Blog posting on ICD-10 and Diagnosis

Mark H Ebell ebell at UGA.EDU
Wed Nov 11 16:01:33 UTC 2015


Great points, John.

Does anyone know if UM is gathering ICPC codes any more? Seems like there must be some health system (even if not in US) that is still doing this so we can follow episodes of illness rather than individual encounters.

From: "Ely, John" <john-ely at uiowa.edu<mailto:john-ely at uiowa.edu>>
Date: Wednesday, November 11, 2015 at 10:24 AM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Mark Ebell <ebell at uga.edu<mailto:ebell at uga.edu>>
Subject: RE: [IMPROVEDX] Blog posting on ICD-10 and Diagnosis

Thanks for sending these Mark.  As you’ve noted, we know surprisingly little about the prevalence of the diseases that cause common symptoms in primary care.  Most differential diagnoses in textbooks and online resources are organized according to anatomy or body system, and we often teach medical students to use these organizational methods (or a mnemonic like VITAMIN D) when trying to generate a differential diagnosis from memory.  But these methods are not very helpful to clinicians.  I think more helpful would be to order the differential diagnosis according to disease prevalence, with the most prevalent diseases at the top.  (If we only knew what these prevalences were . . .)  There are other possibilities for ordering the diagnoses.  We could list serious “don’t miss” diagnoses first, followed by less serious diagnoses, and that would often lead to the reverse order of the prevalence method since rare diseases tend to be serious and common diseases tend to be benign.  Or we could list them in order of which ones are easiest to rule out with a simple test or physical exam maneuver or additional question in the history.  You could even limit the list to don’t miss diagnoses to make it shorter, but I think a comprehensive differential diagnosis would be most useful because, when it comes to diagnosis, the clinician has two jobs:  (1) Don’t miss bad diseases and (2) Make the right diagnosis.  You can’t do the second job with just the don’t-miss list.

John

From: Mark H Ebell [mailto:ebell at UGA.EDU]
Sent: Tuesday, November 10, 2015 8:53 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: Re: [IMPROVEDX] Blog posting on ICD-10 and Diagnosis

The Europeans, and in particular the Dutch, used this system. I know the Lee Green (Alberta) and Don Nease (Colorado) were working with it and created software around it while at Michigan. And, Henk Lamberts published a series of great articles. I’ve attached a couple, I published the grainy one while I was editor of JFP because I thought it was so important. Unfortunately, Henk died a few years ago.

Best,

Mark

From: Mark Graber <mark.graber at improvediagnosis.org<mailto:mark.graber at improvediagnosis.org>>
Date: Tuesday, November 10, 2015 at 9:49 AM
To: Listserv ImproveDx <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, Mark Ebell <ebell at uga.edu<mailto:ebell at uga.edu>>
Subject: Re: [IMPROVEDX] Blog posting on ICD-10 and Diagnosis

Thanks to Mark Ebell for calling attention to the WHO's classification system, the International Classification for Primary Care (ICPC-2).  One NICE feature in ICPC-2 is that it captures the reason for the encounter, which would be a huge help to future research on diagnostic error.  We need that !

Our exclusive use of ICD-10 in the US is a complicating factor in regard to research, because so often a presumptive diagnosis is chosen instead of just the chief complaint.


Mark L Graber MD FACP
President, SIDM  www.improvediagnosis.org<http://www.improvediagnosis.org>

On Nov 9, 2015, at 8:47 PM, Mark H Ebell <ebell at UGA.EDU<mailto:ebell at uga.edu>> wrote:

How about:

http://www.who.int/classifications/icd/adaptations/icpc2/en/

Mark Ebell

From: "graber.mark at GMAIL.COM<mailto:graber.mark at GMAIL.COM>" <graber.mark at GMAIL.COM<mailto:graber.mark at GMAIL.COM>>
Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>, "graber.mark at GMAIL.COM<mailto:graber.mark at GMAIL.COM>" <graber.mark at GMAIL.COM<mailto:graber.mark at GMAIL.COM>>
Date: Monday, November 9, 2015 at 11:08 PM
To: "IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>" <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>
Subject: [IMPROVEDX] Blog posting on ICD-10 and Diagnosis

Dr Yul Ejnes (an internist and  past chair of ACP's Board of Regents) has an interesting  blog post<http://www.kevinmd.com/blog/2015/10/icd-10-isnt-just-the-problem-its-also-the-symptom.html> on the new ICD-10 coding system.  Echoing the same point made in the IOM report Improving Diagnosis in Health Care, he labels ICD-10 an "absurdly complicated payment 'non-system'" and calls for "alternatives that make getting the diagnosis right more important than selecting the correct code."

Mark L Graber MD FACP
President, Society to Improve Diagnosis in Medicine

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