Yet another OBSERVATION vs. EVALUATION issue

Thomas Beale thomas.beale at oceaninformatics.com
Sun Aug 19 07:24:35 EDT 2012


We can't just ditch the word 'diagnosis' - it's not up to any standards 
community to do that. The diagnosis concept, which I agree can be 
weak/ambiguous in general practice, certainly isn't in the acute sector.

I don't have a problem with philosophical arguments that question the 
meaning of the 'diagnosis' concept, but it's not our job in a place like 
openEHR to dictate a new philosophy of medicine to the sector. We need 
instead to reflect the needs of what actually goes on. If 'diagnosis' is 
clearly used in acute care, but only weakly in general practice, we need 
to reflect that.

This is one of the reasons for having a 'problem' archetype and a 
'diagnosis' archetype, as has been done in openEHR. It becomes an 
optional extra to actually call the assessment a 'diagnosis', to code 
it, and to give it a status ('working' or whatever). There may be better 
ways to do that, but I don't think throwing out 'diagnosis' as an 
archetype concept is useful.

- thomas

On 18/08/2012 12:10, Gerard Freriks wrote:
> Good.
>
> lets ditch the term 'Diagnosis' completely.
> Or use it only when we are -as you write- scientifically certain.
> And use other terms. We (EN13606 Association) prefer the 'Reasons for 
> ...' type of terms, because that is what they do in real life.
> They are the excuses to do something (or nothing); they are the cost 
> drivers in healthcare; they must be documented.
>
> Words like 'symptom', 'sign', 'syndrome', 'diagnosis', are fuzzy terms 
> that can mean too many things.
> We need well defined terms in our systems and standards as points of 
> reference we agree on.
> Locally all users must be allowed to use their own fuzzy terms as long 
> as they are mapped to (and used in accordance with) the reference terms.
> *
> *
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