Re: [Gnumed-devel] need assessment from fellow clinicians

[Karsten Hilbert]

> Now if you come to the over-riding diagnosis last, how will you mark then 
> connection?
> Lady, about 65 develops NIDDM.
> NIDDM progresses rapidly to requiring insulin
> She develops vulval dystrophy (*obviously* unconnected)
> 5 years later she has alopecia totalis and is diagnosed as DLE.
> Later, I realise that she never had NIDDM, she has autoimmune disease and 
> destroyed her pancreas and her skin.
> this is a real case - and I have another similar case.
> the problem is real, because the chronic disease by nature will first appear 
> as a series of unconnected episodes. then a connection is made to an 
> underlying problem.

This is *precisely* what we allow to do with the entire
issues/episodes stuff.

In that lady I would have recorded a bunch of episodes over
time. Early in that development I would have thought I had
identified NIDDM as an issue but later found out that
all those episodes really belong to "autoimmune disease". No
problem - just relink the episodes and done !

The above is also quite a nice example of why I think most of
the time the doc will deal with episode names rather than
issue names. Deciding on "issue" is rare. It is also why I
think at first most episodes will belong to the xxxDEFAULTxxx
health issue, eg. they aren't "issued" yet.


Karsten
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