EDITOR—The vision of the future proposed by Dawes and Godwin is an excellent one that can only enhance the knowledge of doctors worldwide and in turn lead to better patient care.1

Unfortunately, as with most excellent ideas, there is still no materialisation within sight. This goes to emphasise how the NHS, owing to underfunding and the continued use of reactive rather than proactive strategies, is ill equipped to cope with large amounts of information.

Hospitals are way behind when it comes to the implementation of corporate intranets. These could be used to hold information on local medical guidelines, and are therefore an important issue in risk management. The local internal telephone directory could be incorporated, obviating the need for expensive reprinting and distribution of paper telephone directories that become rapidly out of date and allowing instantaneous update with correct information. The same could apply every six months when the new intake of junior doctors arrives and one wishes to find out their bleep numbers.

The antiquated system of temporal note keeping needs to be addressed as a matter of urgency. I spent 30 minutes reading every page of a patient's notes just to construct a table of how the patient's weight varied over the past three years. Computer systems in different departments of the same hospital cannot talk to each other. There is too much duplication of information. Computerised notes would allow a full discharge summary to be sent to the general practitioner immediately upon the patient's discharge. Logical notes with problem lists and current management plans would allow greater continuity of care, especially on call. Thyroid function tests would not be repeated three times within a week because the system would automatically tell you they had been done and display the results. It has been shown that computers can be useful and reduce errors made by doctors.2 When are we going to learn that computerisation will not replace our medical knowledge and training but merely augment it and allow better, more efficient, and safer delivery of care to our patients?

EDITOR—Some time ago I invented a new professional obligation, which Dawes and Godwin have peripherally recognised without making explicit.1

A doctor who accesses the world wide web—which is, in principle at least, the sum total of searchable and publicly exposed knowledge of the human race, our species's common capital of the mind—to seek the answer to a question but does not find it there and has the facility to place material on the web, and who later finds some part of an answer by reading books, or experiment, or asking colleagues, or prolonged introspection must place that answer on the web where the next one to ask the same question can find it. The “warm fuzzy” emails that can result from obeying this new professional obligation are worth some work, trust me.