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Re: [Gnumed-devel] Aggregating health issues on screen. - Contextural In

From: Richard Terry
Subject: Re: [Gnumed-devel] Aggregating health issues on screen. - Contextural Info
Date: Tue, 30 Nov 2004 09:01:46 +1100
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> I fully agree with what you say here, Richard. The only thing
> is that we try to be logically consistent and make it possible
> for the doctor to link distinct parts of the encounter
> (encountlets, IOW) to their *respective* problem instead of
> simply linking the entire encounter to a "best-fitting"
> problem.

I'm not sure I fully understand what you are implementing, however I'll make 
these comments.

Clinically information becomes meaningless when snipped out of its context. 
Most encounters are only going to be half a dozen lines,( or half a page or a 
page at the most more rarely). 

Think about this. It is unusal in general practice to have to look back in 
clinical notes.

hen one does, it is usually the last couple of consultations.

Yet when faced witha  difficult case, where the symptoms have started to 
present on a few occasions over a period of time, and the patient history is 
often a little vague, or changing with every presentation,  When you look 
backwards through a set of patient notes - your eye takes in the context of 
the key words, and what information is associated with them. If you cut out 
this context, and link display to only part of an encounter, then you may 
miss the clues that will cause the 'penny to drop' and help you make the 

That's the thing about diagnoses. It is rare that we think consciously 
logically through DD's except on a very crude level - eg upper abdo pain = 
stomach, gall, pancreas, aorta, oesophagus, bla bla bla. Most of our logical 
deduction probably goes on unconsciously, with the brain sorting through 
contextual clues to give additional information and make decisions, yet you 
are not aware of that. Take it away and pay the consequence.


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