Medicine
The doctor and the computer
John Linklater
Newspaper headlines last week drew attention to the perplexity of an elderly retired coastguard wh° got into the grip of the computer at his bank. The machine was trying to extract from him the cost of a holiday which some other unknown person had apparently enjoyed. When he complained to his human bank manager, he received an apologetic and placatory letter, but this did nothing to halt the rising anger of the machine which obstinately added interest to the total bill and looked as if it would take him to court for a debt which he had not incurred.
This type of incident has a deceptive, slightly humorous overtone, and usually ends satis' factorily, but we must not overlook the fact that it only does so because the deranged machine makes its charge known to the customer. If the report were clandestine, this safeguard would no longer apply. In medicine, for example, the patient does not often realise that the most intimate details of his life may nowadaYs officially find their way from. his confidential medical records into a central computer whence they may be published to anybody who has right of access to thalcomputer or to any other corn' puter to which it is linked. Medical records consist largely of opinions which are rarely seen by the pa' tient but, quite apart from fault Y. computing, there is the additional problem that language barriers between doctor and patient nta,Y introduce a new source of error. It could thus occur that a young lady of unimpeachable character acquired a lifelong clandestine slur of chronicvenereal disease or al" d The scheme was introduce quietly by the Government in 196.7 under the anodyne title of Hosr tal Activities Analysis, and has been built up since then, al),, parently without regard to tt(li's recommendations and safeguar I proposed by the British Medica. Association. The Governme°1 view is that NHS records are government property, and that they may be used for government Poi-Poses. So unswervingly singleminded has the Government been in this respect that many observers have -found it horribly reminiscent of the lust of Big 8rother for power at all costs. The value of the computer in Medicine is not disputed. The issue rests simply on the question of confidentiality and control. In its present state of development the cpinputer is a simplified model of the human brain with an unlimit°d capacity to store facts indefinitely to manipulate them according to the rules laid down hY the programmer and to recall them readily. The computer is therefore most useful in the field of statistical analysis and assessment of probability, and could Provide the medical profession with an unsurpassed diagnostic 1°01 as well as a completely new !i3ok in preventive medicine. But in order to exploit the computer Medically it is necessary for the medical profession itself to be in control of computer planning and °Peration at all levels. We must also ensure that medical information is inaccessible except for strictly medical purposes. One of the problems may be that the medical profession has hcit yet decided the precise use to Which it proposes to put the comMiter. Consultants tend to view the computer as a potential ,Tethod of asserting control over Lne general practitioner. They "ave already pointed out that it tiv°1-11d be unrealistic for each arnily doctor to have his own Computer terminal. General prac-, otioners, on the other hand, consider that it is they who are the real doctors of first access and ,,stileW the computer as a handy 'eans of providing completely °P-to-date diagnostic probabilities and therapeutic alternatives in difficult cases, better than any textbook. and more reliable than tnY individual consultant. It will fe for the general practitioner to 'eed the facts, the history and his clinical findings into the computer. Itcl then to be guided in his reatment by the print-out which ill be based on the distilled L-°Mmon fund of all medical It may well be that the cornCtiter will finally erode the rift ,,etween hospital specialists and ,e,rieral doctors by altering the 'cile of each. A general practitioner assisted by a computer will only need a consultant for major surferY and obstetric problems and ,c),r a few very obscure diagnoses. '1, Will therefore be reasonable to 1.ve him back the control of hospital beds and many young con8,111tants will then be glad, and able, `s°,enter general practice after a table period of re-training. The dernaining consultants will, no re,tibt, revert to their traditional Ole as elders of the profession. tr,811t, whatever the future of the e"ntPuter in medicine, it is inPrnbent upon us to ensure, by _stature if necessary, that medical i_eoords are isolated under medical `ontrol from all other records, and
that the computer only discloses the name of a specific patient -to the doctor who is treating that patient at that time.
Previous page
