Development of Hospital Computing

Patient rating of doctors using computers

In order to shed some light on the impact of a computer on medical consultations, 140 new hospital out-patients rated the doctor they had just seen, and their ideal doctor using a 38-item semantic differential-type scale. Sixty-four of the patients had experienced a computer being used by one of the three doctors participating in the study. Each patient's ratings of a doctor were compared with their ratings of the ideal doctor by paired t-tests. The doctors, when using the computer, tended to be seen as less matching up to these ideals than when they did not use the computer. All three received more non-ideal ratings when using the computer. However, this was less so for two of the doctors than for the third, who with a computer was seen as less than ideally listening and paying attention, and was also rated as less than ideally warm, friendly, liking and comforting, perhaps surprisingly, this doctor had tried to minimize the effect of the computer during the consultation, while the doctor who used the computer 'conversationally' during the interview was rated overall as better with it than without it. It would appear that the pattern of computer use in the consultation and even its apparent intrusiveness need not have an adverse effect on patient ratings of doctors, but that computer use can cause problems for this aspect of the doctor-patient relationship.

Patient stress and the computer in the consulting room

This study assesses patient reactions to the use of diagnostic computers by doctors. The setting was a hospital out-patient clinic, and the patients were new referrals with dyspeptic symptoms. Patient reactions were measured through a mood questionnaire of stress and arousal, and a questionnaire on attitudes to the medical use of computers. Patient self-reported stress was more likely to have increased after the consultation if the computer had been used (P less than 0.05). There was a trend for computer patients to show attenuation of the typical post-consultation drop in stress. However, patients who had experienced the computer being used had more favourable attitudes towards medical computer use that inexperienced patients (as assessed by a subsequent postal survey; P = 0.007). Multiple regression showed that while experience of the computer was a determinant of attitudes, patient stress after the consultation was extremely significant (P less than 0.001) with highly-stressed patients being the least welcoming to medical computers, whether or not they had experience of the computer. It is suggested that doctors planning to use computers should take care to preserve their 'human touch' particularly for nervous patients.

FIRST AID: a design philosophy and a program for on-line symptom processing

A major problem for computer-aided diagnosis systems, particularly those designed for on-line use in clinical settings, is that their operation may be obtrusive or unacceptable within established clinical routine. Criteria for a general approach to the design of the on-line aids in clinical decision-making are presented. An interpreter is described that is designed to be broadly applicable within the area of statistical diagnosis, but which is also designed to encourage the development of congenial clinical systems. The use of the program and its features are illustrated by an application in the diagnosis of 'dyspepsia'.

Computerised clinical data base system--Australia

In search for a practical solution to analyse a large quantity of medical information, rheumatic disease data base system (RDDS) is described. Details of data configuration, data entry and retrieval are discussed in some detail. The system incorporates a range of commonly used statistical tests and provisions for more advanced data analysis are made. Additional facilities include provisions for a variety of printed reports, back up facilities and a word processor. The ease of system operation and flexibility are emphasised. Technical support requirements are minimal even when new applications are being developed. The system is fully operational at present and can be implemented on a number of computer systems.