Re: [Gnumed-devel] Patient Education and Consent (was: experimental editor, also SOAP)

[Karsten Hilbert]

> Education and informed consent combine patient reactions, questions, 
> expectations, preferences (S) with (mostly) input from the doctor 
> (pseudo-Objective), so do not cleanly fit in either S or O.
All of this is narrative. I personally put education/informed
consent into P: What plan did I propose, what threats of
omittance, which risks, and which benefits did I discuss.
Decision of patient perhaps with reasons why.

> Or is  clin_aux_note any better place to put education or informed 
> consent? 
Note that clin_aux_note isn't supposed to be used standalone.
It should only be used for tables that really need an
*additional*, linked clin_narrative field.

> One extra thought to handle the case of recommending a patient to 
> undergo a diagnostic test or procedure which at times cannot be done 
> immediately (sometimes has to be done elsewhere and by someone else who 
> even though they may have a major part in consent it may be important 
> to record one's own part in the matter). Just wondering if there is any 
> value to somehow attach a record of [verbal] consent to the item that 
> has to be booked (maybe even storing it with the item). Would this make 
> it easier to assure that the consent has been obtained, and when 
> tracing backward spare having to look through many SOAP notes? Also is 
> there an idea how to "record" patient "written" consent into GnuMed?
Hm, there actually are societies where patient's go "thanks
doctor, although things didn't work out quite as we
planned" instead of "thanks for saving my life but I didn't
give permission to use *that* kind of syringe so I'll sue you
to cover cost of care". (BTW, Germany is slowly getting there.)

Anyways, where was I ? :-)  Ah, I think it'd be trying to
hardcode the schema at a far too detailed level of
granularity. Surely, HIPAA may tempt us to do such things.
However, IF one does one might be better advised to go for the
full circle and implement OpenEHR...  Anyways, IMO
education/consent should be stored in clin_narrative, mainly
soaP (but that's up to the doctor in every single case).

Karsten
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