Subtypes of clinical finding

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Make clinical history, clinical picture, diagnosis, image finding, and
laboratory finding subtypes of clinical finding

Original issue reported on code.google.com by albertgo...@gmail.com on 9 Sep 2009 at 3:44

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I was thinking of this a little differently:
Representation
   Clinical Finding
         Clinical History (Symptoms)
         Physical Exam Findings (Signs)
         Lab Findings
         Image Findings
   Clinical Picture
   Diagnosis

Original comment by arab...@gmail.com on 18 Sep 2009 at 8:29

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BARRY SMITH response:
This looks good to me, except for the mixing of singulars and plurals
and some questions about clinical history and symptoms/signs
Correct version should be:

Representation
  Clinical Finding
        Physical Exam Finding
        Lab Finding
        Image Finding
  Clinical Picture
  Diagnosis

Questions
Can a clinical history not include the clinician asking the patient
about previous physical exam findings?
If we focus on the history of symptoms, can we divide these coherently
into two sorts:

i. those (such as pains, feelings of nausea) only experienceable by the patient
ii. physical symptoms (episodes of coughing, rashes)

Is a clinical history properly speaking a finding, or rather a
documentation of a set of findings?
BS

Original comment by albertgo...@gmail.com on 21 Sep 2009 at 2:52

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SIVARAM ARABANDI response to BARRY SMITH:
As the conversations on 'Symptom' and 'Sign' (note the use of singular) have 
shown,
it is tricky to pin down what is or is not reported during a clinical history 
taking.
But lets look at it from a what it should be (as opposed to what it can be):

Clinical History (syn. Medical History) is the information obtained from the 
patient.
This consists of the history of present illness, review of systems, past 
history,
family history, social history, sexual history, etc. The wikipedia definition 
is 
"Medical History of a patient is information gained by a physician or other
healthcare professional by asking specific questions, either of the patient or 
of
other people who know the person and can give suitable information" . 

Q)  Can a clinical history not include the clinician asking the patient about
previous physical exam findings?
Clinical history focuses on what the patient feels and thinks. Patients can talk
about prior physical exam findings (i.e. signs) but these wouldn't be 
considered as
'Symptoms'. We should think of Clinical History as a documentation of a set of
findings. And is not equal to just symptoms.

Q) can we divide these (symptoms) coherently into two sorts  (see below for 
details)?
From the examples, I think you want to differentiate between those that can 
only be
felt by a patient and those that can be also be observed by a physician. I am 
not
sure if there is a need for this differentiation - we may be complicating things
unnecessarily.  In one of the other discussion, I had suggested the following:
"Symptom and Sign may be defined as subtypes of Clinical finding which would be 
the
representational artifact counterpart of Clinical feature. This will allow 
certain
Clinical features to be classified as both Symptom and Sign where needed (at the
instance level)."

I found this on wikipedia: 
http://en.wikipedia.org/wiki/Sign_(medicine)#Signs_versus_symptoms

Q)  Is a clinical history properly speaking a finding, or rather a 
documentation of a
set of findings?
Yes, clinical history would be a documentation of a set of findings discovered 
by a
physician based on interviewing the patient. 

Here is a new version (the discussion for some of this is on the wiki -
http://code.google.com/p/ogms/wiki/PhenotypeAndRelatedConcepts) :

Bodily Feature (syn. Phenotype)    -  is there really a difference between the 
two?
Clinical Feature (syn. Clinical Phenotype)   - def. = a bodily feature that is
clinically significant. (includes both normal as well as abnormal features).
Disease Phenotype  - def.= a clinical feature associated with one or more 
diseases
(or disorders) and is indicative of something abnormal
Normal Phenotype
Representation
Clinical Finding
         Symptom  - def.= a clinical feature that is reported by the patient during a
clinical history procedure (i.e. outputOf ClinicalHistoryProcedure).
Sign  - def.= a clinical feature that is discovered by the physician during a
physical exam procedure (i.e. outputOf PhysicalExamProcedure).
         Lab Finding
         Image Finding
Clinical Picture
Diagnosis

Procedure
Clinical History procedure
Physical Exam procedure

thanks,
Sivaram

Original comment by albertgo...@gmail.com on 21 Sep 2009 at 2:55

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I noticed that the indentation of the proposed new structure was lost. Here it 
is:

Bodily Feature (syn. Phenotype)    -  is there really a difference between the 
two?
    Clinical Feature (syn. Clinical Phenotype)   - def. = a bodily feature that is clinically significant. (includes
                                                                                                  both normal as well as abnormal features).
        Disease Phenotype  - def.= a clinical feature associated with one or more diseases (or disorders) and
                                                                 is indicative of something abnormal
        Normal Phenotype

Representation
    Clinical Finding
        Symptom  - def.= a clinical feature that is reported by the patient during a clinical history procedure
                                                 (i.e. outputOf ClinicalHistoryProcedure).
        Sign  - def.= a clinical feature that is discovered by the physician during a physical exam procedure
                                        (i.e. outputOf PhysicalExamProcedure).
        Lab Finding
        Image Finding
    Clinical Picture
    Diagnosis

Procedure
    Clinical History procedure
    Physical Exam procedure

Original comment by arab...@gmail.com on 21 Sep 2009 at 4:08

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Propose the following refinement to the previous version:

Bodily Feature (syn. Phenotype) - is there really a difference between the two?
                                      (see NOTE below)
   Clinical Feature (syn. Clinical Phenotype) - def. = a bodily feature that is clinically significant. (includes
                                                           both normal as well as abnormal features).
         Disease Phenotype - def.= a clinical feature associated with one or more diseases (or disorders) and
                                      is indicative of something abnormal
         Normal Phenotype - def.= a clinical feature that is not known to be associated with a disease or disorder
         Symptom  - def.= a clinical feature that is a departure from normal function or feeling which is 
                          noticed by a patient, indicating the presence of disease or abnormality. A symptom is 
                          subjective, observed by the patient, and not measured. [wikipedia]
                                 e.g.: pain, cough, difficulty in swallowing, breathlessness, palpitations, nausea,
                                                      tiredness, etc
         Sign  - def.= a clinical feature that is discovered by a physician, is objective and measured
                           e.g.: tenderness, 3rd heart sound, rales, respiratory rate, blood pressure measurement, etc

Representation
   Clinical Finding
        History finding - def.= documentation of a Symptom reported by the patient during a 
                                                                         clinical history procedure
                                  (i.e. outputOf ClinicalHistoryProcedure).
                                  e.g. h/o chest pain, no h/o palpitations, past h/o breathlessness, etc
                                  This definition may be loosened up to include documentation of events, disorders/diseases
                                        that have occurred in the past, procedures, complications, medications etc.
        Physical Exam finding - def.= documentation of a Sign that is discovered by the physician during a
                                                                         physical exam procedure
                                  (i.e. outputOf PhysicalExamProcedure).
                                  e.g.: tenderness absent, rales (or crackles) heard on auscultation, 
                                                 respiratory rate increased, etc 
        Lab Finding
        Image Finding
   Clinical Picture
   Diagnosis

Procedure
   Clinical History procedure
   Physical Exam procedure

Original comment by sivaram....@gmail.com on 20 Nov 2009 at 2:19

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NOTE: is there no difference between bodily feature and phenotype? Here are 
some examples to work with:
1. Cough?
    - it is clearly a Clinical Feature. But is it a (clinical) Phenotype?
    - if we think of Cough as a function of the respiratory system and its purpose is to clear the breathing
passages of irritants, excess secretions etc., then it can thought of as a 
Phenotype.

2. Pain?
3. Dysphagia (difficulty in swallowing)?

Original comment by sivaram....@gmail.com on 24 Nov 2009 at 9:16

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Original comment by albertgo...@gmail.com on 24 Nov 2009 at 9:18

• Changed state: Started

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The problem is that scientists use phenotype both to refer to something as 
atomic as
eye color as well as to refer to an entire constellation of features such as 
with
Down syndrome.

Original comment by hoga...@gmail.com on 24 Nov 2009 at 10:49