Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2

[J Busser]

Here is a case I saw:

I am referred a patient with (or GP receives a patient newly-moved to 
the area bringing to attention their) hypertension and hypokalemia. 
Their known issues/history , in order of interest to me, are:

1995 hypertension
Hx asthma
arthritis L knee
on hormonal replacement (post-menopausal)
1994 s/p Nissen fundoplication (GE reflux)
1956 s/p sinus surgery
1989 s/p foot surgery
- note hypokalemia had not, in the referral, been expressed as "past history"

I would be tempted to input as health_issues
- hypertension (maybe 'hypertension with hypokalemia')
- asthma (pertinent to drug choices for BP)
- arthritis L knee (pertinent to ?NSAID use affecting BP)

A GP being likely to have to refill the HRT may want that issue to 
stay in view.

The other items however I am less inclined to make as "issues" 
because I may not want them in my "field of view" at each visit 
unless I am prompted by some clinical uncertainty or review to expand 
that view. So if they are to be added as issues, it would be nice to 
make them inactive or otherwise filterable.

But if later her asthma flares and it turns out GE reflux has 
reactivated, the issue "GE reflux" could be created, but I would feel 
stupid if I lose sight of (and the patient must remind me, because it 
was out of view) that theirs was a well-known prior problem. Easily 
avoidable if it was just a matter of "show all" among the patient's 
total listing of issues. But harder if for every symptom that "seems" 
new (at least to us), we must manually check a lot of areas *in case* 
there is something there:
- filtered issues
- unfiltered issues (in case something needs to be resurrected)
- episodes that did not get attached to an issue
- diagnoses (sorry, not sure if they are part of a composite view)
- soap notes for anything that was put there but neither made an 
issue nor linked to a diagnosis (depending on the answer to my prior 
email about other tags in soap notes)
- medications
- anywhere else?

To Richard's point, non-developer doctors may have a harder time than 
us to make instinctive (or to reason out by force of will) gnumed's 
data-constructs for the various places that have to be looked at.

Anything to make it easier for them to not "miss" key info when in 
"re-think" mode (composite view on-demand?, maybe a suitable tree 
could do this?) could be helpful.