Trespassers W

As I mentioned before, we try to record all our consultations under Read coded “problem headings”. The Read Code system has many defects, although that didn't stop the NHS from paying an extremely large sum of money to Dr Read for the copyright. There are plans to move to a (supposedly) better system called SNOMED but, like all aspects of IT in the NHS, progress is slow and the outcome uncertain.

Read codes are divided up into sections, and all the codes in a given section begin with the same number or letter. So history codes begin with a “1”, disease monitoring codes begin with a “6”, and disease codes begin with a capital letter, depending on the type of disease. Respiratory diseases begin with an “H”, and H33 is the disease code for “asthma”. If you have a patient with mild asthma you could use “History of asthma” (a history code), “Mild asthma” (a disease monitoring code) or “Asthma” (H33) as your problem heading. It is good practice to use the disease code whenever possible. If you have “History of asthma”, “Mild asthma” and “Asthma” in your problem list then doctors may record their consultations under different headings rather than just one. And if you have just “Mild asthma” in the problem list then the patient won't show up when you search for asthmatic patients using the H33 disease code. It is the devil's own job to stop staff putting “Mild asthma” in the problem list, and you can understand their confusion. The patient has mild asthma, here is a Read code called “Mild asthma”, why can't we use it?

In general practice we frequently see disease at a very early stage, when it is said to be “disorganised”. That means that the symptoms and signs have not yet organised themselves into recognisable clumps that any old doctor should be able to diagnose. When I was a surgical houseman my SHO used to get cross with GPs who sent in patients with abdominal pain of short duration. “Even God cannot diagnose appendicitis after twenty minutes!” he would say. And it is easy to criticise GPs for failing to make the diagnosis that is obvious by the time they see the specialist some while later. Vague symptoms are our stock in trade, and very often we cannot choose a definitive disease code at the first consultation. Fortunately there are some “vague” diagnosis codes like “Chest pain”, “Abdominal pain” and “Dyspnoea” (medical jargon for breathlessness). And sometimes we use history codes for this purpose.

Today I was delighted to come across a patient where Martha had used the history code “Shortness of breath”. This took me back many years to the time when I would read Winnie-the-Pooh stories to my children at bedtime. No middle-class parent should miss out on this treat, and the opportunity it gives to invent special voices for the characters (based, of course, on Alan Bennett's interpretation). Piglet, you may recall, had a grandfather called Trespassers W, which was short for Trespassers Will, which was short for Trespassers William. And Piglet's grandfather had had two names in case he lost one - Trespassers after an uncle, and William after Trespassers.

Round this spinney went Pooh and Piglet... Piglet passing the time by telling Pooh what his Grandfather Trespassers W had done to Remove Stiffness after Tracking, and how his Grandfather Trespassers W had suffered in his later years from Shortness of Breath, and other matters of interest.

I am looking forward to becoming a Grandfather myself so that I can have the pleasure all over again, though Stiffness and Shortness of Breath will not be so welcome.