Differential diagnosis
In content, FC-Palm’s Differential Diagnosis section is similar to that of FC-Web, except index listings appear only once (eg, “increased tearing, abnormal”) as opposed to appearing under all permutations in FC-Web’s index (eg, under “abnormal,” “increased,” and “tearing”). FC-Palm also employs extensive hyperlinking. Selecting “Incontinence, urinary” produces its differential; tapping “benign prostatic hypertrophy” in the resultant list produces a disease summary, with a link to the corresponding monograph in the Medical Conditions section.
The Differential Diagnosis section does not contain “hyponatremia,” but the Medical Conditions section does. Under the subheading Drugs and Other Therapies, only 2 therapies are listed—demeclocycline and fludrocortisone. There is no mention of water restriction (SIADH) or volume replacement (hypovolemia) per se—just drugs. In contrast, FC-Web’s comparable monograph incorporates volume replacement and free water restriction but only includes the issue of “urgent” volume replacement in the Immediate Action section, not in the important Summary of Therapeutic Options section.
Similarly, FC-Web’s monograph nicely summarizes drug options for pelvic inflammatory disease, but FC-Palm simply provides a listing of individual drugs without any hints about the appropriate combinations—significantly compromising users’ ability to quickly select therapy at point of care.
FC-Palm falls short of the mark for gonorrhea in the same way. The therapeutics screen simply lists 10 drugs (all hyperlinked to further information) without any hints as to recommended or preferred choices. In fact, hyperlinking to further information on ceftriaxone, the Centers for Disease Control’s recommended therapy in pregnancy, one finds the oxymoronic “Use caution in pregnancy (category B),” which might lead a neophyte on a search for the Holy Grail (ie, the nonexistent “better” drug for use in pregnancy).
Final word on firstconsult
FC-Web is well laid out and, using a high-speed connection, functional for point-of-care use, offering sufficiently detailed and extensively hyperlinked disease monographs. For the most common diseases, key questions are generally answered efficiently and in a manner consistent with current evidence or thought. As a bonus, FC-Web provides basic patient education handouts in English and Spanish.
FC-Palm lacks state-of-the-art navigation and search capabilities. FC-Web’s outstanding Summary of Therapeutic Options sections have been gutted in FC-Palm to be substantially less helpful—and potentially misleading—lists of non-prioritized therapies (primarily drugs).
Before we can recommend it as a prime-time handheld application, FC-Palm needs to upgrade its Therapeutics section to be equivalent to FC-Web’s Summary of Therapeutic Options; it should also remedy the nonstandard behaviors, improve navigation, add search options and some user preferences, and incorporate an auto-update feature.