The information technology revolution has changed and will continue to change the world in ways that are as yet unpredictable. As an inherently conservative body, the medical profession tends to be slow to adapt to new technology. Computerization and the Internet will undoubtedly change the practice of medicine. Patients and doctors will have access to more information and misinformation. This will accelerate a fundamental shift in the Doctor-Patient relationship. As information becomes more freely available power will shift away from providers towards clients, away from doctors towards patients. In medicine this empowerment will encourage exploration of what today are considered complimentary and alternative health modalities. This will initially be driven by patients but will in turn encourage doctors to look outside of the traditional boundaries and will almost certainly encourage and accelerate a move away from a reactive disease based health model towards a proactive health based approach.

In the shorter term information technology will provide tools. Already many doctors take their computer systems for granted. Many never have a patient interaction, that is not recorded via computer, or dispense a drug that does not have a printed label. The web allows easy access to medical information and enhances communication with colleagues. This will encourage the move towards individually driven continuous professional development. Access to computerised systems and the Internet will rapidly become the norm. It will be as essential a part of the doctors' office as the telephone.

In an attempt to improve the services that the College and the Journal can offer to our members we have recently upgraded our information technology systems. We have integrated the College Web site and the Journal. The results can be seen at http://www.hkcfp.org.hk.

The new on line format allows linking to external articles and references. Check out the journal on the web. Have a look at Dr. Tang's excellent series demonstrating "What's in the web for Family Physicians". This month the focus is on neurology sites. Alternatively browse our links. The best medical resources are just a click away. If you would like to re-read that article from last year look up old journals in the archives. For students or examination candidates the last 10 years of MCQ's are also available. Over the next few months we intend to continue to make substantial additions to the site. It will soon be possible to answer the MCQ's on-line. Points will then automatically be credited to individual CME scores. Updates of individual CME tallies will be available to check on-line in the secure area of the site.

In addition to the journal the upgraded web site offers a number of other services. The most commonly requested application forms can be downloaded from the site. Visit the Members Area and register for a password. The password provides access to the restricted areas of the site. What do you think of the journal? Why not let us know? Give feedback via email or access the Bulletin Board and leave a message. The Bulletin Board allows an ongoing dialogue on-line. Clinical or medico-political let us have your opinions. We will then publish the best or most relevant in the paper journal.

Whether you read the paper or electronic journal we hope to provide a concise summary of useable and good quality information. This month is no exception. Did you realise that over 100,000 species of fungi have been described in nature? Fortunately less than 200 are pathogenic and a smaller number are responsible for the vast majority of symptoms which are encountered in general practice. On page 72 Dr. Roberts provides a simple and clear summary of the management of common fungal infections.

The incidence of a problem can only be answered by epidemiological studies. In an original paper Dr. Y T Wun and colleagues concluded that consultations solely for preventative care are not common in general practice in Hong Kong page 59. Will this change as people become more informed?

Being better informed will undoubtedly help doctors to manage their patients well. On page 66 Dr. Ho emphasizes the importance of the early recognition of renal disease. In particular a rapid pathological diagnosis can dictate appropriate treatment preventing the progression to advanced renal impairment. Early recognition and appropriate follow up are the key messages.

The importance of early recognition of stroke (brain attack) is emphasized by Dr. R Ho on page 83. In thrombotic stroke thrombolytic therapy significantly improves outcome if given early. As in Myocardial Infarction the event to needle time is critical. As with Myocardial Infarction we will need to change our systems to accommodate rapid diagnosis and management. Despite this obvious advance the real benefits in stroke are to be made in the area of prevention. Up to 50% of all strokes may be prevented through effective management of modifiable risk factors. We can positively influence the health of our population by helping them to stop smoking, lose weight and exercise more. In addition we must develop a system in order to ensure the recognition and appropriate management of hypertension, diabetes and hyperlipidaemia.

Finally, for those who are interested in the dilemmas of information why not read this journal on-line and follow a few links. Aspirin has been "proven" to reduce the risk of stroke and vascular death by 25% in patients at high risk of occlusive vascular disease. When the BMJ¹ recently published a huge Meta-analysis of antiplatelet therapy they commissioned an editorial from an expert. Unfortunately he disagreed and offered a completely different interpretation of the analysis. They commissioned a new editorial and to their credit published the opinion and interpretations of the dissenting expert separately.This is a fascinating example of the complexities of evidence based medicine. We are increasingly encouraged to distrust practice based upon opinion, anecdote and individual experience. That is until it becomes an Editorial and the opinion becomes the "truth". The medical world is no longer black and white. All of this information is available to us and our patients on-line and whether it is stroke or the safety of the MMR we will increasingly be called upon to help in the interpretation of information and the management of uncertainty. Offering certainty where certainty cannot exist will no longer be an option. As information and new knowledge become available at an ever increasing rate now more than ever before, we must stay informed.