Editorials: Reasons for Encounter in General Practice
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Scand J Prim Health Care 1985; 3: 129-132 Editorials Reasons for Encounter in General Practice In order to gain a better impression of the problems dealt with in general medical practice it has been suggested that one should record and classify the patient’s complaint(s) parallel with or instead of the doctor’s diagnosis. Unfortunately there are many problems connected with classifying the encounter between patient and hisher general practitioner. A classification is a common standard that facili- tates comparisons not only between countries, but also between different regions within the same country. However, such standardization implies many difficulties. Symptoms registered by the doc- tor are not the same as those reported by the pa- tient. The individual terminologies are clearly dif- ferent. The desire for comparability and standardization within the medical profession makes it necessary to preserve the doctor’s terminology despite great in- ter-doctor variability. A doctor will for example stress a certain symptom more than the patient does. Differences between expressions make com- munication difficult. There is often considerable difference between the professional and the lay interpretation and perception of what is important. The question is therefore: how much will we gain by recording the reason for a patient’s visit instead of registering the diagnosis. It is conceivable that the concept of illness and consequently of aetiology and even diagnostics are influensed by fundamental features of the doctor’s attitude. The doctor’s classifcation of the reason for the patient’s visit therefore depends just as much on perception and interpretation as on the nature of the problem per se. It would be interesting to com- pare the doctor’s attitudes to health and illness and his recording of various reasons for encounter. In addition to the inter-doctor variability, the classification system itself can give rise to prob- lems. It is of importance that a classification system is exclusive and exhaustive. Any encounter should be classified in one and only one way. On 9-858823 the other hand it must be possible to place any reason for encounter somewhere in the system. It is an advantage if the system has a hierarchical structure so as to ensure that concepts not well defined can be gathered under superior concept headings. However, this demands a fundamental common idea of these superior concepts. In this issue of the Journal, Nylenna de- scribes a study in which he classifies the reasons for consultation in general practice according to a simplified version of the WHO “Reason for En- counter Classification”. This is a two-dimensional system. One part deals with the location of the complaint, while the other indicates the kind of problem. It is thus possible to combine type and location of the reason for the patient’s visit. In order to gain experience with different classifica- tion systems, it is also of great value to try out this classification system in a simplified version, as in Nylenna’s study. This will make it possible to find and agree upon a common classification system. International comparison presumes consensus about classification. A study (1) has been carried out in Denmark, in which the reason for encounter according to the location of the complaint was so recorded. Moreover, it was possible to define the type of contact. In this study some of the results differed from Nylenna’s findings, but the compari- son is not ideal due to lack of mutually standardized recording in the two studies. The aim must be to exclude inter-doctor variabil- ity. This would make it possible to demonstrate differences in morbidity and the threshold of the popuIation for making a visit to a general practition- er. Furthermore it is of importance to record the diagnosis together with the reason(s) for encounter. This makes it possible to describe the diagno- sis which the doctor relates to certain reasons for the patient’s visit, and secondly: the reasons for encounter or complaints as recorded from patients with a certain diagnosis. Scand J Prim Health Care 1985; 3 Scand J Prim Health Care Downloaded from informahealthcare.com by Fontys Hogescholen on 10/28/14 For personal use only.
Transcript of Editorials: Reasons for Encounter in General Practice
Scand J Prim Health Care 1985; 3: 129-132
Editorials
Reasons for Encounter in General Practice
In order to gain a better impression of the problems dealt with in general medical practice it has been suggested that one should record and classify the patient’s complaint(s) parallel with or instead of the doctor’s diagnosis. Unfortunately there are many problems connected with classifying the encounter between patient and hisher general practitioner.
A classification is a common standard that facili- tates comparisons not only between countries, but also between different regions within the same country. However, such standardization implies many difficulties. Symptoms registered by the doc- tor are not the same as those reported by the pa- tient. The individual terminologies are clearly dif- ferent.
The desire for comparability and standardization within the medical profession makes it necessary to preserve the doctor’s terminology despite great in- ter-doctor variability. A doctor will for example stress a certain symptom more than the patient does. Differences between expressions make com- munication difficult. There is often considerable difference between the professional and the lay interpretation and perception of what is important. The question is therefore: how much will we gain by recording the reason for a patient’s visit instead of registering the diagnosis. I t is conceivable that the concept of illness and consequently of aetiology and even diagnostics are influensed by fundamental features of the doctor’s attitude.
The doctor’s classifcation of the reason for the patient’s visit therefore depends just as much on perception and interpretation as on the nature of the problem per se. It would be interesting to com- pare the doctor’s attitudes to health and illness and his recording of various reasons for encounter.
In addition to the inter-doctor variability, the classification system itself can give rise to prob- lems. It is of importance that a classification system is exclusive and exhaustive. Any encounter should be classified in one and only one way. On
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the other hand it must be possible to place any reason for encounter somewhere in the system. It is an advantage if the system has a hierarchical structure so as to ensure that concepts not well defined can be gathered under superior concept headings. However, this demands a fundamental common idea of these superior concepts.
In this issue of the Journal, Nylenna de- scribes a study in which he classifies the reasons for consultation in general practice according to a simplified version of the WHO “Reason for En- counter Classification”. This is a two-dimensional system. One part deals with the location of the complaint, while the other indicates the kind of problem. It is thus possible to combine type and location of the reason for the patient’s visit. In order to gain experience with different classifica- tion systems, it is also of great value to try out this classification system in a simplified version, as in Nylenna’s study. This will make it possible to find and agree upon a common classification system. International comparison presumes consensus about classification. A study (1) has been carried out in Denmark, in which the reason for encounter according to the location of the complaint was so recorded. Moreover, it was possible to define the type of contact. In this study some of the results differed from Nylenna’s findings, but the compari- son is not ideal due to lack of mutually standardized recording in the two studies.
The aim must be to exclude inter-doctor variabil- ity. This would make it possible to demonstrate differences in morbidity and the threshold of the popuIation for making a visit to a general practition- er. Furthermore it is of importance to record the diagnosis together with the reason(s) for encounter. This makes it possible to describe the diagno- sis which the doctor relates to certain reasons for the patient’s visit, and secondly: the reasons for encounter or complaints as recorded from patients with a certain diagnosis.
Scand J Prim Health Care 1985; 3
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130 Editorial
It would be of the greatest value to emphasize the of being aware Of the interaction be-
tween the patient and the doctor in order to im- prove the basis for registration.
REFERENCE 1. Sygdomsmenstret i almen praksis. Laegekredsfore-
ningen for khus amt, 1979.
Laurirs Owsen Arhus
Arctic Medicine
The Arctic area consists of the circumpolar zone: Northernmost America, Greenland, Iceland, Northernmost Scandinavia and Siberia. It is very sparsely populated and restrictions to life is com- mon to the whole area. The organic productivity is small. The low temperature and sparse sunlight are the most important factors governing evolution. Nevertheless there is a fairly versatile fauna and hence human life is also adapted to the stress of the last frontiers.
The Arctic peoples today consist of two quite different groups: the indigenous peoples or natives, and the newcomers. The natives consist of about seventy more or less small ethnic groups. Most of them have been nomads until now. They number about 6OOOOO. Well known groups in the Arctic are Inuits (Eskimos) in Alaska, Canada and Greenland; Lapps (Saami, Samek) in Northern Scandinavia and Kola Peninsula; in Alaska there are also Aleuts and Indians; in Siberia, Chuchies, Yakuts, Evenks, Nenets, Mansies, Koryacs, etc. Today most Arctic dwellers are newcomers. The total population is already several millions. The settlers are not adapt- ed to the strange circumstances.
The scope of arctic medical research must be wide. The health problems must be correlated to the special cultural, ecological, organizational and political backgrounds. The change in culture in- volves and influences both the indigenous people and the newcomers. Their cultures, relatives and roots are thousands of kilometres away. The results to both parts are: mental disturbances with alcohol- ism, suicides, homicides, etc.
Today we are equipped technically, e.g. telecom- munications for X-ray investigations, ultrasound in- vestigations and ECG registration, airplanes and helicopters, etc., but such are expensive-and
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more expensive in the Arctics than anywhere else. So too are research, educational activities, etc.
The pattern of disease in the Arctic has changed radically during recent decades. The average life- time increased considerably with the overcoming of tuberculosis and other infections. If we look at the mortality statistics among Alaskan natives in 1950, tuberculosis was the most common cause of death; since then, accidents, influenza, pneumonia and certain diseases of infancy became more promi- nent. In 1979 the order was different: accidents, cardiovascular diseases, malignant neoplasms, homicides, influenza and pneumonia. Similar trends can be seen in other countries.
Arctic medical problems are discussed regularly at international symposia on circumpolar health. The Nordic Council for Arctic Medical Research has been founded in 1969 by the governments of Norway, Sweden, Finland, and Denmark. It co- ordinates the Arctic medical research work in the Nordic countries. Its permanent secretariat is in Oulu, in Finland.
In this issue an article by Peter Bjerregaard about infectious diseases among the Greenlanders of Upernavik is published. Infectious diseases were the cause of death in only 15% of deaths, but in daily work in general practice they constitute a major part, 41% of the contacts being caused by infectious diseases.
It is important to all general practitioners to get this information of changes in patterns of disease, especially within the infectious diseases. On the other hand we must admit that very many factors make it impossible to compare results from one place with another in the enormous Arctic area. Not only do diseases differ, but also the organiza- tion of health care, possibilities of registering dis-
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