ABC of health informatics: How informatics tools help deal with patients' problems

This episode of care illustrates many of the features of medicine in the information age. People in industrial societies who are, or believe themselves to be, ill can turn to a variety of sources of advice other than health professionals. In most cases these resources, personal knowledge, and advice from family and friends will be enough for people to resolve their health problems. In other cases, the information they obtain will be insufficient or misleading. A primary care clinician is often needed to provide additional information, interpret it, and individualise advice for each of the problems brought to the consultation by the patient. A few patients may seem reluctant to seek information or participate in decisions about treatment options. They prefer being told what to do, but even these patients usually appreciate a paper leaflet or website address that they can give to family or friends who are more enquiring. In this example, some of the problems that had to be dealt with included Ms Smith's presenting problems (tiredness and muscle cramps); opportunistic health promotion (screening for anxiety and depression), managing ongoing problems (metabolic upset and hypertension caused by chronic pyelonephritis), and modifying help seeking behaviours (easing the patient's uncertainty over electronic information sources). Dr McKay had to decide on and undertake seven actions during this consultation. Explaining the cause of the patient's symptoms and available treatments in a way that Ms Smith could understand; Assuaging the patient's anxiety that she may have mercury Poisoning; Starting treatment for hypertension with a thiazide; Starting treatment for hypercalcaemia with bisphosphonates; Referring Ms Smith to a consultant nephrologist; Referring Ms Smith to a community dietitian; Advising the patient on use of internet resources to obtain more information Fortunately, clinicians in primary care teams no longer need to rely on memories of lectures or their old medical textbooks. Better informed patients, medical records that inform and teach, and electronic sources of reliable, well presented information make it easier to make informed decisions on problems presented in primary care. Informatics tools are generally less helpful in more complex situations, in which there may be uncertainty about the outcomes of interventions or no professional consensus on the value of the outcomes that are achievable. Better decisions in primary care should lead to more appropriate referrals to secondary care and a more efficient health service. Research on the information needs of primary care clinicians is informing the development of information services. Educational research is starting to show how to meet those educational needs most effectively and in a manner congruent with professional revalidation.