Epilogue

Abstract

In 1977 Friedman and Gustafson prepared a guest editorial for Computers and Biomedical Research entitled Computers in Clinical Medicine, A Critical Review.² They identified six impediments to a more universal application of computers to medicine (not restricted to clinical information systems). These were:

• I. We have not successfully accomplished the patient-computer and/or physician-computer interaction.

• II. The physician has not been provided with computer-based medical applications that exceed his own capabilities.

• III. A major impediment of the successful utilization of computer technology in medicine and health care has been our inability to prove a significant positive impact on patient care.

• IV. We have not produced applications that are easily transferred from one institution to another.

• V. . We have not conducted research in a manner that is change oriented. (Successful change, in the authors’ view, is characterized by clearly understanding the problem first and then finally working out the best solution to that problem. Computer research, they stated, has been characterized by people skilled in one solution (computers) searching for a problem to fit their solution.)

• VI. We have not learned from previous mistakes.

In conclusion, it is of interest to recall that when Copernicus proved that the earth was not the center of the universe, but rather a tiny speck, he injured man’s pride. When Darwin suggested that we are not specially created, but rather an extension of the animal world, he salted this wounded pride. When Freud taught that we are not the master of our own house, but that we must be content with tiny vignettes of what goes on in our minds, he seared our salted wound. Finally, in a paper entitled “The Fourth Discontinuity,” Mazlish suggests that the computer constitutes yet another blow to man’s ego, for in a sense it places him on a continuous spectrum with the machines that he builds. If so, let us now swallow our pride like those who preceded us, comfort ourselves if need be with the reminder that it is we who can always pull out the plug, and set about the task of developing humanitarian uses for these inanimate machines. Howard Bleich, 1971¹