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I think you are right that automated decision support systems have more of a role then we have yet seen. I think that the role of the "duty biochemist" is at least in part to tailor this information to: 1) The knowledge and expertise of the requestor e.g. some gps need more help than others(if known). 2) Whether or not the result relates to a condition outside the normal practice of the requesting firm e.g. hypocalcaemia on a psychiatric ward. 3) Whether the requesting firm gets irritated by comments e.g. most endocrinologists! 4) Whether, if this result is not acted upon, harm might come to the patient. 5) Whether the requestor wants an opinion - we have a box on our forms that requestors can ask for one and the computer puts these requests on a separate authorisation queue whatever the result. This to a greater extent means getting to know the personalities on your own patch and learning what they actually want. The bigger the operation, however, the more difficult this becomes and I fear it may become a victim of pathology modernisation. I now feel in need of a good rant! Eventually of course we will be able to have information systems which will be able to extract this sort of information from doctors revalidation portfolios, along with their psychometric testing and adjust their algorithms accordingly. Although by then all the doctors will be replaced by robots anyway. Roll on the virtual health care system, I am sure it will be cost effective, all we have to do is get rid of the humans! Mike > -----Original Message----- > From: This list is an open discussion list for the academic community > working in [mailto:[log in to unmask]]On Behalf Of Mike > Collins > Sent: 12 December 2001 14:36 > To: [log in to unmask] > Subject: Re: a challenge for interpretative comments .... > > > As an MLSO I am not involved with interpretative comments > but I would be interested to know how duty biochemists > perform in competition with expert systems. If a fraction of the > effort which has been applied to chess programs had been > used in clinical biochemistry, haematology and immunology > expert systems I suspect that most clinical validation would > be obsolete. > I recall a report that barefoot doctors in Tanzania using > flowcharts were as accurate as (but slower than) experienced > consultants in the diagnosis of the causes of acute abdominal > pain. > Perhaps the ACB should have an annual "Comments > Olympics" at Focus with biochemists and software as > contestants. > > Mike Collins > Mike Collins MLSO3 > Clinical Biochemistry & Immunology > The General Infirmary at Leeds, > Old Medical School, Thoresby Place > Leeds LS1 3EX, UK > [log in to unmask] > [log in to unmask] > 44 (0) 113 392 2915 > http://www.leedsteachinghospitals.com > The opinions expressed here are my own. > My colleagues and employers may not agree with them.