In the 15 years since Dr William Bean wrote his Tower of Babel, 1963,1 hospital medical records have become increasingly bulky and incomprehensible. The caligraphic efforts of the few have given way to the team approach of the multitude, and to the cryptic cuneiforms of the harassed houseman have been added the voluminous written opinions of an army of specialised nurses, dietitians, social workers, psychologists, physiotherapists, consultants, and consultoids in training. To which must be added a modern passion for documentation based on the needs of government, malpractice lawyers, accrediting bodies, educa tors, administrators, auditors, and medical record librarians. So that if you visit a hospital ward you find that everybody is poring over paper and furiously scribbling away?and if you should ever manage to detach a nurse from her desk she is likely to hand you a patient's chart the size of a telephone book, or perhaps even a whole stack of volumes?the Greater Babylon Area Directory, detailed and complete, with all the suburbs and townships that once graced the fertile plain between the Tigris and the Euphrates. You feel faint at this stage and must sit down. You desperately turn over pages of forms and reports and nurses' notes, clothes lists and itemised accounts of services rendered, insurance forms and graphic charts, computerised laboratory data, and an informed consent form detailing the hazards of having a television set installed in the sickroom. It takes five minutes to find yesterday's temperature, twenty to understand the history, and an eternity to determine on which day the penicillin was begun. Suddenly the folder springs open, the papers fly all over the room, and the nurse and you are crawling all over the floor to pick them up; it takes another five minutes to reassemble the record in some sort of order, and then you may start your research all over again. Or you may continue your studies at the outpatient clinic, where the patients are already waiting, each with his own personal telephone directory?some dating back to the second world war. The pages are yellow and stiff and crumbling, the writing has begun to fade, the story makes no sense because the inpatient records are stored separately on microfilm in a warehouse out of the State?so you give up and just renew the digoxin for the eleventh year. It was to correct this that Dr Lawrence Weed first introduced his famous problem orientated records system.2 Convinced that the traditional source orientated record had become unmanage able and that radical changes were necessary, he developed a new system based on a longitudinal recording of the patients' problems rather than diagnoses, a problem being defined as anything that worried the patient or the doctor or anybody else.