For a head start on diagnosis, Allen Wenner, MD, has his patients provide their own health histories, answering questions at computers in his reception room. Then he reviews the histories before seeing the patients.
"I come to the patient with a high level of data," says Dr. Wenner, a practicing family physician, computer consultant, and teacher at the University of South Carolina in Columbia. He explains, "Patients will tell computers anything."
Early this year, Dr. Wenner imbedded a domestic violence scale in his questionnaire. Within a month, he had identified five cases of domestic violence--compared with making two such diagnoses in his previous 17 years in practice.
One case involved a patient with a hematoma of the ankle. When the nurse asked how she got hurt, she said she tripped over the phone--an odd answer. Furthermore, the patient had answered "sometimes" to the computer's question, "Do you ever feel afraid or threatened at home?"
So while Dr. Wenner taped her ankle, he asked what she meant by "sometimes." And she admitted her husband had thrown the phone at her.
"She told the truth to the computer," says Dr. Wenner. "And there I was, an accidental tourist; I didn't exactly know what to do." But at least he had the diagnosis right.
In the late 1980s, after Dr. Wenner put a depression scale into his questionnaire, he began discovering twice as much depression as other physicians were finding. He had similar success identifying alcohol abuse. However, drug abusers and pushers don't like his computer program because it catches them lying.
Dr. Wenner's computerized patient questionnaire has grown to about 15,000 questions. He and his students find the questions in medical literature and elsewhere.
"Most medical software is simplistic," Dr. Wenner says. "Patient interview software has to branch, so if a patient replies in a certain way, that triggers the next logical series of questions. Branching is modeled after the way physicians think."
The real lab for this technology is the doctor's office, not the medical school, Dr. Wenner says. "Until physicians help developers capture what physicians need, the technology will just plod along at a slow pace, of no benefit to anybody."
His solution: "We have to jump in and make these tools work. We can deliver better medical care at lower cost right now, using information technology."
"Computers and Family Practice" contents
FP Report, July 1996 headlines
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