I am wondering to what extent it could be ideal to use GNUmed's
health issue structure to manage what are considered "customary
sections" of a patient's health history.
I could envision a health issue e.g. "Family Hx" which may be able to
be created (if it did not already exist) as a debugged consequence of
typing a keyword (e.g."fhx") and filling in the popup dialog.
A doctor could create one or multiple "episodes" nested under this
item, one for each known or even suspected condition in the family.
These items would most often remain inactive, but could be made newly
active as the need arose. I could envision that when a patient
presents with leg swelling that turns out to be a deep vein
thrombosis (DVT aka "clot"), it may come up that the patient recalls
something about their father having had a "clot".
Prior to the current clinical episode of leg swelling, it would have
commonly gone unknown that his sister or father had had a "clot" and
so this new episode "query clot in sister/father" could be created
and nested under the Family Hx (in addition to the patient condition
of DVT). The plan could include the need for the patient to obtain
more information from his family and, in view of this being
unresolved information, the episode could be made active. When the
patient returns, he could reveal that his sister's clots had been a
history of painful menstrual clots and that his father had had a
heart infection passing a clot to his brain, permitting updating of
this "episode" of family history and a redesignation as not active
and not relevant. The family history would then disappear from the
EMR tree and Progress note widget lists.
Conversely a determination of a family history of malignancy,
especially premature or multiple malignancy, would cause such items
to be marked "relevant" because to inform your patient's ongoing risk
of personal cancer and help better decisions concerning screening and
diagnosis. While always deserving to be relevant when reviewing this
patient's overall problem list. the component items (episodes) might
only be toggled "active" when useful to make them visible in the
Progress notes widget, such as in preparation for a visit where the
q3yearly colonoscopy is needing to be discussed and then made
inactive when it yields a normal finding.
Even when a family condition is absent in a patient, that condition
in the family member (think cancer, Huntington's, dementia) can be
very important to your patient's health and/or their ability to keep
to a care plan.
Social history could work in a similar fashion with respect to risk
behaviours (smoking, ethanol, sex) and could include a subitem
(episode) of relationship stress when applicable.
The beauty of what GNUmed already makes possible is that for any item
in which *some other person* is discussed, for example in the family
history, or in the social history where drug abuse or sexual or
psychiatric issues (say, within the family or with partners)
justifies the assessment or treatment of the patient, the SOAP editor
makes it possible to preserve a record while segregating the directly
or indirectly identifying information into threads that could be de-
selected for export where a referral for consultation or a review of
care did not require them.
Could allergies fit into such a model? Can a health issue, or one or
more of that issue's episodes (relevant allergies, or a personality
disorder or its periodically violent behaviour) programatically feed
the caveats using a "caveats" indicator at the episode level?
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