Thursday, November 19, 2015

Scott Moses' FP Notebook is an astounding, and free, medical reference

Want to double check your doctor’s approach to your cholesterol problem?

Try this Family Practice Notebook (FPN) entry …


… VII. Management: Less than two Cardiac Risk Factors

Cholesterol Management
Goal if LDL Cholesterol below 160 mg/dl (ideally <130)
Low Fat Diet if LDL Cholesterol over 160 mg/dl
Anti-hyperlipidemic if LDL Cholesterol over 190 mg/dl

Desirable lipids: Repeat Lipid panel in 5 years
Borderline lipids: Repeat lipid panel in 1 year
Elevated lipids: Repeat lipid panel in 3-6 months…

Or take a look at the cardiovascular medicine book. (In FPN-speak a “book” is a collection of topics, they are accessible from the top right menu.) Ok, I admit there’s a lot of implicit knowledge in those terse phrases. FP Notebook isn’t aimed at consumers, it’s written for family physicians, though it also works for internists and pediatricians. If you’re not a physician you may have to take my word for it — this is an efficient high quality information source for “up to date” (more on that below) evidence-based US medical practice. It’s also a one man show of epic scale (emphases mine)…

About FP Notebook

… This site is derived from a peripheral brain collection of medical notes and is divided over 5700 topics within over 600 chapters and 31 subspecialty books. Information is gleaned from reputable sources, referenced where possible, taken from lectures and workshops, peer reviewed articles and bulletins, and key texts.

… This site is personally funded by the site author, Scott Moses, MD. Additional funding is obtained via advertising support; all paid advertisements are clearly delineated as such. Our advertising related privacy policy may be reviewed at here

Please let us know if you find any advertising to be distasteful or inappropriate, or which you find dilutes the value or integrity of this web site. Absolutely no content on the site is influenced or authored by advertisers. Content is solely per the discretion of the site author….

… These medical notes began as a few scattered pearls of text stored with the Notetaker application of the HP Palmtop 200LX. Since 1995, notes from conferences, articles, textbooks and colleagues have accumulated to its current state.

As the collection of text grew, so did the complexity of its organization, and a program known as Brains was developed as a stand alone application for notetaking and for compilation of the website.

Brains is able to import raw text from the database, process the outlines, titles and synonyms, as well as images and links.

In its third iteration, Brains is written in C# with a SQL Server database and can output each of the site versions of html in 1-2 hours. This latest version also allows topics to be linked to the UMLS metathesaurus codes, and to be viewed on handheld devices.

… Most images on the site I have created myself. Many of the anatomy images were created using the 3d models from Zyogote. Others use a combination of Adobe Illustrator, Photoshop and Poser software.

When images are used from other sources, they are clearly cited. These include the NIH Virtual Human project and MedPix

… Gray’s Anatomy 20th edition from 1918 (Lewis) is in the public domain following expiration of its patent. Scanned images of the plates are available online at both and Yahoo.

In 2012, I started an anatomy series using the Zygote 3D models. I will provide 2 sizes of these images: 800x600 and 4096x3112 (poster size). I have maintained a margin on poster size images, such that they can be printed at 8x10,16x20, and 20x30 inches without losing content when cropping. Costco prints a 20x30 image for about $8.

You may use these images freely for printing (e.g. classroom poster) as well as presentations (e.g. Powerpoint) as long as they are not re-sold or modified…The author of the Family Practice Notebook, is Scott Moses, MD, a board-certified Family Physician practicing in Lino Lakes, Minnesota.

I think this is his hobby. Some people build cabinets, Dr Moses builds textbooks.

There’s really nothing like this any more - FPNotebook is a relic of a bygone world. Twenty years ago, when he started, there were quite a few free online medical references. I did a small one myself, many better ones were published by medical schools and hospitals. For a while some medical textbooks were available online for low costs, often bundled into services like MD Consult. That’s all gone now; Wolter-Kluwers Up To Date has replace many textbooks and online resources - at $500/year for an individual subscription. Once free references, like American Family Physician, are now buried behind paywalls (thereby raising a bit of revenue but sacrificing much good will).

Even if you have a subscription to Up To Date, perhaps through your institution, I suspect you’d find much to like in FPN. For example, take a look at the updates page including the May 2015 FAST exam update: “Test Sensitivity may be as low as 22% for abdominal free fluid in blunt Trauma”. Want to keep abreast of meaningful changes to American medical care? Forget those expensive newsletters, just subscribe to the (new) updates feed: What a painless way to keep up.

Ok, you get the idea. This is an awesome resource — but how reliable can it possibly be? As Dr Moses notes, it’s entirely dependent on his vigilance and email feedback — nobody has volunteered to do peer review. I can give a partial response — because 10 weeks ago I started doing serious studying for my Family Medicine board exam. I last did family practice in 1994 and I don’t have an institutional subscription to Up To Date, so I used FP Notebook as a supplement to traditional texts, American Family Physician, and examination critiques. Over those weeks I covered a lot of family medicine in FPN; the only error I found was a minor misplaced section heading (an obvious copy/paste error that wouldn’t confuse any physician). I (and many others) found more mistakes in the closely edited ABFM exam critiques. There must be mistakes in 5.700 topics — but that’s an impressive record. I wouldn’t use FPN as my only guide to patient care, but I can testify to its excellence as a study and memory aid — and as a guide to what’s new and important.

FP Notebook is a dinosaur — straight out of Jurassic World, stomping over the puny mammals of the  modern web.

Try it, you’ll like it. (And say thanks — perhaps suggesting Dr Moses add a donation button. If nothing else, a charity donation button?)

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