In a message dated 04/12/98 13:11:39 GMT, Adrian Midgley:

<< -------------------------
 [1] for instance setting it up in Turnpike (non-techies should pay 
 someone to do this for them) as a newsstand rather than a list - 
 there was a thread some months ago about this.  I don't have 
 Turnpike, but Jel would advise individuals I am sure.
 Basically, AIUI, newsstands time out and articles vanish if not 
 read, whereas list items sit there reproachfully.
 
 [2] for instance a journal club.  Say 6 members of like mind take it 
 in turns to read all of a day's mail on GP-UK and forward the items 
 they believe to be of lasting or local significance, either 
 individually or as a digest, to the others.
  >>
Two interesting ideas - is Turnpike available to be downloaded from the 'net,
how big is it and is it really that difficult to set up?

Both of these suggestions of course highlight the information glut on the
internet of which GP-UK is merely a very tiny microcosm.

There are two ways to be *info poor*. One is to have a very restricted access
to information whilst the the other is to have so much and of such variable
quality without the ability to sort and prioritise it that the effect is much
the same. You can die of thirst in the desert but you can also die of thirst
cast adrift at sea surrounded by all of the water in the world - but none of
it drinkable.

The problems of information handling are primarily human ones - the
development of computing and the internet only serves to highlight these
problems but they were there before. They are primarily quality, relevance,
access, shortage of time, abilty to sort and evaluate. Computers greatly
improve accessibility and provide some sorting tools but the cost is the sheer
volume - especially of poor quality and unrefereed stuff. Any idiot with a web
publisher can produce a site which can look quite presentable and therefore
seem authoritative. This is going to be an increasing problem as patients
increasingly access the 'net for information. I think doctors are  going to
have to take an active role in signposting information - e.g. by providing
practice websites with a library of authoritative links - and also by being
prepared to interpret information that patients obtain - especially if they
are in the form of academic papers rather than material written for a lay
audience.

Computerised sorting can be a danger as well as a help. Through AOL I get
selected news items Emailed to me according to a *news profile* that I set up.
The *Daily Me* as Adrian Midgely calls it. Its great but it would be very
limiting if I didn't check the headlines each day - in fact I use the Web to
skim a few newspapers, including American and other non-uk sources.

The technology though is not the real problem unless your role is to specify
and purchase systems for an organisation such as a trust or GP practice. Its
not going to be difficult to have enough knowledge to use quite sophisticated
tools fairly competently. Most modern software is self-training and you gain
competence by using those aspects you need (how many people use or need all of
the capabilities of even a basic word processor?) Having used computers on and
off for 30 years I think that modern software is much easier to use than its
predecessors. Also, I suspect that a revolution in ease of use is just around
the corner - using AI I'm sure it would be possible for computers to learn
about their users and tailor themselves automatically to their needs,
strengths and weaknesses. 

The problem is information. We each of us need to decide what information we
need and what we need it for in our personal lives, in our professional
development, to carry out our jobs and also what information the organisations
that we work for need (and why they need it). Ideally we would all have a
personal information strategy - what newspaper to buy, what radio and TV
programmes to watch, what websites to visit regularly, what newsgroups and
mailing lists to subscribe to, what professional journals to take and read
etc. etc. I doubt many, even on this list, have consciously done this
systematically even though we are probably well ahead of even our medical
colleagues in tackling this problem, let alone the population at large.

For me information falls into three categories:
    1) Information with intrinsic value. Mostly news, both personal and
general. This type of information may not lead to any specific action - but
it's important to know about births, deaths, marriages, divorces, exam
successes and failures amongst family and friends as well as the news about
Iraq and Bosnia and all those things going on in the wider world.
    2) Information required to inform decision making. e.g. current local
antibiotic sensitivities and the length of the orthopaedic waiting list.
    3) Information (call this one knowledge) which informs speculation and
creative thought.

1&2 above could easily be sorted automatically according to a protocol but the
latter would be very difficult to sort without risking losing something.
Serendipity is vital for human advancement.

The information explosion will be critical for individuals, organisations and
nations in the future. It is important to retain control. The internet holds
out both the opportunity for an unprecedented breadth of access to information
whilst also providing a means to subtly manipulate the more poorly equipped
individual - a la Murdoch and the Sun but with knobs on because the system
will have (if it doesn't already) the ability to profile each user and modify
the pattern of data pushed to them accordingly.

I think the jury is still out on whether history will see the development of
widespread access to electronically held, sorted and transmitted information
to be to the greater good. The technology itself will not be a barrier and I
fear that poorly educated individuals with little insight into the underlying
processes may be exposed to poor, innaccurate even malevolent material without
being able to properly evaluate it. It won't be easy for even the most
sophisticated amongst us to retain the ability to be certain of what is going
on and whether what we are obtaining via the 'net is of good quality.
Pertinent to this I believe that it is vital that clinical systems are
independent of any commercial sponsors - no virtual drug reps sitting on my
desktop thankyou.

Robert Upshall



 

  



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