Family Medicine
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ICPC Use in Family Medicine Research World Book of Family Medicine – European Edition 2015 electronic ordering of laboratory tests (4). ICPC has been used extensively for research in family medicine. In Australia, a version of ICPC is used in the BEACH database which contains more than 1,400,000 FD-patient encounter records (5). In the Netherlands and Malta, researchers are able to create reports from TransHis (6), an ICPC-based electronic health record, and the data have been used to develop the first public domain database of the predictive power of symptoms in making a diagnosis, for all relevant primary care diagnoses. ICPC is used by Danes conducting research in rural practice (7), as well as FDs who enter data into the Danish General Practice Research Database (8). The Future of ICPC A workshop on ICPC and other classification systems was conducted at the 2010 WONCA Europe conference in Malaga, Spain between WICC and the WONCA Informatics Working Party (WIWP). WIWP is primarily concerned with education in the field of family medicine informatics. Meanwhile, WICC is developing the third version of ICPC. ICPC-3 has been in development for many years, using data collected with ICPC and other coding systems to allow expansion and modernisation of the classification without losing its core characteristics and values. Further information is available at www.ph3c.org , including the ICPC training module and an extended bibliography. Take Home Messages Structured data in electronic health records are important not only for education but also for research and audit purposes Several classification systems are available, including the International Classification of Primary Care (ICPC) produced by WONCA Revising ICPC and getting more family physicians skilled in its use remain ongoing challenges Original Abstract http://www.woncaeurope.org/content/ws-17-international-classification-primary-care-icpc-and-hows-and-whys-classification References 1. Westbury RC. A classification for family medicine. Can Med Assoc J. 1976 Aug 7;115(3):202. PubMed PMID: 20312758; PubMed Central PMCID: PMC1878637. 2. Okkes I, Jamoulle M, Lamberts H, Bentzen N. ICPC-2-E: the electronic version of ICPC-2. Differences from the printed version and the consequences. Fam Pract. 2000 Apr;17(2):101-7. Erratum in: Fam Pract 2000 un;17(3):275. PubMed PMID:10758069. 3. Bentsen BG, Hjortdahl P. Why do people contact physicians? The development of the core classification of primary health care. Tidsskr Nor Laegeforen. 1991 Sep 30;111(23):2867-70. Norwegian. PubMed PMID: 1948889. 4. Karlstad O, Nafstad P, Tverdal A, Skurtveit S, Furu K. Comorbidities in an asthma population 8-29 years old: a study from the Norwegian Prescription Database. Pharmacoepidemiol Drug Saf. 2011. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21953881. 5. Harrison C, Britt H, Miller G, Henderson J. Prevalence of chronic conditions in Australia. PLoS One. 2013;8(7):e67494. doi:10.1371/journal.pone.0067494. 6. Jean K Soler; Inge Okkes; Sibo Oskam; Kees van Boven; Predrag Zivotic; Milan Jevtic; Frank Dobbs; Henk Lamberts; The Transition Project. An international comparative family medicine study of the Transition Project data from the Netherlands, Malta and Serbia. Is family medicine an international discipline? Comparing diagnostic odds ratios across populations. Family Practice 2012; doi: 10.1093/fampra/cmr099. 7. Klinis S, Markaki A, Kounalakis D, Symvoulakis EK. Monitoring Reasons for Encounter via an Electronic Patient Record System: the Case of a Rural Practice Initiative. Int J Med Sci 2012; 9(8):704-707. doi:10.7150/ijms.4999. Available from http://www.medsci.org/v09p0704.htm 8. Thomsen, R. W., Friborg, S., Nielsen, J. S., Schroll, H., & Johnsen, S. P. (2012). The Danish Centre for Strategic Research in Type 2 Diabetes (DD2): organization of diabetes care in Denmark and supplementary data sources for data collection among DD2 study participants. Clinical epidemiology, 4(Suppl 1), 15. 128
World Book of Family Medicine – European Edition 2015 Janet Christie-Seely, MD jcseely@uottawa.ca 42 – Physician Heal Thyself and then the World: Workaholism, Helpaholism and other Physician Conditions (Fraud Syndrome, Empathopoenia, Email-Overdose, MDeity Syndrome, Cell-phone-Otitis, etc) – Playful but Effective Medications for Serious Symptoms Janet Christie-Seely, MD, FCFP, Professor of Family Medicine, University of Ottawa, Ontario, Canada. Family Therapist Most docs are workaholics or helpaholics -- especially Family Docs (1)! I am both. I still run workshops and a psychotherapy practice at 75. I love what I do, that’s the problem! I’m getting better! I read Barbara Killinger’s “Workaholics: the Respectable Addicts; a Family Survival Guide” (2), often worse in its impact than alcoholism. Take the Workaholic Quiz at: www.cnn.com/interactive/2011/05/living/workaholic.test/ and find out if your case is serious! I was fortunate to train with Virginia Satir, the “Columbus of Family Therapy”, an enlightened lady way ahead of her time. Stone deaf for two years from mastoiditis at six, she noticed people looked very different when communicating, and planned to become a detective on parents when she grew up. Her mother, a Placator never spoke her own feelings, hid anger deep inside, never saying “No!”– like many family docs. Her father was a Blamer, hiding his helplessness and shame of alcoholism. Others looked like computers, the Super-Reasonables –- maybe she met some doctors (specialists particularly) -- hiding discomfort about feelings (“Just give me the facts. Don’t bother me with this emotional stuff!”), quoting N.E.J.M or the Bible. Others were always joking or changing the subject, the clowns hiding despair, the Distracters. She later understood these four came from AND increase Low Self- Esteem (3). So one medication that helps stop the Performance-Based Self-Esteem of most physicians is the prescription of: Congruence! I remember being told to be congruent with patients in Med School, but nobody explained how! Congruence is being respectful, considerate and honest. Non-verbal signals match verbal content. If you’re angry you may look and sound angry, but you don’t blame or accuse, you try to understand the other’s position. HIGH SELF-ESTEEM 129
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ICPC Use in <strong>Family</strong> <strong>Medicine</strong> Research<br />
World Book of <strong>Family</strong> <strong>Medicine</strong> – European Edition 2015<br />
electronic ordering of laboratory tests (4).<br />
ICPC has been used extensively for research in family medicine. In Australia, a version of ICPC is used in the BEACH<br />
database which contains more than 1,400,000 FD-patient encounter records (5). In the Netherlands and Malta,<br />
researchers are able to create reports from TransHis (6), an ICPC-based electronic health record, and the data have<br />
been used to develop the first public domain database of the predictive power of symptoms in making a diagnosis, for<br />
all relevant primary care diagnoses. ICPC is used by Danes conducting research in rural practice (7), as well as FDs who<br />
enter data into the Danish General Practice Research Database (8).<br />
The Future of ICPC<br />
A workshop on ICPC and other classification systems was conducted at the 2010 WONCA Europe conference in Malaga,<br />
Spain between WICC and the WONCA Informatics Working Party (WIWP). WIWP is primarily concerned with education<br />
in the field of family medicine informatics.<br />
Meanwhile, WICC is developing the third version of ICPC. ICPC-3 has been in development for many years, using data<br />
collected with ICPC and other coding systems to allow expansion and modernisation of the classification without losing<br />
its core characteristics and values. Further information is available at www.ph3c.org , including the ICPC training<br />
module and an extended bibliography.<br />
Take Home Messages<br />
<br />
<br />
<br />
Structured data in electronic health records are important not only for education but also for research and<br />
audit purposes<br />
Several classification systems are available, including the International Classification of Primary Care (ICPC)<br />
produced by WONCA<br />
Revising ICPC and getting more family physicians skilled in its use remain ongoing challenges<br />
Original Abstract<br />
http://www.woncaeurope.org/content/ws-17-international-classification-primary-care-icpc-and-hows-and-whys-classification<br />
References<br />
1. Westbury RC. A classification for family medicine. Can Med Assoc J. 1976 Aug 7;115(3):202. PubMed PMID: 20312758;<br />
PubMed Central PMCID: PMC1878637.<br />
2. Okkes I, Jamoulle M, Lamberts H, Bentzen N. ICPC-2-E: the electronic version of ICPC-2. Differences from the printed<br />
version and the consequences. Fam Pract. 2000 Apr;17(2):101-7. Erratum in: Fam Pract 2000 un;17(3):275. PubMed<br />
PMID:10758069.<br />
3. Bentsen BG, Hjortdahl P. Why do people contact physicians? The development of the core classification of primary health<br />
care. Tidsskr Nor Laegeforen. 1991 Sep 30;111(23):2867-70. Norwegian. PubMed PMID: 1948889.<br />
4. Karlstad O, Nafstad P, Tverdal A, Skurtveit S, Furu K. Comorbidities in an asthma population 8-29 years old: a study from<br />
the Norwegian Prescription Database. Pharmacoepidemiol Drug Saf. 2011. Available at:<br />
http://www.ncbi.nlm.nih.gov/pubmed/21953881.<br />
5. Harrison C, Britt H, Miller G, Henderson J. Prevalence of chronic conditions in Australia. PLoS One. 2013;8(7):e67494.<br />
doi:10.1371/journal.pone.0067494.<br />
6. Jean K Soler; Inge Okkes; Sibo Oskam; Kees van Boven; Predrag Zivotic; Milan Jevtic; Frank Dobbs; Henk Lamberts; The<br />
Transition Project. An international comparative family medicine study of the Transition Project data from the<br />
Netherlands, Malta and Serbia. Is family medicine an international discipline? Comparing diagnostic odds ratios across<br />
populations. <strong>Family</strong> Practice 2012; doi: 10.1093/fampra/cmr099.<br />
7. Klinis S, Markaki A, Kounalakis D, Symvoulakis EK. Monitoring Reasons for Encounter via an Electronic Patient Record<br />
System: the Case of a Rural Practice Initiative. Int J Med Sci 2012; 9(8):704-707. doi:10.7150/ijms.4999. Available from<br />
http://www.medsci.org/v09p0704.htm<br />
8. Thomsen, R. W., Friborg, S., Nielsen, J. S., Schroll, H., & Johnsen, S. P. (2012). The Danish Centre for Strategic Research in<br />
Type 2 Diabetes (DD2): organization of diabetes care in Denmark and supplementary data sources for data collection<br />
among DD2 study participants. Clinical epidemiology, 4(Suppl 1), 15.<br />
128