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[Gnumed-devel] The 1,2,3's of SOAP for multiple problems

From: Richard Terry
Subject: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems
Date: Mon, 22 Nov 2004 13:48:08 +1100
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The suggestion of the 1.2.3 below is UNWORKABLE. Before reading my criticism 
please remember that there is a vast difference between half a dozen 
enthusiasts using a program and REAL LIFE DOCTORS, many of whom cannot type 
properly, and don't think in an ordered manner when it comes to data entry.

Multiple reasons:

1. It doesn't work in practice (I tried it for an hour - confusion)

2. Whenever you rely on the user (doctor) to input a number next to the text 
entry - forget it. Even motivated, I found it difficult to do, let alone 
forgetting typo's)

I wish you guys would actually try this in your day to day clinical practice 
ie as you are working with real patients in real time. This is vastly 
different from a good idea (not knocking the ideas - keep them flowing), or 
from using the good idea with an imaginary clinical scenario, what you type 
in as you imagine a consultation usually being very different from the real 

It is also useful to have gnumed running on your puter next to your actual 
clinical software - that way you can duck and have a quick look at it as you 
are actually using your existing clinical software - then  keeping all these 
new ideas in mind - just have a quick think about 'would this actually work 
now' - good example being Carlos's multiple soap thingy - which I don't think 
is practical in its current format - cause you lose everything else that is 
important that you need to orient you to the patient.

speaking of the 1.2 above (which is in effect an attempt to have multiple 
soaps in 1 - Though I personally hate the idea - I had an idea around this - 
that if you were going to have multiple soaps, youmaybe  should have them on 
a tab control - ie if  you really want to keep your stuff separate then the 
user can flick from one to the other - that way the real-estate on the screen 
is not consumed - and it can still sit in the central area. At lunch time 
I'll try and do a quick mockup of these to see if it would work. The tab 
heading could be a past problem, or 'undefined' for a new problem, that way 
clicking between the tabs would be easy.

I personally still like the the idea of the user actively linking the 
consutation to an existing or new problem at the bottom of the SOAP area and 
having the multiple threads present in the same SOAP, which is much more 
workable in actual use.

I've tried half a dozen or more of these variations in the last few weeks - 
I've run them simultaneously on my machine, sitting them side by side as I 
work - ie the SOAP heading, the Patient History, Doctor History, Clinical 
Findings, Assessment, Plan editing area, the ditto + drop down link to 
diagnosis combo box etc.

Just as an aside - continuation of interrupted consultations. This one struck 
me as I had a kid with quite severe tachpnoea and chest recession which I 
wasn't sure was due to asthma or nasty infection. I opted for asthma  and 
gave the kid a hefty dose of bronchodilator, but then had to throw him out 
into the waiting room for it to work or not, and keep going on with the 
consultation. A couple of patients later I reviewed the child - tachpnoea 
dramatically settled etc - ie responded well - this consultation should in 
fact be still active in gnumed - but put on hold. Do we have such a mechanism 
in place?

Anyway, enough of that for the moment. I will have a gui-play with SOAPs on 
tabs in the central area.



> This is good work, I would like to propose a modification based on
> Karsten's suggestion on IRC: instead of a TreeCtrl on the right, just have
> a listbox with health issues numbered, then a single soap control, the
> notes can be tagged to a health issue by adding the number, so with this
> contrived example:
> S: 1. SOB on exertion, while walking up stairs.
> 2. blurred vision
> O: 1. mild bibasal crackles, JVP +2cm, mild pitting oedema to mid-calf
> 2. fundoscopy: some haemorrhages
> A: 1. increasing CCF
> 2. retinopathy
> The health issues are
> 1. congestive cardiac failure
> 2. diabetes
> The numbered list can change over time, as health issues are ordered by
> importance. New issues can be generated implicitly by referring to a new
> number.
> This actually merges nicely with Richard's design: the list of health
> issues becomes one of the tabs in the "pick list" notebook in the top-right
> (along with medications, waiting room, inbox, etc.), leaving space
> bottom-right for Recalls/Warnings and the scratch-pad.
> Ian Haywood
> --
> PGP public key E750652E at
> 9BF0 67B7 F84F F7EE 0C42  C063 28FC BC52 E750 652E

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