Commentary: Computers and Genetic Counseling—Time for a Dialogue?

As an internist and medical ethicist, I do not consider myself an expert in genetic counseling. Yet I share with genetic counselors a passion for making connections with my patients and helping them make informed decisions about their health. I have tried to channel this enthusiasm into the development of a CDROM for educating women who are concerned about their personal risk for breast cancer and are considering genetic testing. My colleagues and I have written about the development of this CD-ROM previously (Green and Fost, 1997a, 1997b), and reviews of the CD-ROM have been both useful and generally positive (Baty, 1999; Crowe, 1999; McGee, 1999). However, some genetic counselors have expressed ambivalence about the use of computers in genetic counseling (Baty, 1999), and I have learned that there has even been discussion of this issue on your own professional list-serve. Some of the concerns raised about the CD-ROM emerge from a conviction that the work of genetic counselors cannot be replaced by a computerized discussion. In particular, some seem apprehensive that a CD-ROM could not possibly do all that a genetic counselor has been trained to do, for a computer program is too impersonal for a topic as sensitive as genetic disease, especially with regard to addressing emotional issues that arise during counseling. Although such concerns may be legitimate, they miss an important point about the purpose and value of computerbased education: these tools are intended not to replace genetic counselors, but to help them perform their jobs more effectively and efficiently. By way of illustration, let me relate a personal story. Recently, my dentist told me that I needed to have a root canal done. Having never undergone such a procedure, I naturally had questions. Anticipating this, my dentist said, “Why