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Clinical Review ABC of health informatics

How decision support tools help define clinical problems

BMJ 2005; 331 doi: (Published 06 October 2005) Cite this as: BMJ 2005;331:831
  1. Frank Sullivan,
  2. Jeremy C Wyatt


    The patient, Mr Evans, presented with headaches and early morning wakening (dealt with in article of 24 September) as the main reason for his consultation. This article, however, discusses how informatics resources can be used to consider issues other than the presenting problem. The Stott and Davies model of the consultation indicates that three other areas of the interaction should be considered.

    • Management of continuing problems—The patient's diabetes may be contributing to the overall picture.

    • Opportunistic health promotion—Ask screening questions about alcohol use and measure the patient's blood pressure.

    • Modification of help seeking behaviours—Discuss issues relevant to self care and when to attend for health checks for established or potential problems.

    Exceptional potential in each consultation. Adapted from Stott NCH, Davies RH. J Roy Coll Gen Pract 1979;29: 201-5

    Management of continuing problems

    Awareness of problems

    Sometimes doctors and patients are not aware of relevant problems. Issues that are apparent to one person may not be apparent to the other. In Mr Evans's case the diabetes is known to doctor and patient. The alcohol problem is, perhaps dimly, apparent to Mr Evans. The high blood pressure reading is something that only the doctor is aware of initially. Neither doctor nor patient is aware of the depression at the beginning of the consultation, but information conveyed before, or during, the consultation may alter that.

    When a health professional realises that he or she is aware of an issue that the patient is not, the matter can be remedied. It is more difficult if the patient is aware of an issue that is relevant, but is unwilling to divulge it. Even more difficult is a situation where neither patient nor doctor is aware of a problem that may be relevant to the patient's problems (see Johari Window). Electronic prompts to bring up such hidden issues are being incorporated into …

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