In 1983 at the age of 52, I made a momentous decision that has affected the way I write, attend meetings, balance my bank account, care for patients, study, send birthday cards, and do virtually every chore for the last 15 years. I decided to learn something about computers before reaching the age of 60 at which time people learn new ideas more slowly. Thank goodness for that decision! Nowadays younger people accept computers the way my generation accepted bicycles and cars; and they have leapfrogged my knowledge by light years. Now at the age of 66, it would be much more difficult to take up such an endeavor with any hope of success for enjoyment.

My first machine was a Sinclair with one K of memory made in England. I spent weeks thinking I had to master programming in Basic or Cobol in order to use it. Then came a Radio Shack model 12 with a big 12 inch double sided floppy disk that held 64 K ram. A friend who had hard-wired his own mail-ordered Healthkit computer installed with a control program for microcomputers (CPM) on my machine and lent me his Wordstar word processor Version 1.0. Hours were spent watching it do miracles. I had learned to type back in high school and it took little time to hone the skill and turn out everything from person letters to the Bylaws of North Central Texas Medical Foundation. It was a miracle! There were some glitches on those early machines: The factory had mislabeled the "A" and "B" ports on the back incorrectly which took a month of my life trying to make the darn thing work before irately returning it back to the manufacturer. Later Radio Shack came out with their own control program but it could not hold a candle to the original CPM.

Then Radio Shack brought out their first portable computer with a little three line LCD screen. Sitting in a medical meeting with the lights turned out looking at the projection screen in the front of the darkened room, I could put the box on the table or in my lap and type notes in the dark. Everyone thought I was a genius! It is still a very efficient way to take away the pertinent ideas from a meeting without lugging out pounds of preprinted paper handouts.

A 100 K baud modem became available for computer to computer communications. It was fascinating but extremely slow as the character slowly marched across the screen. And much time was spent determining what protocol each end of the communication was using. Errors were frequent; there were no automatic error checking "handshaking" protocols available to smooth the process. But it was electronic communication - and it was fascinating to watch. If you wanted to reach a bigger audience you had to sign up with Compuserve and pay long distance telephone charges to a big city. Our first clinic computer had a modem which I used to access the office files from home at night before taking off on a house call or ER visit. My partners still believe that using that modem caused all the crashes of the machine which occurred during those early days.

In my family practice office I found that patients like the idea of answering a series of questions, a sort of "review of systems," before seeing me for their routine physicals. It was a shock that they answered the computer more honestly and completely than my face-to-face question. The hospital Medical Records department hardly knew what to do with a five page single spaced history instead of the scribbled history that was the standard of the time. In addition I splurged and bought a diagnostic program from the society of Internal Medicine called "Internist II." The program would take whatever information was available on the patient and calculate a differential diagnosis in descending order of likelihood. It was shown to be more accurate than 90% of practicing internists in one-on-one trials. It was a little time consuming but was a great checklist to remind me what might have been omitted in my own differential. But medical knowledge and computing was mushrooming too fast and I could not afford the quarterly updates.

After going to work for the hospital, when we had to impress the JCAHO surveyors with our great efforts, we pulled some minor quality assurance studies, put them on presentation graphics with flashy screen changes, and wowed the holder physician surveyors with our knowledge. Using a laptop computer hooked up to a large screen television got the highest score that the hospital had ever obtained from the accreditation survey. By now the surveyors have probably seen enough of such presentations and a new approach will likely be needed. But it may not be as much fun.

And now we are in the era of the Internet. A couple of years ago two high school students designed a search engine for the Internet called Yahoo which is currently the most widely used such Internet tool and is hitting new all time highs on the stock market. According to Yahoo there are over 1500 new sites on the Internet each day. And sometime this year affordable access will become available over plain old telephone lines that is 30 times faster than today and you can simultaneously use the same phone line for voice calls. And new machines are now available that will convert your voice onto the printed page. Even typing will become outdated.

Now that younger minds are delving into the wonders of the computer world I am beginning to feel like a dinosaur. Most of my time is spent doing letters again and balancing bank statements and making birthday cards on a print shop program for my grandkids. But is it not a great time to be alive and see all the wonders that modern technology is bringing? Just one afterthought: One terrorist atomic bomb exploded over the center of the United States would burn every computer chip in our country to a crisp. Not a car would start, no phone would ring, kitchen appliances would not work, no modern device of any kind would operate. And we would be instantly right back to the horse and buggy and digging back yard gardens in order to survive. That thought ought to console some of the real die-hard people who have resisted becoming involved in the modern world of computers.

For some, some of you medical types who are into computing on the Internet, here is a list of the sites that I have found most helpful:

American College of Physicians (www.apconline.org) All of their excellent journals are archived for use for free. Many other services generate charges and require membership.

American Medical News (www.ama-assn.org) Lots of articles of interest for physicians, especially legal and medical practice concerns.

Center for Disease Control (www.cdc.gov) Good source for traveler's health concerns plus links to other government sites. Free.

Dr. Felix's Free MEDLINE page (www.beaker.iupui.edu) Maintained by the Indiana University Ruth Lilly Medical Library with links to other sites.

Internet Grateful Med (www.igm.nlm) Free access to the National Medical Library, abstracts only. In order to get full text reprints of articles, they require registration and either a deposit or credit card for charges.

Medical Matrix (www.medmatrix.org) Mostly links to other sites.

Medical Record Institute (www.medrecinst.com) Everything you wanted to know about where we stand on the development of a standardized electronic medical record.

National Cancer Institute for Health Professionals (www.nih.gov.) This is an extremely large database on governmental medical services with links to many other government sites. Identification is required but no charges.

Oncology Online (www.otnnet.com) Complicated but good information and lots of interchange between physicians. Requires DEA number in order to register.

National Hospice Organization (www.nho.org) General information about hospice care plus member's section where members post questions for others to consider and hopefully reply. It is well organized.

American Academy of Hospice Physicians (aahpm.org) A different service that sends the comment or question submitted by any member to all other members by direct e-mail requesting your input.

Texas Academy of Family Physicians (www.tafp.org) Mostly of interest to family physicians about organizational matters, career opportunities, and family practice research articles.

Texas Medical Association (www.texmed.org) Information about members and organizational matters for members of the TMA.

American Medical Association (www.AMA-ASSN.org) Large database with patient and physician information, new CPT codes, specialty journals.

The Avicenna Virtual Office (www.Avicenna.com) General medical information, upcoming meetings, literature references, clinical trials.

Physicians Online (www.pol.net) Over 75,000 physicians use this as their primary source of information for the Internet. Very complete and exclusively for physicians.

Helix (www.HELIX.com) Free site supported by Glaxo Wellcome Pharmaceuticals. Lots of general information, CME, technology updates, and consumer health information which is general and factual.

National Cancer Institute - Health Professionals (www.cancerlit.nci.nih.gov) Cancer information for health professionals, many links to cancer literature. They will require identification before use but there is no charge.

Paul Renton, Jr's. Family Site (Renton@wf.net) Personal family introduction with links to relatives in Scotland and other places.

David Spencer's Personal Site (dspencer@wf.net) Great slide show of all the beautiful train trips David has taken. Be prepared to spend awhile getting the downloads.

Phil Stephenson, MD, new Medical Director of United Regional Healthcare Services, has no home page, but has an e-mail address. If you cannot run him down, try sending an e-mail to papadocret@aol.com Phil was one of the die-hard pencil and paper physicians but has recently been converted to computer technology.

In the last century Mark Twain made the comment, "Never be the last to give up old ways, nor the first to take up the new." It seems to be good advice even today in the time of modern computers, especially for physicians who have other demands and limited time. But all people today need to become computer literate. Not the bits and bytes of programming, but accept them as the new tool we use in a practical manner. After all, many people drive a car without knowing anything about compression ratios of the engine or even the principle that makes them work. With a little effort you can learn enough to use computing to keep pace in the modern world.

Final thought: We should all probably keep in mind how to ride a bicycle and grow our own garden - just in case a terrorist succeeds in that single bomb some day.

editor@medmag.org