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Providing the best possible care to patients | Aversi Clinic, Georgia

Dr Nino Kiknadze: I am a primary care physician, family doctor and internist at the Aversi Clinic Diagnostic Centre in Tbilisi, Georgia. It is a large clinic and I work mainly in the outpatient department. I also teach pulmonary medicine at Tbilisi State Medical University and support the development of this medical specialty in Georgia. 

Access to BMJ Best Practice and BMJ Learning has been a great support for me and my colleagues - it is the best way for us to update our knowledge and access the latest evidence-based guidance. These resources support us in providing the best possible care to our patients.


BMJ Best Practice helps to practise evidence-based medicine

I see around 15 to 20 patients every day, so time is always an issue. But when I am unsure of something, for instance, which investigations to perform or what drugs to prescribe, I always open BMJ Best Practice to quickly find the best advice and to practise evidence-based medicine. 

For example, when managing patients with abnormal liver function tests, I used the BMJ Best Practice recommendations to alter the investigations I carried out. Before, I used to  assess severity of non-alcoholic fatty liver disease (NAFLD) based on clinical manifestation and abnormal blood tests results and was making referrals to the specialist in the most of the cases. However, following the recommendation provided by Best Practice, I started using NAFLD score calculator. Using the calculator helped me to select the patients who really needed additional investigation and referral to a specialist.

Using BMJ Best Practice has also changed how I care and prescribe for patients taking hormone replacement therapy (HRT). In the past I didn’t prescribe HRT to patients with flushes and sweats - I used to refer such patients to a gynecologist. Now I help women decide whether to take HRT or not, and offer HRT to patients with severe vasomotor symptoms and low quality of life - after full consideration of the risks and benefits. The use of BMJ Best Practice has changed my approach, by grounding it in evidence-based medicine and keeping it in line with the latest international practice.

Although I have knowledge in various respiratory medicine topics, I still refer to them on BMJ Best Practice. Most of the time it helps confirms whether my practice is correct and provides examples of practical things to do in each situation with corrective actions you should take. For example, the topic page for Chronic Obstructive Pulmonary Disease (COPD) topic on BMJ Best Practice is clear, compact and convenient, especially on step-by-step management.  I appreciated the practical recommendations about transition from inhaled corticosteroid (ICS) to the oral route during exacerbations. Also the evidence, which included links to Cochrane Clinical Answers, is helpful. I liked the section on duration of treatment with corticosteroids during an exacerbation of COPD and also the section on the benefits of different types of inhalers. 

BMJ Best Practice has allowed me to refresh my clinical knowledge in several areas beyond respiratory medicine. Georgia is a tourist destination and there are also a lot of visiting students from India, Nigeria, Azerbaijan, and Turkey. They often visit me as a family doctor with different complaints - such as diarrhoea, fever of unknown cause, or upper respiratory symptoms. Using BMJ Best Practice ensures that my differential diagnosis covers (and rules out) the most serious causes. 


BMJ Learning: an important component of teaching medical students

While BMJ Best Practice has been an excellent resource to support evidence-based diagnosis and management, BMJ Learning has helped me to develop material for my teaching at Tbilisi State Medical University. 

I mainly access modules about respiratory medicine and modules on clinical skills. I use these modules with my students as they are short, clear and include various patient scenarios.  One of the most helpful features of BMJ Learning are the assessments provided within each Learning module.  These are informative and allow me  to see both the correct and incorrect answers, with explanations of what is right and what is wrong and why.  It has been an important component of my teaching to go through the answers and explanations with my students.

Aside from using BMJ Learning to help with my teaching, I use Learning to become familiar with a wide range of infectious diseases. Although not all of the infectious diseases are common in Georgia, the course on Especially Dangerous Pathogens is still important. There are occasional cases of Botulism, Tularaemia, Crimean-Congo Haemorrhagic Fever and Anthrax in Georgia. Completing the Learning modules on these diseases helped me to recognise and report them. 

Furthermore, as a primary care physician I have patients come in with everything from mosquito and tick bites to diarrhea and food poisoning! BMJ’s infectious diseases modules were perfect for me - especially during the summer.  I had some patients with tick bites during this Spring-Summer period and the modules helped me to rule out more serious causes of disease. Fortunately most of them were not serious but I did have several patients with Lyme disease. 

Finally, the Learning module on Personal Protective Equipment and isolation for highly dangerous infectious diseases was interesting and very important. It reminded me once again of the importance of following the recommended guidelines for infectious disease control.

BMJ Best Practice is an online decision-support tool for use at the point of care. Structured around the patient consultation, it presents the required information just as it’s needed. 
BMJ Learning is a reliable online learning resource that helps doctors and healthcare professionals to enhance their knowledge and progress their careers. It is one of the world's largest and most trusted independent online learning providers for medical professionals.


The purpose of this document is to educate and to inform. The content of this document does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the authors. BMJ does not endorse any views or recommendations expressed in this document. Readers should also be aware that professionals in the field may have different opinions. Users of this document hereby agree not to use its content as the basis for their own medical treatment or for the medical treatment of others .