Medicine And Books

Making Sense of Computers in General Practice

BMJ 1995; 311 doi: (Published 22 July 1995) Cite this as: BMJ 1995;311:271
  1. Mike Pringle
  1. professor of general practice, University of Nottingham

    Deborah Allan, Chris Quinlan Radcliffe, pounds sterling15, pp 167, ISBN 1 85775 051 9

    General practice computer systems are now commonplace--four in five practices have one. Most general practitioners must, therefore, be familiar with the basics but some will want a book that starts from zero and takes them to second base. Making Sense of Computers in General Practice is just such a book.

    For those who have already started computerising there are, however, a wealth of issues to be faced. These include how best to use a computer in the consultation so as to minimise disruption to the doctor-patient interaction; the role of decision support; the content of a totally computerised patient record; and the limitations of current coding structures. The book covers these topics either tangentially or not at all.

    To take one example, there is concern about the legality of a totally computerised record and this the authors cursorily acknowledge. However, there are basic issues for the quality of patient care which they do not mention. In practices that I have visited where the manual clinical record has been declared redundant the computer record is consistently a poor substitute. It often omits such vital information as duration of symptoms, laterality, severity, examination findings, discarded diagnoses, alternative and speculative diagnoses, information shared with the patient, and--most telling--any quotes from the patient.

    On looking at such records I am reminded of the notes that appear in the record cards of the 1950s or before. When such consultations were recorded, and they often were not, they often consisted of a series of hieroglyphs that have no durable meaning. One practice that I visited recently had a computer record consisting of Read codes of diagnoses accompanied by an in-house set of abbreviations that meant nothing to me. A sheet of translations was located and offered, but such a practice is repeating the worst aspects of records in the past.

    Anomalies like this derive not from any failure of intent on the part of current doctors but from the limitations of the computer programs and the coding structures. Although great strides are being made in both, there is still too little capacity to record a structured record and the solution of using free text is often slow and demanding. Diagrams of anatomical parts, electrocardiograms, and hospital letters can still not be efficiently preserved in an integrated record in any of the common systems.

    These points are not covered in Making Sense of Computers and, to be fair, the authors have not set out to write an advanced guide. The content is aimed at those who have not computerised and know next to nothing about it; if, however, a general practitioner wants to “make sense” of computer use, he or she will have to look elsewhere.--MIKE PRINGLE

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