MD Consult is going away

--- and being replaced by Clinical Key.

This review was negative. I have tried Clinical Key and found it, like MD Consult, to be a decent product although it is apparently more expensive. It is essentially a re-branding by Elsevier of MD Consult with a few bells and whistles and additional journals added. I don't know why they made this decision when MD Consult performed so well at what it was supposed to do. The interface has a new look and appears more geared to searching as opposed to browsing, suggesting a move to be more of a point of care reference for evidence based searching as opposed to an electronic version of the traditional medical library, which was MD Consult's strength.

UpToDate and DynaMed are examples of point of care look-up sites. They are well designed for getting quick answers to focused clinical questions in real time. MD Consult and Clinical Key are less suited for that purpose. Clinical Key's search engine, although powerful and even fun, is imprecise. It searches across a vast array of sources but they are diverse and not filtered in any systematic way as far as I can tell. Search results tend to be random, almost luck of the draw. While searching in that manner can be productive it is not systematic or rigorous according to the standards of EBM. Resources like this are great for background reading such as you might do during down time when you want to dive deep about your patient's disease process. They are less useful when trying to quickly answer focused clinical questions. I use UpToDate to get fast, focused answers during patient care. It is possible though more difficult to use it for background reading. If you use UpToDate to try and assemble something akin to a monograph or a textbook chapter you'll be jumping from page to page and may get lost in what seems an endless trail of links.

A sharp distinction needs to be made. Point of care sites such as UpToDate and DynaMed differ from electronic libraries like MD Consult, Clinical Key and Access Medicine. Confusion results when the distinction is lost. You can use either type of resource for either purpose but certainly UpToDate is optimized for one type of research and MD Consult and Clinical Key for another. No single site works well in both areas.

If Clinical Key is trying to compete with UpToDate it's the wrong focus. Clinicians need both types. They are complementary and neither should replace the other. Several years ago I wrote a post about these two uses of on line resources, reflecting the two distinct reading objectives. In that post I borrowed a couple of terms I had heard form a speaker somewhere: background reading and foreground reading.