPhrase is high on my priority list.
This is <DCBLADDERCANCERRISK>
How else have you used SmartPhrases creatively? Remember, comments will help others in our community so don’t be shy!