Re: [Gnumed-devel] EMR tree display of allergy

[James Busser]

On 20-Sep-08, at 4:42 PM, Karsten Hilbert wrote:

> > > > Unknown (I suggest Unasked is better)
> The "unknown" comprises more reasons for "state not known" than  
> unasked.
>
> It says that the state is not known to the GNUmed system (and thus  
> to the clinician). It　also means
> the clinician is still litigable for that state.
>
> > > > Undisclosed (I strongly prefer Unanswered)
> Fine with me. It is intended to mean that the state is STILL  
> unknown but the clinician is not
> litigable for it anymore (because it WAS asked but not disclosed).
>
> BTW, undisclosed is intended to mean "patient could have disclosed  
> but did not" while "unanswered"
> seems to also encompass "patient was unable to answer" (because  
> unconscious ;-)

To your point about responsibility (litigibility):

Until the point where the question gets asked, the reasons for  
"unknown" seem rather moot. Inputting "unknown because the record was  
only just created and the patient has not yet been seen in the  
praxis" feels to me to have no value.

So while I grant (accept) that if you are supplied with information  
about a patient, say on transfer of care, then you could potentially  
know their allergy information without having asked. Yet at the point  
of transferring it into GNUmed you maybe ought to confirm, any way,  
by direct inquiry from the patient. So "unasked" does remain, to my  
mind, the "state" that cannot be left this way.

I have, by the way, reviewed the discussion in the archive, including

        http://lists.gnu.org/archive/html/gnumed-devel/2006-08/msg00008.html

Once a clinician asks, it is still possible for it to be unknown or  
at least uncertain. The patient may

1) confirm what already exists in other form, for example in transfer  
or personal documents
2) provide you with the information from memory
3) indicate that there exists something about their information that  
they are not prepared to (fully) share

So we are not yet fully through the list of possibilities and yet  
have already reached a branch point. Suppose a patient discloses that  
they are allergic to nuts, but you judge somehow that they are  
holding back something else from you. Do you enter the nut allergy  
*and* put "Undisclosed" if the program logic would even allow this?

Next, even if no nut allergy would have existed, removing from issue  
the program logic, do you put "Undisclosed" just on suspicion, or do  
you at least get affirmation from the patient that there is at least  
partial undisclosure not because of any dislike of you as a clinician  
but because there is something that they simply do not wish in their  
record at this point?

Once you share your view of the above, could you then share how you  
would handle the situation where the patient does recall pretty  
confidently that they did indeed, in the past, have a problem with  
one of their previous medications, but simply cannot remember the  
medication, but they do or don't clearly recall the adverse reaction?