Re: [Gnumed-devel] encounter - translation

[Karsten Hilbert]

On Wed, Nov 04, 2009 at 08:58:23PM -0200, Rogerio Luz Coelho wrote:
> Subject: Re: [Gnumed-devel] encounter - translation
> 
> These enconter - episode - issue translations are still a big step on my
> translation ... I grasp the concepts and I understand where they come from
> ... but they seem unaplicable in my practice settings (my brazilian brain
> can't seem to get to how to translate it)

Imagine a patient with arterial hypertension, diabetes
mellitus 2, and coxarthrosis deformans. This patient also
currently suffers from a minor common cold (I am consciously
avoiding the word "flu").

Now tell yourself:

        "This patient suffers from arterial hypertension, diabetes
         mellitus 2, coxarthrosis deformans, and a minor common
         cold."

Now tell yourself that you don't worry about the common cold
because it'll be over in 5 days:

        "This patient suffers from arterial hypertension, diabetes
         mellitus 2, and coxarthrosis deformans."

Now become lazy and say:

        "This patient suffers from 3 health issues."

Now fill in the blank in this pseudo-brazilian sentence:

        "El paciento suffero de 3 ..."

(never mind, I tried ;-)

Does that help ?

> I got so far:
> 
> issue can have multiple episodes

Stop right there. Encounters are orthogonal to that.

> that can have multiple encounters (visits -
> this one I fully get ;), but it seems it is not a tree view you guys have in
> mind ...

It is more precise to say: A patient can have multiple
encounters/visits -- during each of which a number of
episodes (= bouts of illness activity) are worked one.

This structure IS NOT really a tree !  That is also the
reason why the same encounter will show up more than once in
the tree view -- once under each episode worked on during
that encounter.

> PS: Of course this discussion is kind of "lost-in-translation", what I
> should be thinking is how to make my view of issue-visit fit the way the DB
> is set up ;)

No no no. You should NOT do that. You should

a) try to understand why GNUmed thinks longitudinal health
   care *can* be structured like that

b) try to find good arguments *against* this issue-visit concept

We can then evaluate together whether those arguments
invalidate the model.

You will come to an understanding of why the issue-visit
model is (AFAICT) a valid way of structuring care. It is not
the ONLY model, though, I suppose. So, your own model may
well be valid, too.

> -- although as one of my teachers said in the past
> (administrative concerns should fit the practice, not the other way around).

GNUmed tries to present one (hopefully) well-thought out
model. It is not without flaws - of which I'd love to hear.

However, the above definitely is a basic design concept for
GNUmed - we try not to give up proper medical thinking for
administrative reasons.

Karsten
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