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When there were no national guidelines for treating leishmaniasis, Dr Thi Hao Nguyen, an infectious disease junior doctor in Hanoi, Vietnam successfully used BMJ Best Practice to find out how to manage a patient, even with the added complication of comorbidities.

Background of an infectious diseases doctor

Dr Thi Hao Nguyen works at the National Hospital of Tropical Diseases, a tertiary hospital for infectious disease, in Hanoi. She was based in the department for viral and parasitic diseases from December 2017-November 2018. This is her story of how BMJ tools helped her during this time.

“BMJ Best Practice and BMJ Learning are good and reliable resources that are useful for junior doctors like me.”
Dr Thi Hao Nguyen, infectious diseases doctor, National Hospital of Tropical Diseases

Dealing with difficult diseases

In my department, patients usually have viral and parasitic diseases. The most difficult patients are almost always patients with HIV who also have opportunistic infections.

When I get difficult cases, I quickly refer to the diagnosis and the management sections of BMJ Best Practice. When I have time, I go back to look at the overview and other information. The management section is structured in a way that is easy to access.

For example, you can clearly learn how to manage the patient, which antibiotic to prescribe them, the dose and how long to prescribe the treatment. I think it’s the most useful section in BMJ Best Practice.”

“I follow the treatment algorithm in BMJ Best Practice; I always look at the first line of treatment and second line of treatment as well as any alternatives. This helps me give the patient the right treatment for them. It also saves time and money for both hospital and patient.”

Clear guidance

Dr Nguyen commended the treatment algorithm section, stating it was clear, and easy to understand and follow the guidelines.

With BMJ's resources, I feel more confident when I prescribe for the patient because I have the exact guideline for the patient. I get more familiar with the evidence that guides our decision making and my medical knowledge has increased a lot using this resource.

Sometimes the recommended treatment isn’t available but I really appreciate knowing the updated evidence-based information in BMJ Best Practice.”

BMJ Best Practice helps Dr Nguyen diagnose and manage patients with unusual illnesses. She accesses the resources in both English and Vietnamese, giving her the flexibility to switch between languages when needed.

She accesses BMJ Learning to help her perform medical procedures and techniques correctly. Recently she viewed a learning module on how to perform a lumbar puncture, which helped her and made her more confident in performing the procedure.

I especially recommend modules on procedures for junior doctors. These modules teach us essential skills that we need in our clinical practice.”

Being equipped with the latest evidence-based information about a condition helps Dr Nguyen communicate more easily with her patients.

I remember a patient with the multifocal abscess in the spleen and I had to prescribe her antibiotics to use for at least four to six weeks. I needed to explain to the patient that she needed to use antibiotics for a long time.”

I have the BMJ Best Practice app on my phone, so I showed the patient that her treatment plan was consistent with the international guidelines. Once she saw this, she was confident with the treatment that she was receiving. She was initially worried about her condition and the long treatment I was prescribing.”

Case notes

There’s a patient that I can’t forget as it was really hard to find the right diagnosis. The patient had an existing immunodeficiency and a prolonged fever.

We carried out many laboratory tests to diagnose the patient, but they all came back negative. The patient presented with pancytopenia and the bone-marrow biopsy results showed that the patient had leishmaniasis; a disease we hadn’t seen before.

Currently, there is no national guideline for the exact regimens and exact doses for treating leishmaniasis. We had to use BMJ Best Practice to find out how to manage this patient, especially given their co-morbidities.

BMJ Best Practice provided information on the exact regimen to give the patient and for how long. We then consulted infectious disease experts to confirm the treatment dose.

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BMJ CLINICAL DECISION SUPPORT TRAINING INITIATIVE

To find out more or share your own success stories, contact

Lalitha Bhagavatheeswaran
Programme Manager, BMJ Global Health Initiatives