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CLINICAL REVIEW: Frank Sullivan and Jeremy C Wyatt How informatics tools help deal with patients' problems BMJ 2005; 331: 955-957 [Full text]

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Computers Rule?

Kolja Stille   (7 November 2005)

Computers Rule? 7 November 2005
Kolja Stille, SHO Medicine Lister Hospital, Stevenage, SG1 4AB Send response to journal: Re: Computers Rule?	Has the common (treatment of hypertension) and the rare (hypercalcaemia) collided because of informatics tools? F Sullivan and JC Wyatt describe how information technology can aid in general practice consultations (1). In their example a 58 year old woman with chronic renal failure, hypercalcaemia and hyperkalaemia comes to see her GP and starts treatment of her hypertension with a thiazide diuretic. Thiazide diuretics are effective and cheap drugs to treat hypertension (2), but amongst their effects is a decrease in tubular calcium excretion leading to higher serum calcium, which in this case may worsens the patients complaints. Most are contraindicated in hypercalcaemia (3). Could it be that the “information technology” used, recommended starting a Thiazide diuretic for this patient, following “electronified” guidelines/protocols but without realizing the full picture? A calcium-channel blocker may do less harm and therefore more good in this case. (1)Sullivan F. How informatics tools help deal with patient's problems. BMJ 2005;331:955 (22 October 2005) (2)ALLHAT trial.J Clin Hypertens (Greenwich) 2002;4(6):393 (3)British National Formulary,section 2.2.1 Competing interests: None declared