‘Ever since the start-up period of Prisma, the practice has been using it,’ Adriaan says. ‘In the beginning, I used many free moments to read back cases. I did that to expand my knowledge. Later, I also started using the knowledge base looking for answers and posting cases myself.’
No answers from the guidelines
‘The first case I posted was about mucus production in metastatic lung cancer. I wondered what I could still do about that,’ Adriaan explains. ‘I had already tried some things myself from the guidelines, but that didn’t help me any further.’
‘Lung doctors in Prisma thought of other possible causes of the mucus production than just the cancer. Maybe inflammation was at play or excessive salivation was the cause of the problem. These different insights allowed me to think more broadly and gave me new leads I could take forward.’
Dividing line between specialisms
‘I usually use Prisma for cases that are at the dividing line between several specialisms. To find different answers, but also to be able to immediately make the right referral,’ Adriaan says. ‘Sometimes you just don’t know which specialism a patient belongs to best. Then it’s nice to be able to write to several disciplines with one case.’
‘For example, I once had a patient with complaints of the joints around the sternum. I got advice on this from the rheumatologist, a sports doctor and an orthopaedist. This prevented a referral and gave me a broad perspective of treatment options for now, but also for the longer term.’
‘It also happens the other way round. Sometimes the advice is actually a referral. For instance, I recently posted a case about a 7‑year-old child with recurrent swelling of the fingers. I didn’t really understand what that was and asked for advice from the dermatology, paediatrics and rheumatology specialisms. The rheumatologist suspected that the picture fitted with dactylitis. I did not know that picture well. After referral to the paediatric rheumatologist, it turned out that the rheumatologist at Prisma had indeed been thinking in the right direction.’
‘By being able to interact together on Prisma, the platform also gives me the opportunity for a piece of joint thinking and working on a case. So it brings the first and second lines closer together.’
Scrolling through Prisma
‘Because I read fairly frequently what is posted on Prisma, I know roughly what can be found in the knowledge base. On free moments, I sit back and scroll. I don’t have Facebook, I have Prisma,’ Adriaan says, laughing.
‘Sometimes you find cases that fill a gap where the GP guideline falls short. The osteoporosis guideline, for example, for GPs, is not very clear about how to deal with medication after five years. The second-line guideline is clear about that, and through Prisma I am aware of that. These are instructive things that I can use in daily practice.’
‘I also use the regular teleconsult when a patient is already known in the hospital or when it is very clear which specialism a case belongs to. Prisma proves itself especially when there are multiple specialists answering. Something that is impossible with regular teleconsultation.
‘And those different answers don’t even have to come from different disciplines. Multiple insights from the same discipline are also valuable. Specialists can talk to each other and this often quickly produces useful advice.
‘Responses to Prisma come quickly. Of course I have to call if it is really an emergency situation. That remains. But generally I have a quick answer. Especially if I can already find the answer directly in the knowledge base. Sometimes even while my patient is still sitting across from me. “Wait,” I then say, “I’ve read about this, I’ll just grab it”.’
Prisma is currently only available for GPs, specialists and RGPOs that are based in the Netherlands.