Reasons for encounters and diagnoses of new outpatients at a small community hospital in Japan: an observational study
METHODS: We reviewed data of new outpatients seen in the department of general internal medicine at a small hospital between May 6, 2010 and March 11, 2011. We classified RFEs and diagnoses according to Component 1, “Symptoms/Complaints,” and Component 7, “Diagnosis/Diseases,” of the International Classification of Primary Care, 2ndedition (ICPC-2). Furthermore, we evaluated the differences between observed RFEs and common symptoms from the guidelines, “Model Core Curriculum for Medical Students” and “Goals of Clinical Clerkship.”
RESULTS: We analyzed the data of 1515 outpatients whose age (mean ± standard deviation) was 52.9 ± 19.9. There were 2252 RFEs (1.49 per encounter) and 170 ICPC-2 codes. The top 30 RFE codes accounted for 80% of all RFEs and the top 55 codes accounted for 90%. There were 1727 diagnoses and 192 ICPC-2 codes. The top 50 diagnosis codes accounted for 80% of all diagnoses, and the top 90 codes accounted for 90%. Of the 2252 RFEs, 1408 included at least one of the 36 symptoms listed in the Model Core Curriculum and 1443 included at least one of the 35 symptoms in the Goals of Clinical Clerkship. On the other hand, “A91 Abnormal result investigation,” “R21 Throat symptom/complaint,” and “R07 Sneezing/nasal congestion,” which were among the top 10 RFEs, were not included in these two guidelines.
CONCLUSIONS: We identified the common RFEs and diagnoses and revealed the gaps in between the RFEs observed and common symptoms listed in various guidelines. Our findings can be useful in improving the medical education curricula for general practice.