Reviews of Books and Software model and clarify the seemingly simple Computers have the capacity to assist Book Reviews techniques described in the book. For in­ health care providers in managing infor­ Len Scarpinato, DO, Section Editor stance, I recently demonstrated the use of mation. One such potential is the storage a scaling question with a patient. “ On a of findings, such as symptoms, signs, and (instructive Therapies. William J. Hoyt, scale of 1 to 10, with 1 being no pain and ancillary test data, and the ability to pro­ PhD (ed). Guilford Press, New York, NY, 10 being excruciating pain, how would duce differential diagnoses from combi­ 1994, 340 pp, $35.00. ISBN 0-89862- you rate your back pain?” The resident I nations of the findings. Ideally, using a 094-5. was working with found that question database model, users should be able to In this age of managed care, increasing very useful. Scaling gave the patient a way generate a differential diagnosis for a spe­ emphasis is being directed toward lower­ to express her pain using numbers. cific patient, create differential diagnoses ing health care costs and providing brief, I recommend this book to family for a specific finding, and view the data­ effective services. The field of psychother­ physicians who have the desire, experi­ base’s list of findings for a specific disease. apy is no exception. In Constructive Ther- ence, and personal insight required to ef­ For a dermatology program, for example, tfies, William F. Hoyt has collected writ­ fectively deal with affect in patients and users should be able to determine all pap­ ings from prominent leaders in the field, themselves. For example, the patient may ulosquamous lesions in the database, or who discuss their ideas about a “ new di­ describe her pain as a “ 7” and burst into all papular lesions associated with pruritus tears. rection” in psychotherapy. They suggest and fever. Perhaps the best use of this book is a shift in thinking that “ focuses more on wDIAG is a Microsoft Windows pro­ by family physicians interested in keeping the strengths and resources that patients gram for differential diagnoses of derma­ their fingers on the pulse of the current bring to the enterprise than on their tologic conditions; a DOS version is also trends in the psychotherapy field. Al­ weaknesses or limitations. Similarly, more available. A cover letter accompanying though the constructivist model is cer­ wDIAG indicates that it was developed emphasis is put on where people want to tainly not the only model in the field of go than on where they have been.” “ by doctors for doctors,” and that “ sales psychotherapy, family physicians who of this software are being used to finance There are many names used to de­ read this book will be well acquainted scribe this emerging model. Family phy­ the further development of diagnostic with one of the more popular models in programs for use by general practition­ sicians should take note of the following the field today. terms especially when referring their pa­ ers.” tients to mental health clinicians who use Eric L. Weiner, PhD, MSW Using the Windows File-Run com­ this model: solution-focused, solution- St Mary’s Family Practice Center mand, wDIAG installs smoothly and cre­ oriented, narrative, competency-based, Milwaukee, Wisconsin ates an icon. It occupies 651KB hard-disk constructivist, possibility therapy, solu­ space. I encountered no technical diffi­ tion talk, and restorying. Although differ­ culties in testing wDIAG on a 486 25- ences exist between them, all share a com­ mHz laptop with a gray-scale VGA mon ground to develop “ a respectful Software Reviews screen. Once invoked, wDIAG loaded in partnership between therapist and client, Gary N. Fox, MD, Section Editor 10 seconds, including passing through an emphasis on strengths and resources, compulsory screens. and a hopeful eye toward the future.” wDIAG: Computer Assisted Diagnosis of wDIAG’s main screen consists of a Constructive Therapies will give the Skin Disease (1993). Intercept Press Ltd, menu bar across the top with four choices reader clear insight into the solution- 23 Peveril Hill Rd South, Toronto, On­ for drop-down menus: Inquiry, Diagno­ oriented model. There are numerous case tario, Canada M6C 3A7 (416-785- sis, Disease Rules, and Patient Files, all examples, including applications for drug 3611). $75, DOS version; $100, Win­ accessible by mouse or keyboard. All di­ and alcohol abuse, eating disorders, toilet dows. agnostic inquiry is patient-based. From training, severe sexual abuse, marital dif­ documentation: 21-page, 8.5 X 11-in. the Inquiry-Create menu option, ficulties, and smoking cessation. black-and-white, photocopied manual wDIAG’s. process begins with a forced As a behavioral scientist with family with numerous screen prints for illustra­ sequence of patient name, age, tempera­ therapy training, I enjoyed reading this tion. ture, and sex; and the eruption’s duration book and understood the terminology. how supplied: 1 high density 3.5-in. dis­ (7 choices), course (6 choices), extent However, this book targets experienced kette. (generalized, regional, singular), and so mental health practitioners rather than MINIMUM HARDWARE REQUIREMENTS: DOS on. Once all required data is entered, family physicians. version: IBM PC-compatible with 640KB wDIAG may present a series of questions, I recommend this book for two spe- RAM; Windows version requires Win­ such as whether there are annular lesions cific audiences: behavioral scientists dows 3.1. Although DOS version can be or known exposure to chicken pox. Once working with residents who consult with run from a floppy drive on a 286 machine, data gathering is complete, the user must practicing family physicians, and well- 486 66-MHz PC recommended for sat­ actively select the Diagnosis section to trained family physicians with Level 3 isfactory response times. obtain wDIAG’s primary diagnosis and skills. (Doherty WJ, Baird MA. Develop­ mouse support: For Windows version. differential diagnostic possibilities, along mental levels in family-centered medical toll-free customer support: N o. with their ranking based on a possible "re. Bam Med 1986; 18:153-6). demonstration disks: None indicated. score of 1000. Coaching from a behavioral scientist money-back guarantee: None specified. During data entry, some screens al­ °r related consultant is important to rating: Marginal. low return to previous screens, but this The Journal of Family Practice, Vol. 41, No. 3($ep), 1995 299 Book Reviews mend it for anything other than expand- ing a differential. There are physicians,es­ If you wish to: pecially academicians, who may find the program useful for this purpose, but ] would recommend purchase only with a money-back guarantee. I would suggest the authors consider marketing wDUd as shareware (“ try before you buy”). Gary N. Fox, MB Toledo, Okii Use the <t> and <I> keys to choose line, then press <Beturn> key. <Fl>Restart diagnosis <F2>Preoious frame <F3>hain menu ClinDerm, Version 3.00 (1994), Expert Class Computing, Inc, PO Box 261 Michigan City, IN 46360 (219-874 8981). $295 + $7.50 shipping & han­ dling. Figure. Screen showing checklist with brief explanation of terms. documentation: Fourteen 8.5 X 11-in, photocopied pages, unillustrated. feature is not fully implemented. There Adenoma sebaceum was also listed (50 how supplied: One 720K 3.5-in. « are few unnecessary key strokes. Users points). 5.25-in diskette. cannot elect to stop and “ see” wDIAG's Evaluating wDIAG, I felt users MINIMUM HARDWARE REQUIREMENTS: IBS! diagnostic considerations until all data are should have better access to the differen­ PC-compatible with 256KB RAM, any entered. Additionally, there is no feature tial diagnosis of an individual or set of version of DOS; hard drive or one 3.5-in, allowing listing of diagnoses meeting lim­ findings, better ability to access differen­ floppy drive or two 5-in. floppy drives. ited specified criteria, such as all papulo­ tial diagnoses anywhere along the clinical mouse support: No. squamous listings; users must provide all path, and, in the era of scrolling list boxes, TOLL-FREE CUSTOMER SUPPORT: No. required entries. Among the better fea­ a better interface for accessing previous demonstration disks: Not specified. tures of wDIAG are some checklists with patients and disease rules. In a well- money-back guarantee: None specified. good, brief explanations of terms (Fig­ designed program, users should be un­ RATING: Good. ure). wDIAG allows users to choose any aware that intermediary numbers exist. The rationale and ideal functionality of of the diseases it contains and view the set For wDIAG's questions, users must click software for differential diagnoses of der­ of logic “ rules” used to arrive at the di­ on “ Yes” or “ No” on opposite ends of matologic conditions, as well as another agnosis. the screen, which is an inconvenience. product (Windows DIAG [ivDIAG]), wDIAG's patient-specific data are Users should not have to request the dif­ have been described in the preceding stored as consecutively numbered patient ferential diagnosis as a separate step. Less software review. records. To review or modify a patient’s common illnesses, especially those associ­ Clin derm is a DOS-based program findings, users must first determine the ated with substantial morbidity, should for differential dermatologic diagnoses. patient’s number, then re-access menus be included in the database. The obliga­ The program may be run from floppy to enter the patient’s number. Similarly, tory storing of patient profiles, a nice op­ disks or from the hard drive by creating! to find wDIAG’s rules for a disease, the tion, is generally unnecessary for primary directory and copying the Clinderm files user must first look up the disease in the care use. Disappointingly, windows func­ to it.