Mohammad Al-Ubaydli’s blog

Palm for Doctors

Posted in Articles, Medicine, My publications, Technology by Dr Mohammad Al-Ubaydli on December 1, 2000

This is a ten-part series, commissioned by doctorsworld.com, which looks at the use of Palm Pilots in healthcare. The final article will coincide with the creation of an AvantGo channel of doctorsworld.com, making it available on the Palm. This was also commissioned by the company.

1 – Why every doctor needs  a Palm Pilot

One morning in May, the College porter burst through my door. This was during the final year of my degree. In particular, it was 9.15 am, and my exam was already 15 minutes underway – I thought the exam was in the afternoon.
At 9.20, I was out of my room.
At 9.25, I arrived at the wrong exam hall – the lethal cocktail of morning drowsiness and chronic disorganisation.
At 9.29, I was in the correct place, rushing past a Professor who found this all too amusing.
There is a happy ending to this story – I got my degree, and progressed happily to clinical school. But another good thing happened. I had finally had enough with my disorganisation, and bought a Palm Pilot. Within one month, I had transformed from the least well-prepared student, to the most switched-on person within a 3-mile radius (and lost some modesty along the way).
Every day, I open my Diary. Unlike my friends’ paper versions, which are littered with tiny scribbles and repeated crossing out, my day always appears clear. Changing appointments is easy, and scheduling them as regular events takes no effort. As I go through the day, I pick up the names of good patients to see on the wards (I’m revising for my clinical finals), and add them to my To-do list. If one of the teaching sessions does not happen, my Address Book contains the phone number of the relevant secretary.
I have my entire course’s lecture notes in my pocket. I take them during the lecture, often faster and always more structured than my papered colleagues. Ward rounds are also a place for clinical pearls, which I scribble down. When I see another of my friends with a Palm, I beam these notes to them. Beaming involves lining up the two machines, and seamlessly transferring information using infrared. You really have to try this to appreciate its elegance.
When I see patients on-take, I can clerk them on my Palm Pilot. For this level of text-input, I switch from handwriting to typing – I keep a pocket keyboard in, where else, my pocket. This unfolds into a full-size keyboard, and is a great way to make friends with the patients. They love to play with it. In the morning, before ward round, I add the results of investigations to the record, and proceed to distance myself from the notes trolley. A doctor friend of mine has convinced others on his firm to buy a Palm Pilot. Morning hand overs no longer involve frantic scribbling of patients’ details. They just line up their Palms, and beam away. Then they discuss the most important details… while having a coffee.
But despite all of this efficiency, medicine involves a lot of waiting – especially if you’re a medical student. I no longer find this irritating. I buy books that I never thought I would have time to read, and devour them during these times. I download the latest newspapers, which I digest at my own pace. Incidentally one such publication is the New England Journal of Medicine, which I actually only download to create an impression of hard work. Then there’s the games. My house officer friend is setting his target for this year to finally beat the chess program. Others have found less intellectual games to keep them occupied.
Two years on, and I’ve become such an evangelist that doctorsworld.com has kindly asked me to write a series of articles on the Palm. In these, I hope to show you why having one is so important, and then to guide you, step by step, to use them most effectively on the wards.

2 – Choosing the hardware

Jeff Hawkins, the designer of the original Palm Pilot, carved a small piece of wood that was literally the size of his palm, and showed it to colleagues at 3 Com. This, he announced, was going to be the size of his new organiser. At the time, nobody believed him – Apple was the pioneer of this market, and their organiser, the Newton, was the length of a forearm.
Four million Palm Pilots later, and there are a lot of models to choose from. My advice – decide how much you want to pay, and then find the machine that gives the most at that price. Otherwise, the salesman is likely to dazzle you into unbudgeted territory.
Should you choose Palm as your handheld?
Palm is not the only company making handhelds. Two main competitors are out there – Psion, and Microsoft’s Pocket PC’s. They are both solid handhelds, with neat twists on the genre. But I still recommend choosing a Palm. Although Psion makes beautiful machines, they’re simply too big for ward rounds. Colleagues who have invested in one repeatedly make this observation. Pocket PC’s are Microsoft’s third attempt at this game, and looking increasingly good. However, they’re too expensive, and try to fit too much into a small package, making for slow, complex machines. Finally, both Psion and Microsoft have a small market share – with 80% of the world’s handhelds, Palm ensures that all software is designed for their platform first, and sometimes exclusively.
Which Palm should you choose?
Three companies make Palm-compatible handhelds. Palm, Handspring, and most recently, Sony. The most important decision to make is how much RAM you can afford – this is how much data you can hold, and thus how many programs and textbooks you can keep in your Palm. The cheapest is the newly released Palm m100. This has 2 MB of RAM, and looks very stylish. The best value is the Handspring Visor Deluxe, giving you 8 MB of RAM for £200. At around £ 300, the Palm IIIc is the most expensive, also with 8 MB of RAM. This one, however, is colour, which I believe makes it worth the investment. You get clarity of text simply not achievable in any of the black and white models, and you will appreciate this on the wards. There are plenty of other models out there, including a new colour one from Handspring, and the Sony CLIE, with multimedia capabilities. These are worth checking out.
There’s one more thing to consider – a keyboard. This is invaluable for long writing sessions, including lectures or clerking. Consider investing in a Palm Portable Keyboard, for £60. This is the size of your Palm, but unfolds (beautifully) into a full-sized keyboard. This trick is guaranteed to draw gasps from any audience, and is worth the price alone.
Where to buy your Palm?
Most high street electronics shops sell Palm-compatible devices, including Dixons, and the mobile phone shops. They are much cheaper online, however. So, if you’re comfortable with buying on the web, and confident that you’ve chosen the right model, take advantage of the price differences. Good sites include Dabs Direct, and Technomatic. My personal recommendation is for Dabs, who have an exceptionally good customer service. They are the first to have products in stock, but are immediately honest about any difficulties in delivery.
Finally, don’t forget that buying the Palm is only half the story- you need to buy software that makes it perfect for a doctor. For this I would budget at least $100, or £60, and next week, I’ll look at how to go about doing this.

3 – Choosing the software

Computers are only as good as the software that runs them, and the Palm Pilot is no exception. In fact one of the key reasons for buying a Palm rather than any other handheld is the range of software available. Palm’s CEO likes to refer to it as the Palm Economy – a bustling cottage industry of thousands of developers, each contributing their own unique solutions for the Palm Pilots. This includes big healthcare companies, which target the Palm as the most important handheld for doctors.
Once you’ve gotten the initial pleasure of all this software, there soon follows confusion over how to deal with it. The rest of this series will specifically look at the best applications for the commonest tasks on the wards. But there are three principles to bear in mind, for those who want to get started straight away.
1 – Find a guide you like
In the old days of the internet, two Stanford students made their bookmarks available to the rest of the world. They were shocked at how popular this list was. In classic California style however, they recovered and made a company out of it. Yahoo! remains the number one internet site worldwide. Now, whenever a new area of expertise arises on the internet, it takes very little time for similar bookmarks to arise. These should be your starting points whenever you want to find software.
PalmGear HQ is one of the largest and oldest. In Yahoo! fashion, it provides a hierarchy of good software. It also has numerous reviews, written by people who have bought the software. PDAMD is a much smaller site, but focuses on doctors. The reviews are by clinicians, and you can subscribe to their e-mail newsletter, to keep updated of good software. My favourite is Handango. Apart from looking the most polished, it’s also the most user-friendly. In PalmGear, it’s quite easy to arrive at a list of over 50 programs, simply because they haven’t been subclassified. Handango’s hierarchy is much deeper, and avoids this situation.
Have a look around these sites, and find one you’re comfortable with.
2 – There’s lots of free stuff out there
Many programmer’s make their work available for free. It’s fun to play with, and there’s some real quality out there. Even better are the free documents. Once you’ve bought document readers or databases, there’s some incredible content provided by doctors for free, from paediatric calculations, to common drugs, to the inevitable lists. You can gradually build up a library of information you need for your speciality. The best thing about these is how easy it is to share it – once one doctor has downloaded it, corridor encounters allow beaming to all the other doctors in the team.
3 – Even the programs that cost money, are free to try
Do not buy any Palm programs. At least, not immediately. All Palm programs have at least a 30-day trial. If you don’t like the program at the end, just delete it. There’s no obligation to pay, and no one will chase you for money. This is part of the reason you rarely find negative reviews of Palm software – not having to part with your money makes the whole thing very amicable. When you do find software you like, do not give your credit card number to any web site that is not secure. In other words, if you’re using Netscape, you should have the following locked icon at the bottom of your window…

…and likewise for Internet Explorer.

That’s it really. Go out there and find the good work. And don’t forget that once you make content yourself, you too can share it with the Palm Economy.

4 – Organising your life

Napoleon was one of history’s most successful workaholics, and he expected similarly high standards from his generals. “Only a busy man,” he would tell them, “can have spare time.” Depending on your mood, you can look at a Palm Pilot as helping you organise your busy work around the hospital, or your spare time outside of it. Either way, it would make Napoleon proud. When you buy the Palm, it includes four applications – DateBook, Address Book, ToDo Lists, and MemoPad. Although several advanced extensions exists, this suite does a surprising amount while maintaining simplicity.
DateBook
Click on the DateBook button, and you arrive at today’s schedule. To add a new event, tap the screen for the time you want it to start at. You can then specify the end time, an alarm, or to repeat the event. The latter I found most useful for regular lectures or clinics. Click on the button again, and you are transferred to the weekly view, and a further click takes you to the monthly view.
Daily view
Weekly view
Monthly view
Give it another click, and you arrive at the global view. This neat function combines your day view, with today’s ToDo items. I store my the jobs I have to do for my patients in one of my ToDo lists, so this view lets me see my appointments for the day, as well as the jobs the I have to fit in during the remaining slots.
Global view
Address Book
I write everything down in my address book. No scrap of paper escapes this fate. Names of any person that I meet, contact details of any administrator that gives it to me, directions to any place that I visit. It only takes a minute, and it’s paid back immensely. When it came to organising supervisions for finals, I knew which doctors were friendly, and thus who to ask for help. My ability to talk to beaurocrats has improved in leaps and bounds as I now have all their details all the time. Finally, during exams, I was able to visit all the peripheral hospitals at a moment’s notice, as I had all the directions and local quirks.
If there is one hint that I want you to take away from this article though, it is that you can also use the Address Book to store your passwords. Firstly, however, make sure that you store it as a Private record – that means it’s unreachable without your Palm Pilot’s security password. Furthermore, don’t write words like username, password, or credit card next to it – don’t make it easy to find!
ToDo List
With the ToDo List, you can keep track of jobs to be done. As I mentioned above, it includes the daily activities for the wards. But there are more creative uses. Take books – my other passion. Every good book I read about, I keep a note of. I give it a rating using the program’s Priority function. If ever I am in a library, I check whether they have any of them available. After a while, if I can’t find the book for free, I can then decide to buy it from a bookshop. Finally if I borrowed a book from the library, I can store the date for return, with an alarm a couple of days earlier.
ToDo Lists
MemoPad
MemoPad
This is great for writing scraps of information. My favourite use is penning down gems picked up from ward rounds. It’s then easy to share them with other students. In the picture above you can see the categories that I’ve written notes on – more of this next week, but you can see how much exams are occupying my mind as two categories are devoted to short cases.
Taking it further

As I mentioned last week, the Palm economy allows extensions to your Palm Pilot in every way imaginable. For example I use Launch ‘Em, pictured below, as a better way to organise all my programs. I also use DayNotez as a journal, keeping all my daily memories. It won’t take you long to find needs that the Palm does not perform by default, but you will enjoy the search for the solutions. Happy hunting.

5 – Taking lecture notes

Lectures are the process by which a speaker’s notes become the student’s notes, without passing through either’s brain. With a Palm Pilot, it’s now easy to transfer such scribblings to other students, again bypassing the brain. As ever, you have a wide choice.
MemoPad
This is great for little scribblings. As I mentioned previously, I use them extensively for ward rounds. I also write down lists I pick up from various sources. Finally, I write down my examination sequences for all the systems, so I can quiz myself after I’ve seen patients. My learning curve improved rapidly after this use, as there was no longer a separation between what I needed to do in examination, and what I actually remembered to do. Best of all, the MemoPad comes free with your Palm Pilot.
But at the end of the day, it is a limited program. The length of each note is only a few screenfuls, which definitely won’t last you a whole lecture. And the closest thing to a heading is writing in capitals.
Word Processors
QED is a perky little program written by what appears to be a one-man operation. For $20 you can write essays as long as you like. For an extra $20, you can move documents back and forth between Microsoft Word. However, there is still no formatting. You are paying $40 for a long MemoPad.
QED
DocumentsToGo
May I present DocumentsToGo. If you write any documents on Microsoft Office (Word or Excel) then this is the program for you. Its integration with Office is powerful and professional, and the display is a delight. Just look at the pictures above. It costs $50. This would be money well spent, were it not for one missing feature – it is not possible to create new documents on the Palm Pilot.
If your note-taking is primarily a computer, then this is an excellent way to view and edit the results. My friends swear by it. But for me, it has to be ThoughtManager.
Outliners
If you like the outliner tool on Microsoft Word, then ThoughtManager is the program for you. It works in the same way, and is an extremely elegant, structured and compact way of making notes. For $20, it lets you draw pictures and write lengthy notes. But this program remains the Marmite of software. I love it, my friends hate it.
Start with the headings…
Expand the clinical features…
Expand all the way
You should decide for yourself. The pictures above may illustrate to you some of the power, as you can hide or show detail. As in all Palm software, all of these programs come with 30-day trial periods, so you can try them before opening your wallet.
Joy Machine
It’s worth remembering at this point how useful a Palm Keyboard is for speeding up note taking. It is also worth remembering that the true aim of gadgetry is a feeling of smug superiority. So, when your friends abandon their pen and paper with the dimming of lights for the overhead projector… switch on your Palm’s backlight.

6 – Clerking patients

My patient kept on looking towards a spot behind me while I asked him about his health. He was on the respiratory ward, with an acute infection over a background of bronchiectasis. A charming gentleman, we had been getting on famously, but for the past few minutes I didn’t seem to have his attention. Finally, I gave up, and turned towards the spot behind me, to see what all the fuss was about.
I saw my registrar and SHO.
You have to picture the childlike glee with which they stared back at me. Their faces were poked through the curtains. They made it clear to me that they had been spying for rather a while now. First the registrar had spotted me, then he brought the SHO to have a look. The reason for their bemusement – I was clerking the patient using my Palm Pilot and keyboard.
This is a common reaction to the idea that you may use the Palm on the wards, but it genuinely works well. So how can you go about doing so?
Memo Pad
As with taking lecture notes, the Memo Pad is your experimental starting point. Again, it is limited in length, but most importantly, it lacks the structure that paper can offer. It won’t take long before you will want to graduate to greater things.
Do It Yourself
For those willing to tinker, there are databases that can be customised.. I know that many readers will cringe at the D word, and for those I suggest you move on swiftly to the next section. Otherwise, consider HandDBase. At $20, this is a complete relational database in your Palm. It is relatively easy to set up fields related to the clerking – PC, HPC, PMH, FH etc. As a student, I found it educational to design the templates myself, as it focused my mind on the clerking process. I am happy to give these out to anyone who e-mails me.
Specialist software
There are some excellent clerking solutions out there, but you have to pay more than the usual $20 price. For primary care, or outpatient clinics, the best software may well be Office Notes. Written by Dr Chris Hanson, a paediatrician, it’s flexible enough for the office-based encounter with patients.
But my favourite for the wards remains Patient Keeper. This is the program that the SHO and registrar caught me using that day.
The history view
A urinalysis form
Investigations summary view
At $35, it allows me to do a full clerking, as you can see from the history view above. However, given the legal requirement for paper documentation, this becomes a duplication of you work in MAU. Instead, make use of the ability to store investigations results. The forms available are very quick to input, and powerful to access. My favourite is the urinalysis form.
I’ve seen doctors use this software for morning hand overs. While other firms’ house officers are furiously scribbling the details, the team I saw had a rather civilised tea drinking session while they beamed the information from one Palm to another.
For those who like anecdotes, Patient Keeper was actually written by Dr Maulin Shah, while a medical student. After he posted it on the internet, it was downloaded by a hundred people on the first night. You can read more of the story in my interview with him for Surgical Sieve.
Ensuring confidentiality
Perhaps what worries people most is the risk posed by storing medical information on your organiser. There’s three points to make here. Firstly, I use Teal Lock software. At 2 am every morning, it locks my Palm. Only by writing my password, can I gain access. The software is very flexible – it could have locked up 15 seconds after I’d switched the machine off, or at 5 pm every Tuesday. I find the 2 am schedule to be the best compromise between security and convenience.
Secondly, I don’t store any identifying information on the Palm. I store the patient’s hospital ID, and their initials, but that’s it. The hospital ID allows me to check the latest investigation results on the hospital computer system, while the initials and diagnosis are all I need to jog my memory for the patient’s history.
Finally, a note on legality. The European Union has in place some considerable legislation on databases, and medical records are no exception. Thus to store this information on your Palm, you must register it with your hospital bureaucrats. It’s actually much simpler than it sounds, and consists of filling out a form to declare your intent. You’ll also get a mini-discussion on the security implications.

If you’re still not sure of the benefits, consider a morning hand over session where you just sip tea thoughtfully. It’s convinced many a doctor to make the switch.

7 – Medical references

I once got an O&G registrar annoyed by using my Palm in front of him. The consultant had asked me to wait outside his clinic, as he was dealing with a sensitive case. My short attention span soon had me rooting for my Palm Pilot. Given the patient’s complaint, I started reading about endometriosis. The registrar saw me, and suggested that I do some work. I replied that I was, but he just thrust an information leaflet on contraception in front of me. I thanked him for this, and said I would read it as soon as I’d finished the chapter. Two minutes later, he was back, and more annoyed that I “wasn’t doing work”. I was now presented with a leaflet on fertility. It was the leaflet on endometriosis that broke me, and I asked him why he insisted on this. He said clinic was no place for a Game Boy, and that I should be doing some work.
Needless to say, he calmed down a lot after seeing my chapter on endometriosis.
The free stuff
There is an incredible amount of freely available reference information out there. From paediatric drug lists, to body mass index calculators, you can find them on the handheld portals. Most of these come as documents requiring a special document reader. It’s the reader that you pay for, and the price is the usual $20 range. There’s three basic categories: DOC readers, such as Teal Doc; databases such as JFile; and web page readers such as iSilo. So which reader should you get?
As ever, if you’re not sure, then just download it and try. More importantly, look at the kind of documents available for each, and decide which one gives the best set. It may well turn out that you need more than one reader to fulfill your needs. It’s worth considering which one you would use yourself to write extra reference information. For this purpose, I found JFile most useful, but everyone has their own preferences. When you do write this information however, be sure to share it. It’s only fair to give back to the community that you benefited from.
List lovers

Physik’s List is what got me through my pathology exams, and then my clinical finals. It’s a set of 1083 lists, no less, covering every aspect of medicine. They were written by Dr Mark Bailey, a specialist registrar in infectious diseases, in Liverpool. He compiled them while training for his MRCP exams. What’s truly astonishing is that he wrote all these by hand, in the days before a Palm keyboard. At $15, I think it’s a bargain. Certainly, he’s had good sales, including, he told me, customers from the US navy.

Want the Oxford Handbook?

My dream is to have the Oxford Handbook of Clinical Medicine in my Palm Pilot. As a student, I hated having it flapping in my coat. Things became worse when I got the Oxford Handbook of Specialties (although it proved a useful counterweight). However, Oxford University Press, bless them, have yet to play with the technology. So I turned to the US.

Over there, the Five Minute Clinical Consultant seems to be the equivalent. To be honest, it doesn’t have the charisma of Oxford’s handbooks, nor management of presentations. Instead it’s just a series of short monographs on a diverse range of diseases. But it is available for the Palm, and so I bought it hungrily. I no longer carry any handbooks in my coat pockets. Be ware though – there is a serious price on these books. At $65, it does seem excessive.

There are several other books on the market, the best made by Skyskape, and Franklin. The latter have recently published Harrison’s Principles of Internal Medicine Companion Handbook. These are all available for trial download.
Whatever you choose, the result is the same. For my exams, I was able to revise everywhere. In between ward rounds, waiting for the anaesthetist in theatre, waiting by the bus stop, even supermarket queues. Obsessive I admit, but desperate times do call for desperate measures.

8 – Books for your palm

I once read a business plan to create a magazine for insomniacs. The genius was in advertising on TV at night, when charges are low, and insomniacs are many. As one such sufferer, I am in need of reading material. Even when shattered after a long shift on-call, I cannot sleep without reading. All I ask from my hospital is that they provide a reading lamp. As it happens, this does seem too much to ask.
If you’ve been following this series for a while now, you’ll know what’s going to come next. The Palm Pilot does indeed offer a solution to my problem. Using the backlight, I can switch off all the room’s light sources, and get myself comfortable with a Palm book. This experience is ten times better if you have a colour Palm, and is another reason I recommend getting one.
A small press for a small book
I am addicted to Peanut Press. The company publishes bestsellers and classics on hand helds. A key ingredient is their Peanut Reader. This is a freely available program that allows you to read their books. It also reads the DOC format, which a lot of reference medical information is stored in. Elegantly simple, a lot of thought has been put into how reading on a Palm differs from reading paper. The font size can be changed. You can add bookmarks of annotations. Best of all, the book automatically returns to the page you were last at. It’s quite feasible for the continuous interruption environment of a hospital.
What of the books themselves? Every week, 10-20 books are added, and the company’s been going for a while. There’s something for everyone. I got hooked on the biography and business section. Most compelling is a book I’m reading now on how the welfare system in Illinois was radically reformed by a McKinsey consultant – I know, I know, but trust me that you have to read it. My friend by contrast loves the classics section. She’s rather pleased by the rise in her cultural quotient, and gets to be doubly smug as the books are cheaper.
Which brings me to price. As a rough guide, the books are the same price as you’d find on Amazon, with its reductions, but without the delivery charges of course. That means if a book is currently available in hardback, you will pay hardback prices for an electronic version. This bodes badly for those who predicted electronic books being cheaper.
Cool Britannia
Enter Online Originals. This is a British publisher, and is true to its roots. The content is stunning, the presentation is appalling. Let me explain.
Their reader has managed to combine the worst aspects of paper and Pilot. When you switch to another application, it does not remember which page you were at. So you must scroll till you get to the right place, which is quite a feat given the browsing difficulties of a tiny screen. Alternatively you could bookmark, but why should you be forced into that? Even scrolling down pages is a hassle, requiring tapping the scroll buttons rather than the lower half of screen, which the Peanut Reader offers.
I didn’t lie about the content though. It is a trend setter, including the honour, as early as1998, of the first purely electronic book to be nominated for the Booker prize. This is a remarkable achievement, given that most other electronic publishers have stuck to republishing paper books as the only way to assure good content. Somehow, Online Originals manages to find high quality original content. They’re also fanatical about the promise of the medium, and charge no more than £7.00 per book. This is, I think, a very fair price for a very talented publisher.
In the end, I still buy more books from Peanut Press than all others combined. It’s partially because I don’t read much fiction. But really, their reader makes books a true pleasure, and I hope that other publishers take note from this. At any rate, do judge for yourself.
The future?
You might have heard a lot about Napster in the news recently. It’s a company that gives away tools for music file sharing – which most people have used for music piracy. A highly amusing set of law suits have followed as music companies have tried every thing in their power to shut down Napster, and all attempts at sharing of music. So far they’ve been dramatically unsuccessful, and I guarantee that this will continue. In fact, most recently, one of the major five companies came to its senses and decided to cooperate with Napster.
Every other provider of content is desperate to avoid being “Napsterised”, and book publishers are no exception. As such, all the big players have pumped millions into developing attractive electronic books that they can get paid for, to lure consumers away from pirate versions. The year 2001 will see a flowering of this medium, and book lovers everywhere are key beneficiaries.

And insomniacs.

10. Games

The registrar who told me off for playing with my Game Boy was impressed to discover that it was actually a Palm Pilot with a chapter on endometriosis. I have to say it was a lucky escape. My Palm has its fair share of games, which I’ve put to use in plenty of other occasions. So, for all those illicit moments on the hospital, here’s a list of my favourites.
Technicolor glory
I can’t resist a program that uses the Palm’s colours. And there’s some great ones out there.
ZIOSoft makes gorgeous games for the Palm, including ZioGolf, and Knight Move Color. The latter is an interesting mix between card and board game. It’s proving very popular.
Knight Move Color
ZioGolf
Biplane Ace is a duel with the computer in, you’ve guessed it, a biplane. Zap! 2000 is an arcade style shoot-em up. If you buy a Visor Prism, there’s a special version that takes advantage of the 65,000 colours.
Biplane Ace
Astraware Zap! 2000
Games for thinkers
Of course, some people prefer a more cerebral approach to gaming. Not me. But a friend of mine plays a weekly game of chess on his Palm. He ponders every move over several hours as he goes about his jobs on the wards. Although the game is a tiny amount of code, it consistently beats him. Most infuriating, the game responds to his moves almost instantly.
PocketChess(tm) Deluxe
Blackjack
SimCity
There’s also a version of SimCity for the palm. That’s right, a complete game of SimCity can be played in your hands. It’s rather pricey, at $30, but then again, you get what you pay for. If you’re a fan, consider this very seriously.
Race fever

One of the best aspects of the Palm is the ability to beam. Yet very few games take advantage of this. Race fever is an important exception – you can have a two-player race using the infrared beam. My friends and I are finding this addictive.

Do be warned, however, that it’s not quite as easy to pretend you’re doing work. The sight of two medical students struggling to stay within beaming distance while shouting abuse at each other fools no registrar.

11. AvantGo

Arthur C. Clark famously said that, if a technology is sufficiently advanced, it would seem like magic. I’ve saved the best till last – and my friends truly thought this was magic.
Take my friend who’s doing a Ph.D. on insulin signalling. It’s very molecular, making it consistently above my head. But the work is still fascinating, and it’s always a pleasure talking to her. Once, I asked her what had caught her eye recently in Nature, her bible. She showed me a paper in the journal, about an insulin mouse model – or rather, she showed me an editorial about it. The original paper was actually in the New England Journal of Medicine, my bible. Instantly, I took out my Palm Pilot, and showed her the paper.
She was gob smacked.
Introducing AvantGo
On the face of it, AvantGo is a very simple concept – it keeps a copy on your Palm of web sites that you like. Later, you can read as much or as little of those sites, without needing an internet connection on your Palm. But the company has done a lot of work to extend this. For you and me, they have made the process of acquiring these pages ridiculously simple. For the web site designers, they have provided tools and advice on how to design sites specifically for the Palm.
What can you get
When you visit the AvantGo web site, there’s a simple sign up procedure. It takes you by the hand as you download the software for you Palm, install it, and then pick the information you want to take with you. This information is called “channels”. Then, every time you backup your Palm onto your computer (i.e. “synchronise” it), AvantGo checks if you have an internet connection open. If you do, then it picks up the latest updates to the channels you’d asked for.
Some of the channels on my Palm’s AvantGo
The New England Journal of Medicine channel
It’s always a surprise what you find when you explore the list of channels. There are more cropping up everyday, and one quarter of the non-American ones are actually from the UK. Most impressive is the Guardian’s offering.
Take the selection from my Palm. I have adhoc Cambridge, for local happenings and cinema listings. More recently, I found InYourPalm, a similar channel but which covers Bahrain. So on the plane to Bahrain I was already deciding what I was going to do the next day. To keep up with technology, I have handheldmed.com, The Industry Standard, and Wired Magazine. The crown jewel though, is The New England Journal of Medicine. Imagine that – every week, you receive The Journal, as they call themselves, for free, in your Palm.
And then, there’s Surgical Sieve.
Surgical Sieve
I hope you’ve enjoyed this series. If you’re hungry for more, you might like to consider Surgical Sieve. This is a free monthly electronic magazine that I publish, covering the use of computers in medicine. You can see it on my web site, at idiopathic.com. Alternatively, you can have it e-mailed to you, by writing to me at
<!–
var prefix = ‘ma’ + ‘il’ + ‘to’;
var path = ‘hr’ + ‘ef’ + ‘=’;
var addy59290 = ‘mohammad’ + ‘@’ + ‘idiopathic’ + ‘.’ + ‘com’;
document.write( ‘<a ‘ + path + ‘\” + prefix + ‘:’ + addy59290 + ‘\’>’ + addy59290 + ‘</a>’ );
//–>
mohammad@idiopathic.comThis email address is being protected from spam bots, you need Javascript enabled to view it. Finally, if you’re inspired by all the AvantGo possibilities, Surgical Sieve is a channel you can subscribe to.

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