After shelling out hundreds of dollars for a personal digital assistant (PDA), most physicians hope to use it for more than a high-tech address book. Much of the medical software that can help you accomplish that, however, can cost more than $100 – or about half the price of good low-end PDAs. Fortunately for those who don’t want to pay for new software, many of the best medical applications for the Palm OS are available free on the Internet.

Free to a good PDA

Here are 10 free applications, listed in no particular order, that I have found useful, plus one that comes standard on the Palm OS of which you might not be taking full advantage.

1. Epocrates Rx (http://www2.epocrates.com/products/rx) – This regularly updated medication database’s free basic functions include adult and pediatric dosing, contraindications, adverse effects, pricing, formularies and more. Its multicheck function, allowing cross-checking of interactions among up to 30 medications, is especially useful. For a yearly fee, the software can be upgraded with additional options.

2. MedRules (http://pbrain.hypermart.net/medrules.html) – This collection of evidence-based clinical prediction rules includes Bishop Score, Ranson’s Criteria and a tool that identifies the risk of mortality in community-acquired pneumonia. This program has not been updated in years, but it is still available because of popular demand.

3. MedMath (http://smi-web.stanford.edu/people/pcheng/med-math) – This collection of useful formulas is offered in an easy-to-use interface. Another program that does nearly the same thing is MedCalc (http://medcalc.media.net). Try both of them, and decide which one works better for you. Also, MedMath is bundled with an Epocrates Rx upgrade.

4. ATP III Guideline Calculator (http://hin.nhlbi.nih.gov/atpiii/atp3palm.htm) – This program calculates individualized LDL treatment goals using the Adult Treatment Panel III cholesterol guidelines. In the past, the ATP III calculator did not work on Palm OS 5, but the program has been upgraded and should work now (it does on mine, anyway). Just be sure to download it from the Web site listed here. Other sites might be linking to older versions of the program. Alternately, you could try Stat Cholesterol (http://www.statcoder.com/cholesterol.htm), which offers much of the same functionality.

5. Stat Cardiac Clearance (http://www.statcoder.com/cardiac1.htm) – This software features easy-to-navigate algorithms for determining presurgical cardiac clearance. It is based on algorithms from the American College of Cardiology/American Heart Association 2002 guidelines and the American College of Physicians 1997 guidelines.

6. Johns Hopkins University Antibiotic Guide (http://hopkins-abxguide.org) – This is a regularly updated infectious disease guide. It features treatment guidelines, diagnostic criteria and comprehensive information about medications and organisms. It took me some effort learning how to best navigate this product, but ultimately it proved useful and informative.

7. Stat Growth-BP (http://www.statcoder.com/growthcharts.htm) – This tool calculates age-adjusted percentiles for height, weight and body mass index. It also provides age-adjusted norms for blood pressure.

8. MentStat (http://www.tonywitte.com) – This is an easy-to-use electronic crib sheet for a Mini Mental Status Exam that automatically tabulates the score as you check off the patient’s correct answers. MentStat includes instructions and tips for administering the exam. It’s nice not to scramble around your filing cabinet looking for a written copy of the test (it will be available on your handheld), but you will still need a pen and paper for a few of the items. Another nice thing about MentStat is its small size; it uses only 8 KB of memory.

9. Diagnosaurus (http://books.mcgraw-hill.com/medical/diagnosaurus/) – This application provides lists of differential diagnoses for various signs, symptoms or diseases. It’s useful not only for generating ideas about what could be causing a patient’s symptom (such as right upper quadrant pain), but also for reminding you of possible alternate diagnoses for a current diagnosis, (e.g. cholecystitis). In some cases, it provides etiologies or causes of certain entries, such as lactic acidosis.

10. Shots 2005 (http://www.immunizationed.org) – This software graphically represents the standard immunization schedule, with information on indications and contraindications, adverse reactions, administration and catch-up dosing. It is provided by the Group on Immunization Education of the Society of Teachers of Family Medicine.

Bonus: Memo Pad (standard on most Palm OS PDAs) – This application is perfect for organizing your personal “index cards” of information gleaned from lectures, rounds and journal articles. It’s a great place to stash just about any bit of information that you want handy. For example, some of the things I have found useful to store in my Memo Pad include:

• Commonly used CPT and ICD-9 codes;

• A list of pregnant patients whose newborns I need to see in the hospital;

• Hard-to-remember mnemonic devices, such as SIGECAPS for the criteria for depression or MUDPILES for the causes of metabolic acidosis.

Your imagination is the only limit to Memo Pad’s usefulness.

Powerful information

Most of these applications display the standard legal disclaimer that they are for informational or educational purposes only and should not be used for clinical decision-making. However, having these powerful yet free tools literally at your fingertips could make your life easier and improve your patient care.

Editor’s notes: For more information about using your PDA in your practice and for more applications, visit http://pbrain.hypermart.net, run by Kent E. Willyard, MD.