The amount of medical software available to use with personal digital assistants (PDAs) has grown to an impressive – and perhaps daunting – level. A Web site that tracks health-care-specific PDA programs lists more than 850 resources available for download, and it was last updated back in September 2004; undoubtedly, more are available now.¹ Despite the array of PDA options, or perhaps because of it, many physicians do not use their PDA for much beyond its calendar and address functions. I’ve even seen PDAs used as paperweights, collecting dust while their owners sit paralyzed by fear of spending more money on the wrong software.

To help physicians out of this situation, I have put together a list of the PDA resources most relevant to the practicing family physician. Without further ado, here are my top 10 resources for PDAs (actually, it’s my top 15, due to several ties, but who’s counting).

10. (tie) Geriatrics at Your Fingertips (http://www.geriatricsatyourfingertips.org) and OB Suite (http://www.fppda.com/timobs.html). Geriatrics at Your Fingertips is a free PDA version of the American Geriatrics Society’s pocket guide to the evaluation and management of diseases and disorders that are common among the elderly. It includes assessment instruments, recommended diagnostic tests, management strategies and therapies geared toward older adults.

OB Suite is a free program by Timothy Allen, MD, a fellow family physician. It calculates gestational age (from last menstrual period, estimated date of confinement or ultrasound data), when trimesters start and end, and Bishop score. It also tracks obstetric procedures and patients, and it allows you to beam records for checkout. In other words, rather than hand a crumpled up rag of paper to your colleague who’s taking over, you electronically send him or her all the information that you’ve dutifully updated while on call. OB Suite includes a Windows desktop application that allows you to add and edit patients from your computer and to e-mail checkout lists if a face-to-face handoff is not readily accomplished.

9. (tie) Skyscape (http://www.skyscape.com) and Unbound Medicine (http://www.unboundmedicine.com). Both are medical software vendors that have converted hundreds of texts into a format that’s relatively easy to read on your PDA. Imagine having the latest version of references like Current Consult Medicine 2006 ($64.95 from Unbound Medicine), Griffith’s 5-Minute Clinical Consult ($64.95 from both vendors) or the Harriet Lane Handbook ($39.95 from Skyscape) available at the patient’s bedside.

8. (tie) The Medical Letter (http://www.medicalletter.org) and Prescriber’s Letter (http://www.prescribersletter.com). Both organizations publish well-known newsletters giving unbiased information on new medications, indications, devices and procedures. Now you can carry several years’ worth of newsletters in your pocket, ready for access at the touch of a stylus. The PDA editions are available when you subscribe to the newsletters. A one-year subscription to the Medical Letter is $89, and one year of the Prescriber’s Letter costs $88.

7. Mobile MerckMedicus (http://www.merckmedicus.com). This program offers free access (as long as you’re willing to register) to Reuters Medical News, the Merck Manual of Diagnosis and Therapy, the 4th edition of Pocket Guide to Diagnostic Tests, and selected citations and abstracts from MEDLINE’s database of journals.

6. POCKETConsult (http://www.pocketconsult.com). I find POCKETConsult’s MD Consult News slightly less cumbersome than Reuters Medical News via Mobile MerckMedicus. Both are excellent resources, but only if you are willing to update your PDA daily to ensure that you’re carrying the latest information. Also available free from POCKETConsult is MD Consult Drug Updates (which gives you the latest information from the Food and Drug Administration), many medical calculators, Mosby’s Drug Consult Interaction Tool and This Week’s Journals. Mosby’s tool helps determine if there are any drug-to-drug interactions to watch for among your patients’ medications. This Week’s Journals is a collection of article abstracts from journals of your choosing for you to read at your leisure. (I know, I know – what leisure?)

5. Shots 2006 (http://www.immunizationed.org). Thanks to Shots, I long ago stopped trying to memorize each new rendition of the Advisory Committee on Immunization Practices’ recommendations. Shots, which is free, includes both the adult and pediatric recommendations, including basic and high-risk indications, adverse reactions, contraindications, catch-up protocols and administration hints. Invariably, your patients will raise concerns about certain vaccines. To help you respond eloquently, Shots includes “risk communications,” a collection of frequently asked questions with answers. If only this had existed while I was in medical school! Kudos to fellow family physician Kent Willyard, MD, for developing Shots, updating it regularly for several years and then passing its upkeep to the Group on Immunization Education of the Society of Teachers of Family Medicine.

4. StatCoder (http://www.statcoder.com). This collection of applications was developed by Andre Chen, MD, MBA, another family physician. Because the American Medical Association holds the copyright to CPT codes and charges Chen for their use, he is forced to charge a fee for his coding software. On the other hand, he offers several free downloads that are easy to use during patient encounters.

3. (tie) MedRules (http://pbrain.hypermart.net/medrules.html) and MedCalc (http://www.med-ia.ch/medcalc). These programs are both free medical calculators. MedRules, also created by Willyard, includes patient-oriented, data-driven formulas such as the APACHE II severity of disease classification system, the Gail model for breast cancer risk, the Ottawa rules for ankle, foot and knee, and a formula for estimating the probability of strep pharyngitis. MedCalc, created by Mathias Tschopp, MD, focuses on more basic physiology formulas such as absolute neutrophil count, alveolar-arteriol O₂ gradient, corrected sodium (in hyperglycemicsituations), Gault-Cockroft equation for creatinine clearance and Winter’s formula for expected pCO2 in metabolic acidosis. Be aware that Willyard has elected not to update MedRules as Tschopp has for MedCalc.

2. (tie) MeisterMed (http://www.meistermed.com) and iSilo (http://www.isilo.com). Andrew Schechtman, MD, a family physician and a field coordinator for Doctors Without Borders, developed MeisterMed, which includes a variety of coding and clinical references, such as an adaptation of the Centers for Disease Control and Prevention’s 2002 sexually transmitted diseases reference, a dermatology reference replete with photographs, a splinting guideline and a reference for anyone presenting with any number of electrolyte abnormalities. Most of these references are free and were developed by Schechtman. MeisterMed also includes a section called Medical iSilo Depot, where Schechtman houses an even broader collection of guidelines and references, which he developed by scouring the Internet for medically relevant iSilo files. The iSilo program is required to read these files. While the full iSilo reader is available for a free 30-day trial, it functions in a limited fashion if you choose not to pay for it. In my opinion, however, it is $19.99 well spent (and I say this without receiving any remuneration). Think of iSilo as a way to share all the notes that you’ve collected in your little black book with other physicians and for you to see what others have kept in theirs.

1. Epocrates (http://www.epocrates.com). I consider Epocrates in all its variations the must-have application for family physicians. I especially recommend Epocrates Essentials, which includes a version of Griffith’s 5-Minute Clinical Consult (Epocrates Dx), a laboratory reference (Epocrates Lab), an infectious disease reference (Epocrates ID) and an alternative/complementary medicine database in addition to its standard medication data (Epocrates RxPro). Even if you choose not to pay for the full experience, the free version of Epocrates Rx allows you to check for drug-to-drug interactions among up to 30 medications and for compatibility issues between intravenous medications. Furthermore, several complementary calculators and references are available for those of us who are less savvy users, along with free CME. Now, I cannot go so far as to recommend obtaining your 150 hours of CME every three years by staring at your PDA’s screen, but it’s handy while you’re at the airport waiting for a flight.

From extraneous to essential

Although I developed this list for PDAs running on Palm OS, most of the above resources are available for PocketPC users. Don’t forget to synchronize your PDA with your computer often (daily would be optimal). With the right programs and frequent updates, you can turn your PDA paperweight into an essential part of your daily practice.