Re: [Gnumed-devel] Ian's SOAP widget - RFE/AOE

[Karsten Hilbert]

> > RFE
> > Subjective
> > Objective
> > Assessment
> > AOE
> > Plan
> I'm not clear on the distinction between RFE and Subjective and AOE and
> assessment (at least, I'm not sure there's enough difference to warrant
> typing the same stuff twice)
You are entirely correct that in principle no amount of
difference should warrant typing stuff twice. Avoiding that
can be overcome by purely technical means, though.

> Can we say to use the assessement as the AOE if the AOE line is blank?
Yes. That would be the default if indeed the AOE line is
blank.

> Can you post a few examples to demonstrate this?
OK, I will try.

*------------------------------------------------------------
1) baby boy

RFE: cough 3/7

S: had >6 last 5/12, now norm temps, non-productive,
night>>day, whooping w/ shortness of breath, no vomiting but
würgen (I can't seem to remember that word), known good
diphth vacc, no hx croup/asthma

O: 37.6°C, norm heart sounds, p100, lung clear, rhonchi at
tracheal level, drums normal, throat red/no pus

A: appar. trivial cough from URTI, likely viral

P: sympt.//herbal anti-tussant at night, Viburcol if uneasy,
review +5/7
notabene: recurring - acquired functional immunodeficiency ?

AOE: viral URTI

*------------------------------------------------------------
2) 76yo lady

RFE: pain/swelling left foot after fall

S: -2/7 tripped off sidewalk, increasing
pain/swelling/redness/stiffness l ancle/forefoot, init. some
bleeding from wound, Tet -12y, osteopor., no temps, no
shivering

O: scratch l o ancle, due to massive swelling ligs not palpable,
very sore/red/stiff; overweight

A: Fx likely, wound infection, ABs/XR needed, low
compliance, suspect bimalleolar Fx, risk factors++

P:
1) clindamycin - consider shot?
2) wound smear
3) Sol.hydroxychin. wrap + ice
4) Td booster now
5) review after lft lower leg/ancle/foot XR today

AOE: susp. left bimall.Fx w/ certain wound infection
*------------------------------------------------------------

1 is likely to produce a one or two-encounter episode but may
eventually lead to a health issue being identified
(acqu.imm.defic.) following which the rare but inevitably
recurrent UTIs start making sense and can be relinked from the
default health issue to the new one.

2 may lead to admission, operation, casting, pneumonia, death,
or reconvalescence. You never know. Likely it won't be done
with just a few encounters. And it will produce more episodes
later on, eg. when she develops DVT due to not walking due to
constant post-traumatic pain.

Also, in 1 the AOE is unlikely to change while in 2 it surely
will, at minimum after the study.

Does that make sense ?

Karsten
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