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Lalitha BhagavatheeswaranProgramme Manager, BMJ Global Health Initiatives
As a busy oncosurgeon specialising in gastric cancer, his biggest challenge is working with out of date local guidelines whilst trying to practice evidence-based medicine. Fortunately, he has overcome these challenges by using BMJ Best Practice. Here he tells us how:
For example, in the Abdominal Surgery Department at Poltava Regional Cancer Hospital where Dr Chuprina works, he reveals that doctors manage patient cases according to many different local protocols.
These guidelines are in place to help doctors like him diagnose and treat relevant patients. However, they can be extremely time-consuming to read, and Dr Chuprina says he spends hours familiarising himself with them. He also regularly revisits these guidelines in order to commit them to memory so that he can effectively put them into practice.
Even with all this work, he finds himself having to make decisions outside of these guidelines on a weekly basis because there are only so many areas these guidelines can cover. In practice, the way doctors diagnose and treat patients must be adapted according to the latest evidence (as and when there is a need for it).
Since Dr Chuprina started using BMJ Best Practice, he has begun to apply new evidence-based knowledge and guidance to help him treat and diagnose patients. After reviewing the guidance, Dr Chuprina has changed his approach to treating patients with gastric cancer:
I recently saw a 55 year old man with gastric cancer. In the past, I would have just offered surgery. But now, I am practising according to the modern evidence base as outlined in BMJ Best Practice. As advised, I started pre-op chemotherapy instead, then did a gastrectomy before starting adjuvant chemotherapy. He is now better and receiving follow-up care at home. He has had no metastasis or recurrence.”
A problem Dr Chuprina says his department faces is that they are often unclear as to whether or not they are following the latest guidelines. To his knowledge, some of their local protocols are not renewed according to the latest investigations or evidence-based recommendations, and contain information which is around 20 years out of date. BMJ Best Practice is helping to modernise their protocols. So far, they have done this for the management of pancreatic, liver, ovarian and cervical cancers. Dr Chuprina is also enjoying the accessibility of BMJ Best Practice:
BMJ Best Practice is very simple to use because it is clear and straight to the point. I can access the information I need on my smartphone as well as on the internet.
This means I can use BMJ Best Practice anytime… whether it’s at work or at night when I’m at home. ”
