The following is a current draft list of questions for potential inclusion in the Virtual Town Doctor instrument. With the exception of some questions derived from ongoing doctoral research, all questions are taken directly from or closely adapted from published instruments with plausible claims for validity and references in medical literature. Except for the referenced pain and quality of life instruments, all the source surveys focus on diagnostic categories: primarily heart disease, arthritis, and asthma

Although the intention of the instrument currently under development is to move beyond some of the limitations of previous work, nonetheless the list as presented does share and reflect the primary assumption of the source documents. It is assumed that the ultimate target of the questions will be a patient who is presently diagnosed with at least one illness that is potentially physically limiting. However, because of the inclusion of nearly as many general questions as specific questions, this assumption will not necessarily limit the scope of the survey as presently conceived.

The proposed questions have been divided into ten component areas: nine deriving from the work of Evans and Kindig, and an additional area ("Pain") that was understood to complement that sociological model. In most cases (with the exception of the "Prosperity" and "Physical Environment" components), these components are further divided into three very broad areas of inquiry: general questions, questions relating to a primary diagnosis or the diagnosis of interest, and questions relating to any concurrent conditions. In most cases, the questions in one of these three broad areas of inquiry could be usefully restated to gather information in one or two of the other areas. When this is believed to be the case, a parenthetical statement to this effect appears in the list, along with the estimated minimum number of questions that could be restated in this way. Each of the three areas is further broken down into eight categories of analysis. Although at this stage the organization of questions is tentative and is far from perfectly uniform, the general pattern followed can be summarized:

The number of questions in the draft list, including restated questions, follows here, broken into the ten major components that constitute the highest level of organization at present:

This total does not at present include many of the questions identified by Richard Berlin.

Standard for Inclusion

In the process of formulating this list, scores of surveys were examined. Many questions were found to be substantially repetitive or even identical, and many were therefore not included. When questions were not identical, a difference of verb or of predicate adjective was regarded as sufficient to distinguish a question as unique. Therefore, "Have you felt blue?" would be regarded as distinct from "Have you thought blue thoughts," and "Have you been blue?" would be regarded as distinct from "Have you been depressed?" This procedure seems consistent with the contention expressed by many authors of psychological instruments in particular, who suggest that greater validity can be achieved by asking essentially the same question in several slightly different ways. (It has been shown, for instance, that older Americans will identify with informal labels such as "moody" or "the blues," while avoiding the clinical implications of the term "depressed.") In cases in which the examined questions did not meet the standard of uniqueness, the question from the instrument with the more fully documented validity was used; or in cases in which no difference in the quality of documentation was evident to the non-specialist, the question deriving from the survey with the earlier original publication date was used. After this selection process, most of the questions at this stage have come from ten core instruments.

Because of the large size of the survey proposed, the potential for a much greater breadth of data-gathering and analysis emerges as an advantage. In addition, a deliberate attempt was made to build areas underdocumented in health instruments into the tentative organizational structure of the developing instrument. At this stage, as mentioned above, almost no original questions have been included in the design. Therefore, even though a formal statistical sample of survey instruments was not taken, it might be reasonable to suggest that empty spaces in the outline of the present list represent deficits in many existing assessment tools generally. A brief glance at the question lists makes it clear that the subcategories "History," "Patient Objectives," and "Suggestions for Improvement" are most frequently empty. Therefore, if this outline were to be developed further, it seems likely that the resulting survey would provide a greater chance to allow for patient input, as well as greater medical access to background information. Specifically, the ability to include more questions allows for a more complete assessment of health-related behavior. It is also arguable that the greater flexibility of the proposed project allows inclusion of both positively- and negatively-phrased questions, therefore reducing the likelihood that result may be skewed by limitations on questions. ("How bad has your life been?" may be a question that gives a different view than "How good has your life been?" and a balanced view may only emerge from an instrument with dimensions generous enough to include both kinds of inquiry.)

At this stage, however, the potential richness of context allowed by the eventual application of the kind of model proposed takes shape only in a list that is long and unwieldy and contains noticeable gaps at the same time. The lengthier components of the list, in particular the "Well-Being" component, for instance, are confusing and contain many overlapping questions composed of factors that would be difficult to sort out in the effort to obtain a clear finding at the end of a hypothetical survey containing even some of these questions. Although this length and complexity may prove frustrating at present, it may also make clear the desirability of more sophisticated methods of delivering surveys. Similarly, the gaps may make the deficits of existing instruments more visible and therefore more remediable.

Clearly, for reasons briefly suggested above, the majority of future work on this instrument falls into two areas: further organization for clarity of interpretation; provision of new material to fill the gaps that have appeared so clearly. There are many further instruments that could be assessed in the effort to provide further material: instruments in gerontology and in disability assessment in particular seem to provide more contextual questions than other instruments. In addition, almost any number of additional disease-specific assessment tools can be consulted. Finally, though, both the work of fleshing out the outline and of refining that outline itself may require creative inquiry to complete a task of a pattern and scale that seem never to have been attempted before.