Begin forwarded message:
Date:
December 9, 2011 2:48:13 PM PST
Subject:
Re: [Gnumed-devel] medication handling
2011/11/28 Busser, Jim <address@hidden>
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
Agree ...
I have a 2nd question. When talking with patients who do not have all their cognitive functions, say Dementia, say Unread (yes this is a important part of my practice) sometime they say they are in a medication, go out the door, and then come back with the
RIGHT medication (it really happens).
Can we have a way to make a medication marked as "wrongly stored - patient never took this" ?
Rogerio
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