Introduction

During the everyday general practice consultation described in the box opposite, the common and rare collide. A problem that may have been a routine matter becomes one of enormous importance to the doctor and the patient. At least seven problems should be dealt with during the consultation. This article, which follows on from the initial contact between Dr McKay and Ms Smith described in the first article of the series (BMJ 2005;331: 566-8), explains how a range of solutions may be presented to doctors during the consultation to augment their decision making processes.

Presenting problems

Ms Smith came to see her GP because of tiredness and muscle cramps, and these problems need to be considered in detail. Potential solutions should be discussed with Ms Smith in a way that she can understand.

The patient's history indicated that, among other things, her pulse should be taken and her blood pressure measured. The abnormal physical findings recorded in the electronic notes were pallor and a blood pressure of 178/114 mm Hg. The raised blood pressure was a potentially important new finding, and the practice's decision support software gave advice on what to do next. Most of the advice on checking for secondary causes of hypertension and end organ damage was familiar to Dr McKay, as was the recommendation on PRODIGY (Prescribing RatiOnally with Decision Support) to repeat the examination on several occasions before starting treatment.

The rest of this article describes Ms Smith's return visit, when several blood pressure recordings and routine biochemistry test results were available to Dr McKay. Clinical decision support tools are being refined to provide the knowledge that doctors need without overloading them with unnecessary advice. This goal may be difficult to achieve because the amount of information needed varies between health professionals and clinical situations. …