things simultaneously is required.

puter in a busy practice for the processing bus, the hard disk runs past 12 years I can appreciate the at an average access time of 16 frustrations of using the wrong ms. This would improve disk actools for the task. The microcom- cess considerably. Further, the use puter and standard business soft- of a standard cache program, ware are not appropriate in a which arrives already installed on clinical medicine setting. A mini- the Northgate computer (I becomputer capable of doing many lieve) helps improve the data acthings simultaneously is required. cess time considerably. Furthermore, the complexities of Neither Desqview nor Winmedical practice demand custom- dows uses expanded memory for designed software. the 386 machine; they use extendIn my opinion Dr. Davis will ed memory, remapping it into exfrighten many physicians away panded memory. Extended memfrom ever considering the use of ory is basically computer memory computers in clinical practice be- that continues on after the existcause he makes it sound so com- ing memory has been used, much plex and difficult. With the proper like serial transmission along eleccomputer system I assure Davis tric power lines. Expanded memothat word processing, scheduling, ry, on the other hand, runs "in entering and displaying medical parallel" with the existing memorecords, billing, electronic mail ry. This is an extremely important and communication with other technical distinction, as the procomputer databases can all take grams won't work with expanded place simultaneously in the setting memory. of a busy clinical practice. I am curious why Davis chose My recent article' goes into the memory sizes he did. He considerable detail about just such should be aware that the 460 kiloa system. Physicians need all the bytes (K) of memory that he quotencouragement they can get to ed could be a minimum, and that, drag them into the computer age. when properly configured, his system should have a minimum of Mel Petreman, MD about 538 K for use with DesqWellington Medical Systems Ltd. view. The maximum program size 1651 Boundary Ave. can be set to any number up to Nanaimo, BC and including 4000 since Davis appears to have 4 megabytes (MB) Reference of random access memory on his 1. Petreman M: The automated medical office. Can Fam Physician 1990; 36: 1417-1419, 1427

dow. Rather than using the TSR method of access one can simply flip windows using the Desqview standard commands. I compliment Davis on his aggressive use of microcomputers in an existing family practice. He has certainly attempted to make use of the appropriate tools to enhance his effectiveness during day-to-day activities. I believe, however, that his estimate of his time savings is a gross underestimate. It seems unfortunate that Davis is running back and forth to one computer each day, potentially hampering the effectiveness of the use of his system and the appropriate sharing of files. I wonder if, with a machine such as the 386, which is designed for multitasking and networking, Davis might not have been better off looking at a 386 for the file server on a network, running the same programs. Although the cost would have been slightly greater, at approximately $1500 per additional terminal (for wiring and software), this arrangement might have further assisted Davis in enhancing his effectiveness. Also, why, with such an expensive system available to him, has Davis failed to make use of existing on-line databases? With the plethora of information currently available to us, it appears, to me at least, that the use of some form of on-line database searching will be a mandatory component of every physician's practice in the coming years. Many good programs are available for accessing such systems, and several good systems are available to be accessed, at a variety of costs.

machine. Davis fails to mention whether he has customized Desqview for his own use so that it automaMay I point out several miscon- tically sets up and begins all of his ceptions that Dr. Davis seems to programs when he turns on the have arrived at in the use of machine. If this is not the case his Desqview 386? use of the "Alt/S" command folDesqview is one of several lowed by the two-letter program major multitasking programs built designation would not work. Inspecifically for the 386 machine. stead it would be necessary to The others include Windows, ver- press the "Alt" key, then the 0 for sion 3.0; V to the MAX; OS/2, "Open" and then the two-letter Albert J. Kirshen, MD Hospital section head, version 1.2; and 386 to the MAX. program designation. geriatric medicine Davis does not specify the Davis's statement regarding Health Sciences Centre speed of his hard disk. I would terminate-and-stay-resident (TSR) Winnipeg, Man. hope that in a 386 machine of the utilities fails to take into account type he mentions, which is a the ability to have such programs I congratulate Dr. Davis for dem