Dr. Nico Kahl: 3 ways to use Ask in the ER

Hi, my name is Dr. Nico Kahl, and I'm a board-certified emergency physician here to tell you about how I use Doximity Ask in my clinical practice. There are 3 main ways that I like to use Doximity Ask. First is for clinical drug reference. Second is for summarizing clinical notes.

And third is for generating custom patient discharge instructions. During a busy shift, every minute counts. And as any ER doctor will tell you, it's not the real emergencies that slow us down. It's having to look up a drug dose when a pharmacist is nowhere to be found. It's having to take the time to review a 5,000-word oncology note before you go to see a patient who is newly diagnosed with cancer who presents to the ER, or it's generating custom discharge instructions for somebody who blew up a firework and injured their hand on the Fourth of July.

The tools you use define how efficient you can be. And Doximity is a Swiss Army knife for my clinical practice. Let's talk about Clinical Drug Reference first. There are two ways to access this in Doximity Ask. First is on the left-hand side under the toolbar, you can click drug lookup and then you'll get a suggested list of drugs or you can type one in.

I prefer to freestyle it though, so that I can stay in the same query bar as my other Doximity Ask questions. Let's say I have a pregnant patient, 38 weeks pregnant, who has symptoms of urinary tract infection.

One of the drugs I commonly use to treat UTI are nitrofurantoin. So I click it, type it in, it shows up right below the search bar here, and then you have a list of numerous facts about nitrofurantoin. I scroll down to the contraindications, and right there it reminds me that pregnant women near term should not be given nitrofurantoin, and there's additional information specific to pregnancy here.

Now let's talk about looking up dosing. Keflex, cefalexin, is another drug that I use to treat urinary tract infection. But let's say that I have a patient who's in their 80s, an older adult, and their creatinine just came back showing that they have poor renal function. I go to the drug reference card for Keflex and scroll down to find the renal impairment specific population.

I can even find the dose adjustment, and right there I've avoided having to go to a separate clinical drug reference site to look up renal dosing. I keep moving on through my day. Let's say I have another patient who's coming in and has urinary tract infection, but this one is allergic to Keflex.

And let's say that they have pyelonephritis as well, some involvement of their kidney, so I can't give them nitrofurantoin. We're gonna try to give them Bactrim. But let's say this patient also has a history of seizure disorders. And I remember that there might be interactions with phenytoin. I scroll down to the bottom to the interaction checker.

I can type in phenytoin, which I know the patient is on. Let's say they're also on a blood thinner, Eliquis, because they have a history of PE. Now you have an example down at the bottom here showing you the drug-drug interactions and even the details if you want to get into specifically which enzymes are potentiated or inhibited by the drugs in question.

Now let's jump into creating custom templates for your Doximity Ask queries, and then two specific applications that I think are great. First is summarizing clinical notes, and second is generating custom patient discharge instructions. So let's go to the left-hand side here. Under templates, you see this plus sign. This will present you with a couple templates that are pre-filled out, such as discharge summary or consult note, or you can start with naming your own template and giving your own specific instructions.

Once you click Create Template, it will be saved under your templates on the sidebar, and you can even add a document that you might need to reference, for example, your group's template for a note, and then you want to make your own custom instructions on top of that. Let's talk about two that I've found useful.

One is chart or note summarization. Here, once you click your chosen saved template, it will take you into the specific template, and you can edit your instructions if you need to make any tweaks, or you can add a specific document for this note. If you had it saved in PDF or it was faxed from a different hospital and then you uploaded it, you could then add this in as a document if you need to summarize it that way.

Or let's say we have a note that we're copying in.

This is a de-identified note that is not a real note from the electronic health record. But this is an example of a 46-year-old male patient that's a stockbroker presenting with abdominal pain. You have your full H&P, but this is a pretty long note to have to read through. So all I have to do is ask Doximity to summarize it for me.

I can jump into a different window. It just takes a few seconds. And then you have a short summary that is more suitable to your needs when you're writing your own note and need to refer back to the encounter that the patient recently had in the ER. Now let's talk about my third favorite way to use Doximity Ask, which is generating custom patient discharge instructions.

We're going to change our template on the sidebar, then we're going to type in our question. Let's say we have a patient with hand blast injury from firework. Rather than waiting, I'm gonna check out the query that I had recently asked, which was that question. And here are my discharge instructions. Again, this is not something you see every day, but when you do see it, you want very specific discharge instructions, and Doximity can help me with that so I can keep seeing patients and getting through a busy shift.

And not have to take my work home with me at the end of the day because I stayed efficient.

I used to rely on information scattered across the web on sites that were tailored to a specific type of reference, but now I find it all in Doximity. I can summarize clinical notes, I can create custom discharge instructions, and I can do clinical drug reference cards. Thank you for your attention, and I hope you find this useful in your own clinical practice.