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Re: [Gnumed-devel] need assessment from fellow clinicians

From: Elizabeth Dodd
Subject: Re: [Gnumed-devel] need assessment from fellow clinicians
Date: Tue, 3 Aug 2004 07:17:47 +1000
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On Monday 02 August 2004 08:04, Karsten Hilbert wrote:

> > This is harder to do if
> > the diagnoses are distributed across multiple health issues when each
> > just reflects various dimensions of a chronic disease.
> That would mean the treating doc hasn't yet realized they are
> dimensions of a chronic issue due to lack of data, lack of
> insight - or she has done so on purpose.

Now if you come to the over-riding diagnosis last, how will you mark then 
Lady, about 65 develops NIDDM.
NIDDM progresses rapidly to requiring insulin
She develops vulval dystrophy (*obviously* unconnected)
5 years later she has alopecia totalis and is diagnosed as DLE.
Later, I realise that she never had NIDDM, she has autoimmune disease and 
destroyed her pancreas and her skin.
this is a real case - and I have another similar case.
the problem is real, because the chronic disease by nature will first appear 
as a series of unconnected episodes. then a connection is made to an 
underlying problem.


Removing the straw that broke the camel's back does not necessarily
allow the camel to walk again.

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