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Deciphering differential diagnoses

Clinical Decision Support Training Initiative - case study

Deciphering differential diagnoses

“When you start the module, there are pre-questions and real-life case scenarios, which I can apply to my clinical practice and teaching.

This is what I like about BMJ Learning. All the information is evidence-based with references. As we teach students, we have to speak with evidence."

 

Dr Duong works as a geriatrician within the Palliative Care Department of the University Medical Centre, University of Medicine and Pharmacy, Ho Chi Minh  City, Vietnam.

“These two specialities in Vietnam are quite new and there is not a lot of knowledge in these areas.

It is important to use tools like BMJ Best Practice and BMJ Learning to help guide us.”

When Dr Duong faces a clinical challenge, such as when a palliative patient presents with new symptoms, he opens up the BMJ Best Practice app to guide him.

“As a principle, working in palliative care, you have to anticipate emergencies.” 

The ability to type the patient’s symptom in the search bar has been a particularly useful feature for him. 

"For example, if the patient comes in with airway obstruction, you can type that in and BMJ Best Practice will present different potential conditions, so I don’t miss out on all the causes.”

Dr Duong regularly refers to the investigation section on BMJ Best Practice to help him decide on which diagnostic tests to order – in case the initial test results come back normal. Once there is confirmation on what condition the patient is presenting with, he refers to the management section on BMJ Best Practice.

The treatment algorithm helps him decide what treatment to provide his patients, and what to move onto, if the first line of treatment fails or is not appropriate for the patient.

BMJ Best Practice provides a systematic and holistic approach to managing patients with acute and chronic conditions.”

In geriatrics and palliative care, most patients have chronic conditions. Sometimes they also present with acute conditions. In BMJ Best Practice, they have a section called 'complications', which I often refer to, to look at potential complications related to a particular condition.

For example, an elderly patient with stroke might have aspiration. With aspiration, there are complications such as pneumonia, acute respiratory distress syndrome, and fibrosis. BMJ Best Practice provides a systematic and holistic approach to managing patients with acute and chronic conditions.

The patient discussion section on BMJ Best Practice has also been a useful aid to Dr Duong’s clinical practice. It helps him remember what information he needs to communicate with his patients.

“I have a lot of patients with faecal incontinence, they have problems passing their stool. The patient discussion section reminds me that I need to speak to my patients about coping strategies such as skincare, psychological support and emotional support.”

Teaching medical students with evidence-based resources

As an education coordinator, Dr Duong prepares educational material for medical students and colleagues in palliative care. He refers to modules relevant to his field such as “Anaemia in old age: common presentations”, and pulls information from them for his presentations and teaching materials.

“When you start the module, there are pre-questions and real-life case scenarios, which I can apply to my clinical practice and teaching. This is what I like about BMJ Learning. All the information is evidence-based with references. As we teach students, we have to speak with evidence."

Case notes.

"I recently looked up 'airway obstruction' for a patient who presented with shortness of breath, because I believed they might have been misdiagnosed as having a chest infection.  BMJ Best Practice guided me to what the differential diagnoses could be.

I ordered an X-ray and chest CT scan as recommended by the investigation section. The scan results showed that the patient’s airway obstruction was caused by a thyroid tumour which grew into the mediastinum."


BMJ Clinical Decision Support Training Initiative

Our Clinical Decision Support Training Initiative was awarded the prize for Innovation in Global Security 2018 by the Geneva Centre for Security Policy (GCSP).

The educational initiative gives healthcare professionals access to the latest evidence-based information on infectious diseases through our online learning and decision support tools, BMJ Best Practice and BMJ Learning

By improving the knowledge and skills needed for early detection and diagnosis, doctors are more prepared for the prevention and management of infectious diseases.

Learn more by watching this video below.

Sharing knowledge

Sharing knowledge

New knowledge is generated rapidly yet often diffuses too slowly. Ensuring that knowledge is disseminated quickly, effectively, and widely is our priority. 

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Strengthening health systems

Strengthening health systems

Our evidence-based tools and resources help frontline healthcare professionals improve the management of both communicable and non-communicable diseases.

Read More
Building an evidence base

Building an evidence base

We teamed up with the University of California, San Francisco (UCSF) to develop Research to Publication, a modular, scalab...

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Convening people

The actors involved in global health are changing, and a multi-sectoral, cross-cutting approach is essential for tackling the priority issues.

We have extensive experience in bringing together thought leaders, policy makers, healthcare professionals and senior stakeholders from all sectors with an interest and mission for improving global health and global health security.
Our programme of events collectively attracts more than 10,000 delegates annually from over 85 countries, including: Contact Lalitha Bhagavatheeswaran to talk to us today. 

Support for Global Health specialists and practitioners

BMJ Best Practice provides quick, accurate, concise and evidence-based answers to clinical questions. Our online decision support tool also has the latest research and guidelines – all built into the clinician’s workflow.


Research to Publication helps improve research outputs and acceptance rates with a comprehensive set of stand-alone, self-study modules.


BMJ Learning is one of the most credible online medical education resources available. It is designed to help students and healthcare professionals achieve accreditation and skill development throughout their career.


The Practical Approach to Care Kit (PACK) is a clinical decision support programme guides primary healthcare clinicians through the diagnosis and management process of more than 500 common symptoms and conditions, including:

  • Cardiovascular and respiratory disease
  • Tuberculosis
  • HIV and AIDS and other infectious diseases
  • Skin disorders
  • Women’s health
  • Mental health
  • End-of-life care. 

This four pillar training programme improves primary health care in low and middle income countries. It works most effectively by partnering with governments, universities and NGOs to partner with us. Provide PACK to your clinicians working in remote areas today by contacting Dr. Tracy Eastman.

Dr Tracy Eastman, KTU Director of PACK Global Development and Delivery
Tel: +44 (0) 208 872 6323
Email: teastman@bmj.com

Mitali Wroczynski works closely with ministries of health, agriculture, and defence to influence policy decision-making, and develop new global health partnerships.

She pioneered BMJ’s clinical decision support training initiative that supports healthcare professionals working in low and middle-income countries to improve the detection, diagnosis, and management of infectious diseases and contributes to building health system resilience. Mitali has also played a key role in making risk communication a central issue for managing major infectious disease outbreaks, epidemics or pandemics, as part of the EU-funded programme, TELL ME.  

Contact Mitali to find out how together we can address global health and global health securities priorities: 

Mitali Wroczynski
Head of Strategic Partnerships, Global Health & Global Health Security
Tel: +44 (0) 20 7383 6517
mwroczynski@bmj.com