Re: [Gnumed-devel] Debate on the AOE/Summary of Encounter

[Richard Terry]

Comments on the Below and the attatched png dump regarding summaries.

We may be getting into semantics here re the AOE. Can you explain again what 
you mean by this. I took it to mean a summary of the entire (multiple SOAPS) 
of a patient episode, becuase this is what I have used in my clinical notes 
for the last 22 years.

My Summary of Encounter (on my paper records) lived in the right hand column 
of my progress notes and contained significant info re the consulation. That 
way one can scan entire years of consultations very quickly to get the 'FLOW' 
of the patients health over a period of time. 

I've found this very useful when trying to either elucidate difficult cases 
(or to look back where I could have fucked up and made a diagnosis earlier, 
for example - my paper could notes look something like this (but I hope not!, 
the case is for demo only)

date                notes                                 summary
-----------------------------------------------------------------
01/02/2002    bla ba                                vague abdo pains ?cause
10/03/2002   BP script, pain gone
                     anxiety, panic attacks                     Panic Attacks
11/10/2003    vomiting/diarrhoea etc            Gastroenteriitis
12/12/2003      vagues abdo pains, last
                         colonoscopy 12/2002-NAD
                        marital upsets ++ anxiety        Abdo pains/Anxiety
01/02/2004      Rectal bleeding bla bal          >colonoscopy
15/02/2004      Review colonoscopy
                       inoperable rectal carcinoma              Ca Rectum

Here the right hand column serves as a 'memory jogger'. review.
One has the quick info + the more detailed info. In this case perhaps my 
judgement that the patients chronic anxiety condition could have been causing 
his abdominal pains (as it had for the last 20 years) could have clouded my 
judgement and made me miss the Ca Rectum (touch wood this has never 
happened).

Even after 20 years, most patients only have half a dozen or more pages unless 
they have been extremely complicated.

There is no reason why the gnuMed notes shouldn't be presented in that format.

In my computerised records, I had a text box pop up asking for the summary and 
used the popup phrase wheel to present any previous summaries (for any 
patient) as the pick list, because obviously many summaries will match (eg 
Annual checkup, Anxiety attack, Colonoscopy arranged,  etce tec. See the 
attatched png.

> > The AOE is as the name suggests an assessment or summary of the entire
> > encounter which will most often be made up of many soap notes.
>
> Since I invented the term I shall take the liberty to
> disagree. What I had in mind is this (and this is consistent
> with some of the literature):
>
> patient has problem, comes in, states as RFE
>
> doctor dissects the problems and acts
>
> doctor writes one AOE per "episode"
>
> I have started to think that AOE isn't the best term for what
> I intended. Actually, what I thought it would contain is the
> "outcome" of the encounter-part relating to one episode (which
> may exhaust itself in that one encounter).
>
> I agree that perhaps it is not useful in the basic version of
> a "SOAP" SOAP control to include the RFE as it would usually
> already be there (disregarding the "quality" of it) courtesy
> of frontdesk staff. So, in this specific instance, let's
> follow Richard's advice but in *principle* - no, if someone
> feels like including the RFE - fine.
>
> > AOE textbox probably at bottom the progress notes screen which will
> > contain a summary/doctors comments of the ENTIRE encounter
>
> This is not what I intended. Also, this is not possible in the
> backend. The backend links AOEs to episode-encounters. We do
> not have a field for "summary of encounter". That would,
> however, be generatable. Just concatenate all the AOEs for one
> encounter.
>
> Karsten

medical_records_summary.png
Description: PNG image