Checking a clinical guideline between patients

The situation: a question in the gap between patients

The gap between two patients in a clinic or on a ward is often a minute or two, and that is when clinical questions come up: whether a drug class is still first line after the last update, which test a new presentation needs first, or what finding should trigger a referral. The question is usually narrow and the answer exists, but it sits inside a guideline that can run to dozens of pages, with numbered recommendations spread across sections and updates published as separate documents. In that gap a doctor has three realistic options: rely on memory, ask a colleague who is just as busy, or open the guideline and search it while the next patient waits. Memory is fast but dates, because major guidelines from bodies such as NICE, ESC and KDIGO are revised every few years. Searching the document is accurate but slow on a phone. Typical questions in this gap look like these:

• Is an SGLT2 inhibitor recommended for a patient with type 2 diabetes and chronic kidney disease, and since which guideline?
• Which test does current guidance put first for suspected heart failure in primary care?
• Which features of a thyroid nodule should prompt referral for ultrasound?

What goes wrong without a cited source

Without a cited source, a quick answer can be out of date, from the wrong country or simply invented, and there is no fast way to tell which. Memory tends to hold the guideline you trained on, not the update published since. A general AI chatbot can give a fluent answer that blends US and UK guidance, repeats a recommendation from a superseded version, or names a reference that does not exist: studies of early ChatGPT versions found that many references it wrote from memory were fabricated. A web search mixes the guideline with patient leaflets, sponsored pages and forum posts. Each failure costs more than the minute it saved: a choice made on an old recommendation, a referral made too late, or a second search after clinic when the doubt returns. The risk is highest when the answer gives no year, because an undated recommendation cannot be compared with the current version.

• Superseded advice. The answer is right for the 2019 guideline and wrong for the current one.
• The wrong country. NICE, US and European guidance can differ on thresholds and first-line choices.
• No way to check. Without a link, the only way to confirm the answer is to start the search again.

How AskMed helps between patients

AskMed shortens a guideline check to one question and one tap on a citation. Before it writes anything, AskMed searches a fixed list of medical sources: guideline bodies and agencies such as NICE, the US Preventive Services Task Force, WHO, CDC, ESC, KDIGO, GINA and GOLD; journals and databases such as PubMed, the Cochrane Library, NEJM, The Lancet, JAMA and The BMJ; FDA and DailyMed drug labels; and references such as StatPearls and BMJ Best Practice. It ranks guidelines and health agencies first, adds "latest guideline update" to management searches, gives the year of every guideline recommendation it states, and says what changed when guidance has moved. The answer opens with a direct reply, and each claim links to its source, numbered in a source list labelled Guideline, Research, Drug label or Reference. If no usable source turns up, AskMed says so instead of answering from memory.

• Source filters. Turn guidelines, research, drug labels or references on and off, and set the number of sources from 3 to 12 (8 by default).
• Follow-ups. A short follow-up such as "and if eGFR falls below 20?" is read together with the previous answer, and every answer ends with three suggested follow-up questions.
• History or Private Mode. Answers are saved to History for after clinic; Private Mode stops new questions being saved.
• AskMed works on iPhone and iPad, Android and the web, with one account on all of them.

Checklist: a guideline check in about a minute

The checklist below turns a guideline check into six short steps you can do between two patients. It works best when the question is written the way you would ask a senior colleague: who the patient is, what the setting is, which country's guidance applies and what decision you are about to make. Each step uses a feature that exists in the AskMed app on iPhone, iPad and Android and in the web app, so the same check works on a clinic computer or on a phone in the corridor. The aim is not to read the whole guideline but to confirm one recommendation at its source, note its year and move on, with a saved answer to return to after clinic for the detail you skipped. If a step fails, for example because the source does not say what the sentence says, stop and read the guideline itself before acting.

1. Write one specific question. Give age, the key condition, kidney or liver function, pregnancy, the setting and your country. Use generic drug names.
2. Narrow the sources if you need to. For a pure guideline question, leave guidelines on and turn other source types off in the filters.
3. Read the direct answer first. The first paragraph answers the question; the sections below add criteria, options and evidence.
4. Open the citation behind your next step. Check that the source says what the sentence says, for the same patient group.
5. Check the year and whose guidance it is. A current national guideline outweighs an older review or another country's advice.
6. Ask one follow-up, then move on. The answer stays in History, unless Private Mode is on, for reading after clinic.

Limits of a quick guideline check

AskMed is an AI medical reference for education and reference, and a quick guideline check with it has clear limits. Answers are written by an AI language model from the sources AskMed found, and no person reviews them before you see them, so an answer can misread a source or leave out a recommendation that matters for your patient; that is why every claim carries a citation to open. AskMed searches a fixed list of sources, so guidance published only by a local health board, a hospital or a national society outside that list may not appear. AskMed never gives drug doses, dose calculations or schedules; exact dosing comes from the current prescribing information or your local formulary. It is not a symptom checker, it does not diagnose or decide treatment for a person, and it is not for emergencies. Where national guidelines disagree, follow the one that applies where you practise.

Related

• GuideHow AskMed answersWhere answers come from, how citations work, why there are no doses, and the limits.
• ComparisonBest AI apps for doctorsAskMed, OpenEvidence, ChatGPT for Clinicians and others compared on sources and sign-up.
• ScenarioA night shift with no senior to askCheck a cited answer at 3 a.m., and know when to escalate instead.
• ScenarioChecking a NICE guideline as a GPFind what NICE recommends for a UK primary care question, with the year and the link.
• ScenarioPreparing for ward roundsCheck the criteria behind each plan before your consultant asks.