Re: [Gnumed-devel] medication handling

[Busser, Jim]

On 2011-11-27, at 12:48 PM, Karsten Hilbert wrote:

> - discontinue must be in the past if not null
>   (remember, we are storing *current* state of medication)

the above is reasonable, because even when you *intend* a medication to stop 
(which information can be held in GNUmed's duration field) there are downsides 
to pre-entering a date of discontinuation:

1) the patient may have discontinued it early, or

2) the patient may have continued it, on account of a future clinician in some 
cases appropriately continuing it


The above contrasts with the case of when a drug was (or will be) started… 
GNUmed does allow the current state of medication to include the plan for a 
medication to begin at a future date, and I think this is reasonable.

(Whether or not they actually began the drug can only later be determined from 
interacting with the patient.)


One other thought about the columns… patients are sometimes very imprecise 
about *when* they discontinued a medication. When I see a patient on a Friday 
and they tell me they discontinued a medication some time in the previous week, 
they can have difficulty to tell me whether it was on the Sunday (5 days 
before) or on the Wednesday (9 days before) and when they did not see me in 
some months some of them have trouble to tell me whether they ran out of 
something or stopped to take it 3 weeks ago or 6 weeks ago. To some patients, 
those details just aren't that important. For this reason, I would support (to 
the right of the 'Discontinued field) a boolean checkbox

        [   ] uncertain

which, if checked, would confer the status of discontinued (whether or not a 
date was inputted to the discontinued field). In this case, the user can choose 
to enter a date if they believe it holds some approximately useful purpose. The 
advantage is that at the point that the record is being updated, it is known 
the patient is at least not *currently* taking the medication.

-- Jim