Re: [Gnumed-devel] vocabulary question - doctors, please speak up

[James Busser]

On Nov 28, 2006, at 7:23 AM, Karsten Hilbert wrote:

> Hi all,
>
> we have so far used the term "health issue" as one of the
> (optional) grouping concepts in GNUmed. I feel we should
> change the label for the concept to something better suited
> to English clinical use.

I was thinking something like "Foundational issues". Would a  
mathematical analogy be anything like "prime numbers"... are we  
seeking a level of labelling to which manifestations and  
complications can get attached?

I am waiting til I get time to play a bit more with a newer version  
of gnumed. In the meantime if it may affect the answer Karsten is  
looking for I was again thinking how these "levels" of categorization  
work. The following is a bit free-form but maybe that is OK :-)

We can have a symptom whose diagnosis is delayed. Diarrhea can later  
be diagnosed as due to Crohn's. We have previously discussed that the  
label can change from "diarrhea" to "Crohn's" with the diarrhea  
information preserved inside the notes. I think we also established  
that an episode of illness that does not acquire a deeper explanation  
may not get attached to some foundational issue, but until the  
Crohn's is diagnosed it would be important to be able to view in one  
place all of the episodes of diarrhea that were *not* yet given some  
explanation or attachment to a foundational health issue. Maybe these  
unattached episodes of diarrhea would collect with all the episodes  
of sore throat and all the episodes of cough or bronchitis under  
Unattached/Other... and these could be viewed by date or by name to  
permit the recognition that a patient has X episodes of bronchitis, Y  
episodes of ear infection and Z episodes of diarrhea in a 3-year  
interval, maybe they have an immune deficiency.

When the patient returns with diarrhea, it is not always from  
Crohn's. It could be gastroenteritis, or lactose intolerance, or  
Clostridium difficile.

Crohn's sometimes requires surgery. Occasionally patients have lost  
enough bowel that they get short gut syndrome producing diarrhea. So  
how would those look in a data structure?

Crohn's
Lactose intolerance
(History of) C difficile colitis (after it has been treated)
(History of) laparotomy with small bowel resection
Short gut syndrome

We tend to think of the (History of) as "Past Medical History" and  
"Past Surgical History" but may it be better to retain these items at  
the same level of the data structure as they appear above, and simply  
suppress the retrieval or display of the items we may not want to see  
until we ask to review more completely the file?

I know that in some systems there are special fields into which to  
type "Past Medical" and "Past Surgical" histories but that impedes  
the re-use of the data does it not?

I am sorry if I "run on" again with cardiac examples but if a patient  
has heart failure and angina, those are "problems" that may have to  
be managed at the same time as their underlying causes (coronary  
artery disease, diseases on one or even multiple heart valves) are  
surely important to keep track of.

Going back to the Crohn's example, it can help to be able to produce  
a relationship view of some of the problems for example the  
following. But maybe this cannot adequately flexibly be done in a  
software design and people will take the view that it must be  
reserved for the human brain to do real-time or else would require  
heavy tailoring to suit the mind of the individual user.

        Crohn's
                (History of) laparotomy with small bowel resection
                        Short gut syndrome
                Monoclonal antibody therapy
                Hematopoietic stem cell transplantation
        Lactose intolerance
        (History of) C difficile colitis (after it has been treated)