Re: [Gnumed-devel] encounter - translation

[Karsten Hilbert]

On Sat, Nov 07, 2009 at 07:26:45AM -0300, Rogerio Luz Coelho wrote:

> Ok so I´ll try to explain how I am using so far GNUmed and the way it stores
> my patient data:
> 
> *** I am not currently connected to a GNUmed DB so the terms in English
> could be messed up.
> 
> 1st Visit) Patient gives name and DOB and tells why she came to me
> - back pain.
> 
> -- ) Put "I have back pain" in the RFE field
> 
> -- ) take family history if any
>   -- FUNDATIONAL HEALTH ISSUE = "Family History" with multiple --notes-- one
> for each     problem that is relevant (precocious CVD, genetical issues,
> Cancers, etc..)
> 
> -- ) take personal history
>  -- ONE FUNDATIONAL HEALTH ISSUE PER PROBLEM = Hormonal Birth Control, Skin
> Problems, Osteo-Muscular problems, etc... AND a ISSUE called "Back Pain"

Personally, I would make the "back pain" an *episode* first,
unless I know it really is a long-term underlying issue.

> -- ) Start to colect the SOAP
> 
> -- ) Enlist all Measurements that are of note (I sometimes also put the
> REALLY important ones in the sOap field - so you can see them the next time
> you see the patient when you click on the open encounter view of the Note
> applet)
> 
> -- ) Define the Summary of the visit (here I think I start to get in some
> problems with the design)  as " First Visit, Back Pain , asked to do this
> and that and return in 2 weeks"

IF during that encounter the only *active* problem being
worked on is the "back pain", then, yes, that makes sense.
Otherwise I would put it into the soAp of the back pain
note. The AOE / Summary would become "new patient / back
pain" for me.

> 2nd Visit) Now 2 weeks pass and patient is better but not 100%
> 
> -- ) Click on "Back Pain" in the Note Plugin, new Note has "Back Pain" on
> the title.
> 
> -- ) RFE = " Better but not 100%"

To me that's Soap, but, hey, you decide. I would write "more
back pain help wanted" or something like that -- what the
patient *wants*.

> -- ) SOAP
> 
> -- ) Summary = " Better but not 100%, start acupuncture and return weeklly
> for 1month"  ** ;) my free on-list merchandising ;) **

Again, I'd put that in soAp. Again, IF only back pain was
worked on the Summary would be: "back pain: start acupuncture"

(my way of doing things)

> -- ) Save = GNUmed asks if I want to close the new or old (see ???

Huh ?  That episode of back pain is still going on, isn't
it? That second visit should be part of that first episode.
It will be a new encounter, however, that's true. But if
that encounter truly is 2 weeks back it will not be
considered for continuation (unless you've got really weird
configuration going on in your database)

>  - I am
> thinking a little different of the design, because it seems obvious to me
> that if it was supposed to work the way I am doing things the client would
> not ask me nothing ;)
> 
> *** on the way out patient says "Oh doctor, I want to discuss also my Birth
> Control Method"
> 
> -- ) Click on "Hormonal Birth Control" and a new Note opens.
> 
> -- ) RFE = Birth Control Guidance

No. This is still the very same visit. So you need to *add*
to the RFE which might become:

        "back: <100% better // birth ctrl: review"

> -- ) SOAP
> 
> -- ) Summary = Changed Birth Control method to Hormonal Pills with
> Drosperidone and only 4 days off = "Yaz"

Again, same visit, so *adding on*:

        "back pain: start acupuncture // birth ctrl: now Yaz"

> 3rd Visit) one week later patient tells us she is better form back pain
> after last acupuncture session, seems 100%
> 
> -- ) RFE = Better, maybe 100%
>
> -- ) Click on "Back Pain" - new note is created
> 
> -- ) SOAP
> 
> -- ) Summary = "Better seems 100%"

AOE: "back: seems 100%"

> -- ) Click on "Hormonal Birth Control"
> 
> -- ) SOAP
> 
> -- ) Summary = "All is fine with 1 week use"

AOE: "back: ~100% // birth ctrl: OK @ +1/52"    ;-)

> You see my method of using GNUmed is a Problem --> Visit paradigm.

I see, yes.

> Please feel free to enlighten what you think could change for easier use :)

Well, what you *could* do is to serialize per-problem SOAP
input and force a new encounter for each problem and make
them chronologically consecutive.

This would give you some pain, however, when you discover
you want to document something else after you already forced
the new encounter for the next problem. It won't be
impossible because GNUmed now supports editing previous
notes which you could use to add on to a "previous"
encounter but it's not particularly convenient.

Here's the big BUT to all of what I said above: Whichever
way you use GNUmed - it is important that it helps your
practice. It is not important what I think you should or
could do !

You might want to add a wishlist item on launchpad along the
lines of:

        Improved integrated editing of previous encounters'
        notes and/or enable the notes editor to load old notes
        for editing.

Karsten
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