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

From: J Busser
Subject: Re: [Gnumed-devel] The 1,2,3's of SOAP for multiple problems-2
Date: Tue, 23 Nov 2004 02:26:52 -0800

Here is a case I saw:

I am referred a patient with (or GP receives a patient newly-moved to the area bringing to attention their) hypertension and hypokalemia. Their known issues/history , in order of interest to me, are:

1995 hypertension
Hx asthma
arthritis L knee
on hormonal replacement (post-menopausal)
1994 s/p Nissen fundoplication (GE reflux)
1956 s/p sinus surgery
1989 s/p foot surgery
- note hypokalemia had not, in the referral, been expressed as "past history"

I would be tempted to input as health_issues
- hypertension (maybe 'hypertension with hypokalemia')
- asthma (pertinent to drug choices for BP)
- arthritis L knee (pertinent to ?NSAID use affecting BP)

A GP being likely to have to refill the HRT may want that issue to stay in view.

The other items however I am less inclined to make as "issues" because I may not want them in my "field of view" at each visit unless I am prompted by some clinical uncertainty or review to expand that view. So if they are to be added as issues, it would be nice to make them inactive or otherwise filterable.

But if later her asthma flares and it turns out GE reflux has reactivated, the issue "GE reflux" could be created, but I would feel stupid if I lose sight of (and the patient must remind me, because it was out of view) that theirs was a well-known prior problem. Easily avoidable if it was just a matter of "show all" among the patient's total listing of issues. But harder if for every symptom that "seems" new (at least to us), we must manually check a lot of areas *in case* there is something there:
- filtered issues
- unfiltered issues (in case something needs to be resurrected)
- episodes that did not get attached to an issue
- diagnoses (sorry, not sure if they are part of a composite view)
- soap notes for anything that was put there but neither made an issue nor linked to a diagnosis (depending on the answer to my prior email about other tags in soap notes)
- medications
- anywhere else?

To Richard's point, non-developer doctors may have a harder time than us to make instinctive (or to reason out by force of will) gnumed's data-constructs for the various places that have to be looked at.

Anything to make it easier for them to not "miss" key info when in "re-think" mode (composite view on-demand?, maybe a suitable tree could do this?) could be helpful.

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