Re: [Gnumed-devel] Changes to GuiMain - Suggestions (ctd)

[Karsten Hilbert]

David,

I have thought long and hard about the multi-problem problem.
:-)

Due to my limited work experience I have only been able to
experiment so much, however.

May I propose the following:

Given that an episode based structure is implemented our
multi-problem encounter would become an multi-episode encounter.
Now, either during typing or during rearranging the typed
notes I want to be able to hit <Alt-E> to change the episode
for the current logical block.

Logical blocks are S/O/A/P or whatever system one uses.
Logical blocks also would be notes taken previously (like
before doing the sonography) and now during the same
encounter. However, if I then attach the same episode to them
notes of the same type (SOAP) will be grouped into one logical
block except if they are separated by a configurable amount of
time (the patient came in the morning with subacute
Appendicitis and came back in the late afternoon after
deterioration).

An example:

Patient with abdominal pain.

Tells me "pain, steady, not really convulsive although at
times worsening, no throwing up, since yesternight"

I type that and attach the episode "subacute appendicitis" as
my working diagnosis. This is now a logical block.

I then do the physical and write down my findings. They are
another logical entity because of being of a different type (O
vs. S).

Then the patient says "Ah, doctor, I _did_ throw up once this
morning. I forgot about that." I'll type that and _right now_
it is a logical block separate from the first "S" notes logical
block. However, when I change notes type again (or leave the
record or whatever) it will be grouped with the first "S"
notes logical block since the data was captured during the
same encounter AND I didn't change episodes.

Then the patient remembers that his left ankle is still
bothering him at times due to that last-years fracture which
prompts me to type some more notes after selecting the
appropriate old (or creating a new if non-existant) episode by
just typing <ALT-E>. "S" notes logical blocks for this episode
need to remain logically separate from the "S" notes of the
"subacute append." episode.

I need to be able to switch episodes quite at will.

Now, if the patient returns in the evening for deterioration
of the abdominal pain (don't take me up on the medical side
here - he did throw up in the moring already :-))  I will
reselect the old episode (the one selected last in the
morning should be autoselected) and type a few more notes and,
say, a referral letter. Those notes, even if of type "S" and
belonging to the same episode as in the moring should remain
a separate logical block since it effectively is a different
patient-encounter.

Another approach would be to cycle through existing episodes
for this patient upon hitting <ALT-E>. On wrapping around a
field for typing a new episode name is offered.

Am I making any sense here ?

I do see your point about not using the word wheel for "S"
notes.

> My notes are a summary of the consultation not a 
> re-enactment. (It was only barely sufficiently interesting the first time 
> through.) 
:-))

Karsten
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