Re: [Gnumed-devel] Re: clin_diag

[Jim Busser]

On Jul 22, 2004, at 4:38 AM, Karsten Hilbert wrote:
> > so that row is being permitted to code only one diagnosis, not 
> > multiple?
> It doesn't *code* the clin_narrative row at all. It gives
> additional information about the soAp row making it a
> diagnosis. And yes, you can only once give additional detail
> about any single soAp row.

so a clinical row is able to parent one, but only one, row in the 
clin_diag table

so if a patient comes complaining it's hard to breathe, (say shortness 
of breath with both chronic bronchitis and congestive heart failure 
components, or chronic bronchitis and pneumonia) you cannot 
create/attach both diagnoses.

The "Reason for Encounter" will have been attached to a single health 
issue. Its attachment could be changed to the other issue,  whether 
that issue already existed or needed to be created, but if the visit 
relates to *both* problems, it feels unnatural and not useful to try to 
split the symptoms and findings across different soap notes. It might 
be handled using 1. 2. 3. as point form within one soAp note.

Maybe the best way here, to keep it simple, is to create the main SOAP 
note under whichever had seemed to best health issue (whether the 
underlying one, or the one most worth being linked to the details) and 
then at the end replicate just the AOE row or if there was no AOE, the 
soAp row, and attach the copy to the other health issue which may (or 
may not) need to be created. This health issue, for this 
episode-encounter, would have a total of only one soap row and for 
anyone wondering how that could be it would need to be discerned from 
what is in the soAp or AOE record or the user could loosen focus if 
necessary to view what else happened at that encounter.