GP computer use to patients queried

Family doctors who use computers during consultations can help improve their performance in tasks such as immunisation, checking blood pressure and prescribing. But Glasgow University researchers are asking how much patients benefit?

"There is tremendous pressure on GPs as consumers of new technology just to go with the latest whizz-bang development, and that may not be appropriate," said Frank Sullivan, senior lecturer in Glasgow's department of general practice. "Computing should be evaulated to separate the wheat from the chaff."

Dr Sullivan and research assistant Elizabeth Mitchell have surveyed studies worldwide of computing systems in primary care. But while they found 347 papers, most were descriptive, with only 30 tackling the effects of computers on consultations, the doctor's performance, and the impact on patients. Only one of the three studies on patients showed an improvement.

In a research paper published in the British Medical Journal, they reveal that the Government spends about Pounds 47 million annually on primary care computing, and that nine out of ten practices are computerised, with more than half of GPs using desktop computers.

Use lengthens consultations by about a minute to eight minutes, but while the medical content of consultations increases, the patient's "social" contribution is cut back.

Dr Sullivan said computerisation could help combat the "inverse care law" of the people in need of most care being least likely to get it, since it forced GPs not to discriminate on the basis of how articulate or assertive a patient was.

But he questioned its value in general practice. A computer could help a junior hospital doctor decide whether or not to admit a patient who had turned up at casualty with chest pains, he said, but the evidence was less straightforward for a GP called out at 2am to a patient with a range of problems who had atypical chest pains. An intuitive response could be equally valid.