Re: [Gnumed-devel] Gender as "required"

[Karsten Hilbert]

On Tue, Jan 22, 2008 at 09:39:27PM -0800, James Busser wrote:

> I would like to present an argument for why gender, although it should be 
> available and usually completed in the "Register new patient" widget", 
> should not be "required" i.e. that it be permitted to be null.
I disagree on this.

> I cannot imagine the front line staff asking a patient "what is your sex"?
Well, why not, in fact. Those in which it is uncertain are
by my observation used to being asked. Usually what happens
in our practice is that a patient is entered with perhaps
the wrong gender. The issue resolves itself as soon as the
practice nurse summons the patient to the exam room:

"Mr Gondwanily, please !"

99% of the time Ms Gondwanily knows its her, just gets up
and when following the nurse discretly points out the error.
We have never had bad feelings arise from it. OTOH we always
apologize, too.

> Gender in the backend does not really protect against duplicate patient 
> creation, because I cannot imagine you would truly have two patients with 
> the same name and date of birth who would be legitimately differentiated by 
> actually being of 2 different sex/genders.

Botelli, Andrea - German: female, Italian: male

not too far fetched, I suppose

> So the main purpose that gender would seem to serve is to assist what 
> clinical decision support systems (reproductive health screening, cancer 
> screening etc) that may be able to be interfaced to GNUmed later and, to a 
> lesser extent, statistics.
That is the real value in the value. Most of the time
billing *requires* the gender to be entered, too (regardless
of the schizophrenic decision to not include it on our
current German medical card ...).

> If we made it gender not required, it can still be left, through social 
> control practices, for the front desk staff to be directed to enter it 
> routinely (as they do the other information like address and phone numbers) 
> *except* they would omit it when they may truly be unsure. This would 
> assist those instances I myself experience when referred a new patient with 
> partial information --- typically with a foreign name, whose gender cannot 
> be surmised --- who otherwise cannot be entered into the system,
I would take a guess, inform myself on the likely gender (on
the web), -- or even use hermaphrodite as an interim
measure.

Karsten
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