Thursday, 7 February 2008

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.

15 comments:

A. said...

I detect the symptoms of poor database design! I can become almost obsessive about data and databases, but there we go, it's my job.

Don't you dare become a gandparent before I do. I've been waiting years! It must be my turn :)

cogidubnus said...

Too late...I've been there for seventeen years and it ony serves to make me feel prematurely aged....

cogidubnus said...

"Too late...I've been there for seventeen years and it ony serves to make me feel prematurely aged...."

And I'm still in my fifties, and I still can't spell "only"...(sorry!)

Maggie said...

I have to admit it's a long time since I thought about Trespassers W. Thank you for the reminder and the big grin it gave me. :-)

Best wishes from grey Liverpool

steph said...

That Read code sounds awfully over-complicated and leaves me suffering from shortness of breath!

I can't wait to have a reason to get all my favourite story books out of the attic again!

janeway said...

Why is the treat of reading Pooh restricted to middle class parents?

Just curious.

cogidubnus said...

"Why is the treat of reading Pooh restricted to middle class parents?"

Janeway - that's a risible assertion - it isn't...

I'm determinedly (some would say, because I got an eleven-plus pass to a Grammar School, perversely), working class, of working class parents (geordie railway clerk and cockney gas mantle maker)...

My parents read me these stories when I was little, and I've read them (among lots of other things) to my five kids too...

Why are you trying to re-introduce class into a society which is at last gradually forgetting it ever existed? Self-conscious about touching your own forelock, or ashamed of your family's position perhaps?

Dr Andrew Brown said...

Steady on, chaps! Janeway didn't say that reading Pooh was restricted to middle class parents, she was responding to my implication that this was so. I was half expecting a comment about that. I didn't mean to suggest that non-middle class parents couldn't or shouldn't read Pooh to their children, but it just struck me as a particularly middle class thing to do. I'm afraid I am bound to reveal my prejudices from time to time in what I write. I hope they will not be too awful, and please be gentle when pointing them out to me.

A.: Read codes are a bit of a sow's ear, or a curate's egg depending on how generous you want to be. And I'm in no rush to be a grandfather. One of the advantages of not being a psychopath is that I can delay gratification of my desires. :-)

Thanks everyone for your comments. I'm glad that "Trespassers W" brought back happy memories. Look, if Scousers may read Pooh then anyone can! ;-)
[Just kidding, Maggie.]

cogidubnus said...

I am puzzled...

Janeway said "Why is the treat of reading Pooh restricted to middle class parents?"

I responded to "Why is the treat of reading Pooh restricted to middle class parents?"

You said she didn't say "Why is the treat of reading Pooh restricted to middle class parents?"

What the f**k?

Dr Andrew Brown said...

Cogidubnus: I have seen so many furious arguments on the internet about who said what and what was meant by it. I do not wish to see something similar break out here.
Specifically I do not wish to see comments in which one visitor criticises another.
You can criticise me if you like: that's what comments are for. I've been surprised and relieved to have received very few critical comments so far.

cogidubnus said...

fair enough

blue eyed gypsy said...

Dr. B,
There's no 'emoticon' for tongue in cheek, else I would have used it when I posted my comment. My apologies for not making it clear it was a jest (though it was almost worth it, having caused someone actually to say "Steady on, chaps!").

janeway said...

and that last was from 'janeway'

Dr Andrew Brown said...

No worries!

My Dad was (I suppose) working class while my Mum was middle class. They were both very tolerant and it wasn't a big thing. Except that they read me Revd W Awdry instead of A A Milne.

Revd Awdry was a really nice man. I wrote to him once (aet 7 or thereabouts) and he sent me a postcard back.

Maggie said...

"Thanks everyone for your comments. I'm glad that "Trespassers W" brought back happy memories. Look, if Scousers may read Pooh then anyone can! ;-)
[Just kidding, Maggie.]"

Ha ha, while I am proud to be a Scouser now, I was born and brought up in Harrow. ;-) In fact I rather think The House at Pooh Corner I have is a first edition... But it's been loved to bits and is falling apart, and I used to tear the corners off the pages and chew them when I was a kid. (don't kids do odd things - not sure why I did it!) So it isn't worth burgling the house for it! ;-)