The info poor

There are two ways to be 'info poor'. One is to have a very restricted access to information whilst the other is to have so much and of such variable quality without the ability to sort and prioritise it that the effect is much the same. You can die of thirst in the desert but you can also die of thirst cast adrift at sea surrounded by all of the water in the world - but none of it drinkable.

The problems of information handling are primarily human ones - the development of computing and the internet only serves to highlight these problems but they were there before. They are primarily quality, relevance, access, shortage of time, ability to sort and evaluate. Computers greatly improve accessibility and provide some sorting tools but the cost is the sheer volume - especially of poor quality and un-refereed stuff.

Any idiot with a web publisher can produce a site which can look quite presentable and, therefore, seem authoritative. This is going to be an increasing problem as patients increasingly access the Internet for information. I think doctors are going to have to take an active role in signposting information - for example, by providing practice websites with a library of authoritative links - and also by being prepared to interpret information that patients obtain - especially if they are in the form of academic papers rather than material written for a lay audience.

Computerised sorting can be a danger as well as a help. Through AOL, I get selected news items emailed to me according to a 'news profile' that I set up, similar to the 'Daily Me' described by Adrian Midgely. It is great but it would be very limiting if I did not check the headlines each day - in fact I use the Web to skim a few newspapers, including American and other non-UK sources.

The technology though is not the real problem unless your role is to specify and purchase systems for an organisation such as a trust or GP practice. It is not going to be difficult to have enough knowledge to use quite sophisticated tools fairly competently. Most modern software is self-training and you gain competence by using those aspects you need (how many people use or need all of the capabilities of even a basic word processor?).  Having used computers on and off for 30 years I think that modern software is much easier to use than its predecessors.  Also, I suspect that a revolution in ease of use is just around the corner - using artificial intelligence,   I am sure it would be possible for computers to learn about their users and tailor themselves automatically to their needs, strengths and weaknesses.

The problem is information. Each of us needs to decide what information we need and what we need it for in our personal lives, in our professional development, to carry out our jobs and also what information the organisations that we work for need (and why they need it).  Ideally we would all have a personal information strategy - what newspaper to buy, what radio and TV programmes to watch, what websites to visit regularly, what newsgroups and mailing lists to subscribe to, what professional journals to take and read etc. I doubt many have consciously done this systematically even though the readers of this journal are probably well ahead of even our medical colleagues in tackling this problem, let alone the population at large.

For me, information falls into three categories:

1. Information with intrinsic value. Mostly news, both personal and general. This type of information may not lead to any specific action - but it is important to know about births, deaths, marriages, divorces, exam successes and failures amongst family and friends as well as the news about Iraq and Bosnia and all those things going on in the wider world.
   
2. Information required to inform decision making. e.g. current local antibiotic sensitivities and the length of the orthopaedic waiting list.
   
3. Information (call this one knowledge) which informs speculation and creative thought.

1 and 2 above could easily be sorted automatically according to a protocol but the latter would be very difficult to sort without risking losing something.   Serendipity is vital for human advancement.

The information explosion will be critical for individuals, organisations and nations in the future. It is important to retain control. The internet holds out both the opportunity for an unprecedented breadth of access to information whilst also providing a means to subtly manipulate the more poorly equipped individual - because the system will have (if it does not already) the ability to profile each user and modify the pattern of data pushed to them accordingly.

I think the jury is still out on whether history will see the development of widespread access to electronically held, sorted and transmitted information to be to the greater good. The technology itself will not be a barrier and I fear that poorly educated individuals with little insight into the underlying processes may be exposed to poor, inaccurate even malevolent material without being able to properly evaluate it. It will not be easy for even the most sophisticated amongst us to retain the ability to be certain of what is going on and whether what we are obtaining via the Internet is of good quality.

Pertinent to this I believe that it is vital that clinical systems are independent of any commercial sponsors - no virtual drug reps sitting on my desktop thank you.