Family Practice Vol. 17, No. 5, 448
© Oxford University Press 2000
ICPC-2-E: The Electronic Version ICPC-2
Family Medicine Research Centre, University of Sydney, Australia.
We are profoundly disturbed that Okkes et al.1 used the publication in Family Practice of the announcement of the release ICPC-2-E and description of its development to proselytize the dogma that the ICD 10 rubric nomenclature is a satisfactory terminology for general/family practice. This position is by no means universally supported within the WONCA International Classification Committee of which the authors of that paper and the authors of this letter are members.
The development pathway of ICPC commenced at the Fifth World General Practice Conference Melbourne in 1972 as a result of a clear perception among primary care researchers that the ICD classification was inherently unsuitable for reporting the activities of general/family practitioners and the problems of their patients. Over the years, the structural differences between the classifications have increased and ICPC-2 has become a very useful and widely used classification for reporting the epidemiology of general/family practice.
More recently, the ICPC has been adapted for use in electronic systems for primary clinical coding of data in electronic health records and for secondary coding of data collected in paper-based surveys. This has necessitated the development of systems to classify the language of general/family practitioners reliably according to ICPC.
The language of general/family practice has been evolving since the 1960s as the discipline has differentiated its role of caring for patients in the community and sharing perceptions of health and illness with patients of diverse social, cultural and ethnic backgrounds. Dixon2 in 1983 emphasized the role of language in defining a culture and lamented that the language of general/family practice did not well reflect its ethos. The shared perceptions of practitioners and patients in the community have assisted the evolution of the language and a closer cultural match with the realities of community-based care.
Chute3 described the difficulties of using ICD 10 to codify patient problems even in the hospital system and found Read and SNOMED terminologies to be a much better fit. Read, having evolved in British general practice before extending to other disciplines, might be expected to be a better fit; however, it also started as a top-down nomenclature with an authorship based in a coding centre and has developed a certain life of its own. The amalgamation of Read into SNOMED will create a terminology designed to be all things to all clinicians. This project is reminiscent of attempts to make Esperanto the world's universal language.
An alternative approach in some countries4,5–8 has been to use the diverse dialects of general/family practice to create an ‘interface terminology’ to translate the language of practice into the concepts and groupings of ICPC (or other classifications). Such a process has been demonstrated to produce valid and reliable classification at the ICPC level8–10 while allowing linguistic and cultural diversity at the doctor–patient level.
General/family practitioners have worked hard in the last four decades to establish their position and relevance in health care. They have achieved this by a process of cultural adaptation to the communities in which they work and by developing a shared language with their patients. This has become part of our heritage and must be protected from misguided attempts to force an artificial ‘standard’ language on our communications.
May the force protect us from classi-speak.
References
1
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; 17: 101–107.
2 Dixon AS. Family medicine—at a loss for words? JR Coll Gen Pract 1983; 33: 358–360; 362–363.
3
Chute CG, Cohn SP, Campbell KE, Oliver DE, Campbell JR. The content coverage of clinical classifications. For The Computer-Based Patient Record Institute's Work Group on Codes & Structures. J Am Med Inform Assoc 1996; 3: 224–233.
4 Britt H. A new coding tool for computerised clinical systems in primary care—ICPC plus. Aust Fam Physician 1997; 26: S79–S82.
5 Britt H, Scahill S, Miller G. ICPC PLUS for community health? A feasibility study. Health Inf Manag 1997; 27: 171–175.[Medline]
6 Roland M, Jamoulle M, Dendeau B. Le DSI (dossier sante informatise) et LOCAS (Logiciel de Codage et d'Aquisition de Synonymes). Courr Fed Maisons Meds 1996; 12–21.
7 Viner G, Bernstein RM, Hollingworth GR. SIN-FM: (a short indexed nomenclature of family medicine). Proc Annu Symp Comput Appl Med Care 1994; 1032.
8 Bernstein RM, Hollingworth GR, Viner G, Shearman J, Labelle C, Thomas R. Reliability of ICPC and ICD-10 coding of clinical encounters using Encode-FM as the data entry terminology. In Proceedings of the 15th WONCA World Conference. 36. June 1998. Dublin.
9 Britt H. Reliability of central coding of patient reasons for encounter in general practice using the International Classification of Primary Care. J Inform Primary Care 1998; May: 3–5.
10 Britt H, Angelis M, Harris E. The reliability and validity of doctor-recorded morbidity data in active data collection systems. Scand J Primary Health Care 1998; 16: 50–55.[Medline]
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