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End-user development means the active participation of end users in the software development process. In this perspective, tasks that are traditionally performed by professional software developers are transferred to end users, who need to be specifically supported in performing these tasks. We have developed a methodology that supports user work practice and metadesign, allowing experts in a domain to personalize and evolve their own software environments. In this article we illustrate how this methodology is applied to a project for the development of an interactive system in the medical domain. Physicians and their activities have been carefully analyzed through a field study that is reported in the article, in order to provide them with computer systems that may improve their work practice and determine an increase in their productivity and performance, that is, a better quality of diagnosis and medical cure, with the achievement of competitive advantage for the organization they work in.