Sunday, February 25, 2007

A doctor’s life on line 1986-2007

In October 1984 I attended the annual meeting of the Arkansas state chapter of the American College of Physicians, held at a resort on Greers Ferry Lake near Heber Springs Arkansas. The buzz between sessions was DRGs, new that year and the subject of much anxiety and frustration. The assortment of topics across the subspecialties of Internal Medicine was so-so. One talk by Richard Wheeler, M.D. of the department of Medicine at the University of Arkansas grabbed my attention. It would not only change my practice but revolutionize my professional life. Dr. Wheeler talked about medical searching on line. He told us there was an electronic version of Index Medicus called Medline and mesmerized us with a demonstration of how anyone with a home computer, a modem, some telecommunications software and a subscription to one of the commercial information retrieval services could do comprehensive literature searches right from the comfort of home. It was more difficult back then because the Internet was not ready for prime time, there was no World Wide Web and there were no web browsers.

A 1986 review article titled Computerized Reference Management: Searching the Literature from the American journal of Roentgenology explains how it was done and gives today’s reader a sense of the novelty of on-line medical searching in those days. The introductory section reads “The literature may be searched by hand with Index Medicus or by computer with MEDLINE, but the contrast is striking.” On the next page is this statement: “Until recently, only librarians and specialists with extensive training performed on-line bibliographic searching. Now, using a computer terminal, a modem, a telephone, and a password, a radiologist can have access to a wealth of information.” The article listed several commercial literature retrieval services that were available by subscription including Knowledge Index, Paper Chase, Dialog and BRS/Colleague.

In 1986 I purchased my first home computer, an Apple IIc. Since on line research was not popular at the time resources were hard to come by (especially in the hinterlands where I lived) and it took several months to put the pieces together and begin searching. An Apple Personal Modem had to be purchased separately. Telecommunications software was not easily obtainable in stores but eventually I stumbled on Apple Access. Next I had to find a telecommunications network (I used Tymnet) and an information retrieval service. I chose BRS/Colleague which featured not only Medline but also a full text collection which could be linked to from some Medline citations. (BRS/Colleague eventually became Ovid Medline). Boolean searching was self taught using the tutorial contained in the BRS/Colleague user manual which arrived in the mail along with my password. Up and running at last, I was hooked.

There were no “pages” displayed. Text which scrolled down the screen was saved on a 5.25 inch floppy disk for printing later. The whole thing was cumbersome but over time I ascended the learning curve. By the time I became proficient and comfortable my “setup” was becoming obsolete, but after all that effort I was reluctant to change. Besides, the system met my medical searching needs nicely for years. By the early 90s the Apple II series was discontinued. 5.25 inch floppies were no longer sold and there was no support from Apple. Shortly thereafter, with the advent of Mosaic, the first web browser, the World Wide Web became practical for home use. Despite these advances I stuck with my Apple IIc, recycling my old floppy disks until 1998, when, under pressure from my wife and kids, I relented and purchased a desktop PC equipped with Windows 98 and America On Line. Now not only was Medline searching suddenly easier but there was also Medscape, Virtual Hospital and Cyberounds. The Apple IIc was immediately retired.

The medical Internet has grown and information retrieval is much better now, but there may be a downside. As is true in clinical practice, the ease and convenience that comes with new technology can lead to a decline in basic skills. Though the formal discipline of Boolean searching is as necessary now as it was 20 years ago for precise and comprehensive searching, today’s new and more user friendly resources don’t require the skill and many don’t even support it.

Here are some fun facts and links I ran across during my research for this post:

Although Al Gore didn’t invent the Internet he introduced a bill in the Senate which provided funding for the development of the first web browser.

The futuristic looking computer used by Dr. Floyd (Roy Scheider) on the beach in the movie 2010 is an Apple IIc.

Apple II’s history.

The Obsolete Computer Museum.

Old Computers.

1 comment:

blogborygmi said...

Interesting to hear the original presentation of medline, how it was received. And you made me feel nostalgic -- my first computer was an Apple IIc, too.