Medical practice and informatics tools: A vignette

In this article the authors recreate an improvisational vignette originally presented at the Third Annual Information Connection in Burlington, Vermon t, in January 1998. The vignette illustrates various state-of-the-art decis ion-support systems for clinical care and their promises and problems in re al-world medical practice. The characters are Dr. Alex Grant, a rural physi cian in solo practice; Anna Everett, a patient suffering from chronic heada ches; Bob, a hospital librarian; and Sarah, Dr. Grant's nurse. The short pl ay centers on Dr. Grant's attempt to diagnose the cause of Anna's headaches (which he and she believe to be sinus-related) and the roles information t echnologies - Medline searching, Anna's own Internet searches, the use of M DConsult, which provides Internet access to standard medical texts, journal s, etc., and a desktop decision-support tool called Problem Knowledge Coupl ers-play in this process. The vignette concludes with the realization that while computer technologies can be of great help in medicine "there is stil l a need for a good doctor to pull it all together.