Medical practice and informatics tools: a vignette.

: In this article the authors recreate an improvisational vignette originally presented at the Third Annual Information Connection in Burlington, Vermont, in January 1998. The vignette illustrates various state-of-the-art decision-support systems for clinical care and their promises and problems in real-world medical practice. The characters are Dr. Alex Grant, a rural physician in solo practice; Anna Everett, a patient suffering from chronic headaches; Bob, a hospital librarian; and Sarah, Dr. Grant's nurse. The short play centers on Dr. Grant's attempt to diagnose the cause of Anna's headaches (which he and she believe to be sinus-related) and the roles information technologies--Medline searching, Anna's own Internet searches, the use of MDConsult, which provides Internet access to standard medical texts, journals, etc., and a desktop decision-support tool called Problem Knowledge Couplers--play in this process. The vignette concludes with the realization that while computer technologies can be of great help in medicine "there is still a need for a good doctor to pull it all together.