What Diagnosis?

Share | In the early nineteen sixties Larry Weed promoted the problem oriented medical record (POMR) in order to focus physicians on all of a patient's problems rather than focusing mainly on the chief complaint. No doubt the problem oriented approach was a systems improvement resulting in an improvement in medical care. Indexing all of the problems on a list with dates and resolutions made better sense of the patient record. The POMR was widely accepted but usually implemented in a mixture of the traditional source oriented medical record and the system promoted by Larry Weed. A medical school may title the teaching as POMR and then proceed to teach source oriented history taking with a chief complaint and a problem list.

Some complain that the POMR tends to focus on treating problems whilst ignoring diagnosis. Indeed, medical records and reimbursement documents force a qualifying diagnosis, but anyone wrestling with the ICDA diagnostic codes knows that a diagnosis can be written at various levels, four digits or five digits. For example are we treating cough, community acquired pneumonia or pneumonia due to a specific organism? The list is  long and reflects historical diagnoses based on gross findings. A physical diagnosis without regard to the bio-molecular underpinnings may be based on the problem list. For example: gastritis, hypertension, pneumonia, colitis, arthritis, arrhythmia, etc. 

The qualifying diagnosis for the guidelines may not accurately reflect the true underlying condition.