Re: [Gnumed-devel] Aggregating health issues on screen. - Contextual Info

[Richard Terry]

Ah, I really get the passion in your reply, or perhaps irritation or both. 
Please bear with me and read on. I feel a little guilty like I'm a dog which 
a bone between its teeth who won't let go.  Even if you skip over the top 
part of this mesage, please reply to the bottom bit.

> > This works really well. Having a pre-defined
> > number of SOAP's as per carolos's current implementation
>
> It doesn't. You are getting something wrong there.

Karsten obviously it 'functions' the same way. The point I was making is that 
it is unecessary duplication of an identical peice of screen design.

> > Parsing will beome
> > a nightmare. Ordinary people just don't do that. On paper yes - we do it
> > every day because paper is well suited to that - but not electronically.
>
> Tell you what I fail to see the difference. However, as I
> said, I am fine with more structured approaches.

I've discussed this ad-nauseum with malcolm Ireland (BTW I attatch a quick 
reply he sent to me last week - which is equally equivocal about what to do 
because of lack of any recognised good solution). Malcom''s considered 
opinion is that  it is impossible to transfer the paper paradigm to the 
electronic medium. He made the interesting comment to me on the phone the 
other night when we discussed it at lengh again, that he beleives that once 
we have a generation who have been brought up entirely paperless, then some 
bright spark will (not constrained by the paper paradigm cemented in their 
brain) come up with a good way of doing it electronically. Until then, 
anything is better than the current crop of abysmal software.

> > By the way, I'm having a focus group next week with our local GP on 'data
> > input paradigms in medical records', where I'm going to see what they
> > think works (won't tell them about gnuMed and SOAP until after they do
> > all the talking - and describe how they currently do it in their computer
> > systems and what the problems are).
>
> Sounds good.

I will certainly pass this informaton on to you.

> For $Deity's sake, Richard ! We've re-hashed that just
> recently. It doesn't matter one friggin' bit how you LABEL
> your input fields !! The SOAP input widget doesn't care in the
> least. It'll accept input and hand that input with some
> formatting applied to the parser that's being invoked on Save.

Sorry, but maybe I've just totally mis-understood, as I'm not involved with 
the backend stuff. Do you mean that the SOAP (or whatever) doesn't matter if 
there are 4 lines or 10 different types of lines, that the existing code will 
save them appropriatley to the database?

>
> 1) I am fine with Carlos labelling the fields any way you see
>    fit even in the very first release.
> 2) Of course, in Germany those fields won't be called
>    "Subjective" or anything stupid like that.
> 3) The label/type-per-label of the input fields is going to be
>    configurable to anyone's personal whims in v0.2.

Sounds good.


> Please do explain the difference between the following. I am
> simply to stupid to figure it out:
>
> Subjective:   Patient Complaint:
> Subjective:   History Taken:
> Objective:    Clinical Findings:
> Asessment:    Assessment:
> Plan:         Plan:

Not too stupid, I'm sure we both understand them the same way. BTW I continue 
to marvel at europeans who are can converse in their non native tongue with 
us antipodeans who are so hopeless with language.

Nothing about the consultation is 'objective' anyway.  All of these - the 
patients complaints, history taken, clinical findings, assessment and plan 
are subjective!

The importance I think of separating the patients dialog from the doctors 
dialog, is that it keeps in the forefront of the doctors mind what the 
patient wants. BTW if you refer back to the screen dumps I used the following 
headings:
===========
Patient Request
History Taken
Clinical Findings
Assessment
Plan
==========

I think to look at  the Patient Request is interesting. I've been actively in 
clinical practice now for (shudder) 28 years. I've found over the years that 
despite 'sorting out' the history I had obtained from the patient, come to a 
diagnoses, implemented management, that at the end of the consultation I 
often got a sense of 'incompleteness', ie I was 'technically correct', but 
functionally useless (see joke below which just came to mind).

As the  years rolled by I realised (I'm a slow learner) that what I wasn't 
doing despite all my training, was really finding out at the beginning what 
the patient wanted to get out of the consultation - which was often very 
different from their presenting complaint as we all know. 

Hence my usage of 'Patient Request' and separation from  the 'History Taken'  
We all know this I guess but I still every day find consultations which go 
astray because I didn't clarify it at the beginning. Hence the history of 
'cough and chest pains' bla bla, takes on a very different direction when I 
ask the patient as I usually do 'What do you want to get out of this 
consultation' , which often is something like 'Uncle fred just had lung 
cancer diagnosed, I've had a bit of a cough, and I'm afraid I've got it too', 
insteading of me at the end of the consultation saying, 'you've only got a 
minor cold', which does nothing to re-assure him.

Now this is a non-subtle example, but as you know many consultations are not 
that obvious from their symptoms which on the surface can appear quite minor 
or inoccuous.

ie:
Subjective:Chest pains, cough  becomes: Patient Request:Worried may have lung 
cancer because has cough.

Anyway, will await your reply with interest.

The Joke should you care to read it:

Airliner flying into fogbound New York, round and round in circles, lower and 
lower- the pilot and co-pilot shitting themselves because running out of 
fuel. Suddeningly there is a small break in the fog, and they see a man 
standing on a balcony of a skyscraper close by. The pilot opens the window 
and yells out "Where are we", the man yells back "Your in an aeroplane". With 
that the pilot banks the plane to the right, down, left, and there's the 
runway and they land without incident. The co-pilot marvels at this and asks 
how in the hell he knew where to go. "Well", said the pilot "the answer was 
technically correct, but functionally useless, so the building had to be the 
IBM building, so I immediately knew where I was".

Regards

Richard

MalcolmIreland_SOAPetc.txt
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