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Dr Gulnar Magauina is the Head of the Complex Care Department at the Republican Diagnostic Centre. She has more than 30 years of experience in medicine with a background in internal medicine, family medicine and immunology. Dr Magauina is the champion for the Clinical Decision Support Training Initiative at her facility in Kazakhstan and uses the resources on a daily basis. BMJ recently spoke to her to find out more about how she uses the resources in her daily practice.

“Having access to BMJ’s resources is like a dream come true.”

Thanks for taking the time to speak to us Dr Magauina, especially during this time when healthcare workers are working tirelessly through the pandemic. How are you using BMJ's resources to practice evidence-based medicine during this pandemic?

Having access to BMJ’s resources is like a dream come true. As doctors, we are always struggling with evidence-based international standards. Our jobs are not easy. We have many difficult moments with patients with difficult cases. BMJ’s resources are helpful because they collect the global protocols and evidence-based medical information, all in one location.

I think Kazakhstan has done a great job of controlling the outbreak of Covid-19. My ward in the hospital was closed early and the government introduced quarantine and self-isolation measures early on.

I have been conducting online consultations with patients who are presenting with symptoms - to understand what stage of the illness they are in and advise them on the next steps. As new information is emerging on the virus, healthcare professionals need the latest guidelines to support clinical decision making. BMJ’s resources on Covid-19 in English and Russian have been supporting me with all aspects of these consultations.

“As new information is emerging on the Covid-19, healthcare professionals need the latest guidelines to support clinical decision making.”

You see patients from across the country with complicated illnesses. How do you use BMJ Best Practice and BMJ Learning to support your clinical decision making?

Recently, I had a difficult case of a 48-year-old male patient who had strange changes in his femoral x-ray. I suspected Paget’s syndrome, however, I had to rule out other diseases first. I checked BMJ’s resources to help me with the diagnosis as I had never come across a patient with this disease before. I had another resource regarding Paget’s disease from Russia, however, BMJ Best Practice contained the latest evidence-based guidelines, so I decided to refer to BMJ instead.

While referring to BMJ Best Practice, I asked detailed questions such as: “Do you have this symptom? Have you previously had a viral infection such as measles”? My patient responded with answers which aligned with the illness. After confirming the diagnosis with my colleagues, I referred to the treatment algorithm on BMJ Best Practice to decide which treatment to give to the patient. I prescribed the recommended treatment and the patient recently contacted me to tell me he is feeling much better. The protocols I followed resulted in a positive outcome for my patient as well as cost-efficiencies; using BMJ’s resources helped avoid unnecessary test ordering.

That’s great to hear! Did using the resources help you communicate with your patients?

Yes, definitely. When a patient is in front of you and you are reading through the resource, the patient trusts you more. As a clinician, when I am reading the resource and every symptom and sign matches to the patient, it makes you more confident in your decision making. I genuinely want to help patients and find out what is best for them.

For example, with the patient who had Paget’s disease, I had the BMJ Best Practice topic open in front of him. He was interested in knowing what was being recommended and what the next steps were. He knew the information I provided to him was trusted as it was international best practice and is used by international doctors, and is not just a recommendation from me. The resources are patient orientated and help strengthen the communication between the doctor and patient.

How are you using the resources to support your continuing professional development?

As I deal with many difficult cases, BMJ Learning is a perfect resource for me to use to strengthen my knowledge of conditions I am not too familiar with. I like that I am able to print the resource out on BMJ Best Practice and learn more in-depth on BMJ Learning. It’s great that I get a certificate after completing each module, however, it’s the knowledge that I gain which I find invaluable. I’m able to have discussions with my colleagues on the real-life scenarios presented in the modules.

You never stop learning as a doctor. For example, I recently saw a small baby who didn't have any antibodies, such as IgM and IgG. I read various resources to understand what this disease could be. I combined what I had learned through BMJ’s resources with discussions with a colleague in the USA to support the potential diagnosis. We explored the possibility of severe combined immunodeficiency and decided that the best treatment would be transplantation. We referred the patient to Japan for treatment.

I also had an interesting patient who had Wiskott-Aldrich syndrome. I had never seen a patient with this condition before, so I referred to BMJ Best Practice for guidance. I was able to refer the patient to the National Maternity and Childhood Centre for treatment and management. By having access to these resources, I am able to strengthen my knowledge and skills as a medical professional.

“As I deal with many difficult cases, BMJ Learning is a perfect resource for me to use to strengthen my knowledge of conditions I am not too familiar with.”

It's wonderful to hear that BMJ’s resources have been supporting you to deal with novel diseases such as COVID-19 and rare conditions such as severe combined immunodeficiency. Thank you for being a champion of the programme and setting an example to other doctors in Kazakhstan.

You’re welcome. I hope all doctors can use BMJ’s resources to support them in practising evidence-based medicine. It’s the easiest way to become a more knowledgeable and effective doctor.

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

Lalitha Bhagavatheeswaran
Programme Manager, BMJ Global Health Initiatives