Re: [Gnumed-devel] Re: clin_diag

[Karsten Hilbert]

> 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.
Why of course, you'll have to have two soAp rows being
detailed by two clin_diag rows, one for each. clin_diag rows
don't attach diagnoses to a patient, they declare a
narrative row to BE a diagnosis. I do understand that we were
saying we wouldn't be having SSOOOAAPPPP episode notes for
now.

> 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,
Episode, not health issue.

> 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.
Entirely dependant on the patient at hand. For one patient it
may make perfect sense to put them under different
episodes, for another one we are dealing with essentially the
same episode.

> 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.
Exactly. There would of course be the need to be able to view
encounter-wise as well as issue/episode-wise.

Karsten
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