Hand-held brain extenders

I thank Gavin Greenfield for his comments on my article.1 I think that research on the acceptability of this technology and the barriers to its use for both patients and health care providers may be warranted, owing to the increasing use of personal digital assistants in the medical field. CMAJ has started publishing the table of contents for each issue as well as selected articles in a format compatible with handheld devices (www.cma.ca/cmaj/etoc/etoc-pda.htm).

In a recent article on problems in clinical judgement, Donald Redelmeier and colleagues noted that computerized diagnostic tools have been found to be inferior to a clinician's judgement.2 I think that the use of a personal digital assistant is qualitatively different from the use of a PC-based diagnostic tool, as the handheld does not supplant, but rather supplements, the clinician's skills.

I have found that my Palm helps me by providing information nuggets in a just-in-time manner and diagnostic information to supplement my decision-making. One example of this would be the Wells table for diagnosis of deep vein thrombosis.3 However, such anecdotal reports may not necessarily reflect actual changes in patient care; clinical trials are needed to compare outcomes with and without Palm-based clinical tools. I look forward to reading the results of such trials in future issues of eCMAJ.