Re: [Gnumed-devel] Medication lists - when 'started' is uncertain

[Busser, Jim]

Today, I saw for the first time an 80 year old patient who has outlived 3 GPs.

She has no idea how long she has been on each of her 3 antihypertensives.

She does not carry with her any reliable documentation.

She is nevertheless semi-independent. Her daughter had dropped her off at the 
clinic, and awaited the patient to phone her cel for a ride home after doing a 
bit of shopping, and her memory is not terrible.

One of her medications, she believes, she started a few years ago. The other 
two, she thinks, she has been on for between 5 and 15 years.

--> What "start date" it is suggested that I fabricate?

--> Where do I record, in a place in GNUmed where I will reliably see it, the 
cave to ignore some medication start dates as completely unreliable?

My least-worst option currently is to

1) enter the current date

2) accept that in my GNUmed-current my "Started" date cannot be reliable except

- if I inputted no dates older than my first use of GNUmed purely when such 
dates were known exactly, and

- accept that GNUmed will forever (and increasingly) contain a mixture of 
accurate dates and made-up, fabricated or guess-timated dates, plus dates where 
I did not even bother to figure out when the drug was started, and where I 
simply accepted the default current date.

I find the above to be less helpful than to enter no date at all.

Which GNUmed does not permit.

So, while I do not wish to seem overly critical, this is not IMO a very 
acceptable solution.

We had quite a fight or struggle (figuratively, not literally) within this 
project a couple of years ago, when it was eventually accepted that it might be 
necessary to allow to create a patient's record without a date of birth.

The use cases included:

(a) having to capture communication about a patient in advance of their first 
visit, and

(b) the recognition that, in the case of very old patients, an accurate date of 
birth was sometimes not known.

These are what gave rise to supporting a date of birth to be recorded as 
'estimated' rather than known precisely.

I am having trouble to understand why, therefore, the insistence to input a 
medication start date when the start date can legitimately be

        "not known".

I will appreciate this point to be conceded and, with 1.4x, either (or both)

- relaxation of the constraint and / or

- adding, in the GUI, a boolean checkbox representing a backend column

        is_uncertain

-- JIm