The high rate of change in all areas of our society is a double edged sword. Change brings new opportunities, but it also brings the need to keep abreast, and the need to adapt. For physicians and other health professionals, the rapid changes that characterize medicine and computing give us the chance to be behind in not one, but two fast changing fields.
 
One way to deal with the sheer volume of change is to let others digest and condense key information for us. This is generally an efficient use of time since it lets us concentrate on opportunities we can apply today. Unfortunately, this passive mode of learning leaves us less ability to shape those opportunities.
 
But another way to cope with change is to actively keep track of its cutting edge. If we are aware of what researchers are cooking up in their labs, we are not as likely to be surprised by tomorrow's changes. We might waste some time looking at research that will never be used, but that inefficiency is offset by our chance to participate in creating the future shape of medical practice. In the field of genetics, for example, we need not know about the latest restriction nucleotidase but we should know about the polymerase chain reaction (PCR) and the explosion of new PCR diagnostic tests. Society will look to nongeneticist clinicians to comment on the ethics of using tests to diagnose disease for which there is no treatment.
 
In relation to Medical Informatics, society will naturally turn to physicians to explain what researchers are working on now. Is it ethical to let computers not only diagnose patients but also provide treatment? What are the pros and cons of putting electronic patient records on a smart card or collecting patient records in a national data repository? How do we measure the full value to patients and society of high cost technologies such as telemedicine, or the value to students of computer aided instruction? Some of these questions do not have answers, but we need to be informed if we are to construct intelligent opinions.
 
Technology being transferred out of the lab today will affect us all in the next year or two. Medicine's future is inextricably connected to developments in many areas, including Artificial Intelligence, Computers in Medical Education, and Non-text Medical Information Processing (such as images, sound, video, and tactile sense) -- and what some feel is the single biggest area of Medical Informatics today: electronic improvements to the medical record. These will all give rise to ethical and policy concerns that we should be anticipating and working to influence now.
 
Inside Medical Informatics' deceptively tidy framework, the future is likely to be unpredictable, which can be translated into "interesting and exciting." The one constant physicians can expect from Medical Informatics is change.

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