UpToDate Clinical Story: A Specialist Corrects Misdiagnosis of Sarcoidosis to HLH and Lymphoma

There are two key lessons to learn from this case. First, we have to be careful in treating young and otherwise healthy patients. They have so much reserve to fall back on that sometimes we don't appreciate how sick they are. The same symptoms in an older, frail person would trigger alarms and possibly faster treatment. Second, this patient had been assigned a diagnosis with a degree of certainty that was unwarranted. Once you offer a definitive diagnosis, some doors close. That was a disservice to her, in that it cost her time. The wrong diagnosis is much more harmful than saying, "I'm not sure."

Trust in UpToDate

Medical decision-making often involves uncertainty, and UpToDate does a terrific job of helping physicians to navigate that. It's important for us to think about what we know, but perhaps more importantly, what we don't know, when making diagnoses and treatment recommendations.

There are four main scenarios within which I apply my medical knowledge and training, and I use UpToDate for all of them, albeit, for different reasons:

• First, as a specialist, I see patients on a daily basis who have conditions with which I'm quite familiar. However, I still check UpToDate to make sure I haven't missed anything. There may be several points I've covered, but UpToDate might raise the one additional point we should discuss.
• Second, there are conditions that I know quite a bit about but don't see as often, such as hypertension. I use UpToDate to double check my management plan and confirm it is still based on the most current clinical evidence.
• Third, there are conditions I encounter only occasionally. I know I've forgotten some of the specifics, so I use UpToDate to make sure I'm treating my patients according to current best practices.
• Fourth, there are some cases I've never encountered before. In the case of HLH, UpToDate helped me learn enough about the condition in a matter of minutes, which had a potentially life-saving outcome for my patient.

In addition to trusting UpToDate content to treat my patients, I value being able to access UpToDate within the EHR. The pop-up menus and suggestions are really helpful, and of course, highly relevant to my patient. I also use the drug interactions database from Lexicomp^® on a daily basis, which ensures I'm keeping my patients safe from medication errors.

Lastly, to further engage patients in their care, I share UpToDate information written especially for patients. In the exam room, I show them graphs, tables, photographs, illustrations and other information, which I also email. I've found that patients appreciate the chance to further review the information on their own and share it with friends and family. When patients truly understand the nuances of their condition, they can participate more fully in their care and make more informed decisions.

Using UpToDate in my clinical practice gives me the confidence to take on challenging cases and provides a solid platform for lifelong learning. I truly cannot imagine practicing without it.

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