Interview with Dr Le Dai Duong « Back to Case Studies
Doctor in the Geriatric and Palliative Care Ward and Education coordinator at the Palliative Care Department at the University Medical Centre, University of Medicine and Pharmacy, Ho Chi Minh City
Dr Duong works as a geriatrician in the geriatric and palliative care wards.
“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 an 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.”
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.