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March 13, 2002:

Doctors don't know it all
But Bud Rose '63 helps them find answers

In the mid '80s, Burton "Bud" Rose '63 came across a study that found that two out of three patients raised a question during an office visit to which their doctors did not know the answer. And if a doctor could answer all her patients' questions, she would change four treatment decisions in every half day of practice. That study motivated Rose, a nephrologist, to develop an informational resource for physicians that answers their questions in just minutes or less.

A clinical professor at Harvard Medical School, Rose started UpToDate in his basement in 1989. He compiled information on his own specialty first, then added cardiology, oncology, infectious diseases, and obstetrics and gynecology, among others. More are being added.

UpToDate's database, which is available online (uptodate.com) and on CD, is organized by the questions doctors might have on how to treat a patient, such as how to manage an asthmatic during pregnancy. Rose and his staff "recruit experts from around the world to write answers to those questions," he says. The answers include a summary of the published literature and recommendations on the action to take.

Individual health care providers and major teaching hospitals, including Duke, Johns Hopkins, and Harvard hospitals subscribe to the program. Doctors can use it for a quick answer or to review current literature. "What UpToDate allows any doctor to do is achieve instant expertise in any area," says Rose. His company's mission "carries with it a giant responsibility ... to be right." So it has all kinds of quality controls, says Rose.

A doctor emailed Rose a few months ago to say that UpToDate helped him save a life: "A patient came in with abdominal pain," says Rose, " and blood in the urine. The first thought was that the patient had a kidney stone. But the doctor taking care of the patient just wasn't comfortable. Something didn't seem quite right." So she checked UpToDate and found that one of the diseases that can mimic a kidney stone is an aneurysm of the aorta. That diagnosis — of a potentially fatal condition — turned out to be correct.

By Kathryn Federici Greenwood

You can reach Kathryn at federici@princeton.edu