Table 5.

The frequency of 5 levels of cognitive skills in MBC

Reasoning skills	Number of messages (%)	Examples
Elementary clarification	165 (27.9%)	“Do we need to consider the withdraw symptom?”
		“The patient just has muscle pain.”
In-depth clarification	189 (31.9%)	“Both Gabapentin and Pregabalin were approved by FDA to treat DPNP…”
		“The patient has mild ~ moderate pain caused by exercise …ibuprofen therapy is not working well for this patient due to its short half-life.”
Inference	148 (25%)	“FDA has warned the suicidal risk especially for young patients, thus should let the patient know…”
		“The patient developed sexual dysfunction, thus should avoid SSRI…”
		“Need 5 weeks wash out period due to fluoxetine’s long half-life…”
Judgment	15 (2.5%)	“Many cold meds share the acetaminophen ingredient; if take cold meds, it’s possible to cause acetaminophen overdose…”
		“The priority goal is to control the pain, although Pentazocine has fewer side effects, it is not a good choice for this patient.”
Strategies	16 (2.7%)	“If one drug failed, it doesn’t mean other drugs in the same class would fail, we could try at least 2 SSRIs before switching to other class, I will recommend another SSRI, e.g. Sertraline 50 mg PO QD…”
		“Since the patient had tried Bupropion and Citalopram with full dose and duration, this is resistant, severe depression. Amitriptyline probably won’t be helpful…According to the notes, I will recommend olanzapine/fluoxetine 6 mg/25 mg PO QPM…”