Lancet Global Health: Climate change and the right to health of people with disabilities (2)

21 December, 2021

When I first began to do General Practice family medicine in the UK, most patients with asthma - especially children, who had coughs were diagnosed as having infections by viruses or other infectious pathogens. This was even if the patient, once again especially children, had repeated consultations with cough.

As respiratory medicine and respiratory pathology, anatomy and physiology became better understood, a realization that cough was caused by bronchospasm (narrowing of bronchioles (Wikipedia - "The bronchioles or bronchioli are the smaller branches of the bronchial airways in the respiratory tract. They include the terminal bronchioles, and finally the respiratory bronchioles that mark the start of the respiratory zone delivering air to the gas exchanging units of the alveoli. The bronchioles no longer contain the cartilage that is found in the bronchi, or glands in their submucosa".)

In fact on joining General practice and reviewing and summarizing my 2500 patients' notes, with the help of my wife, it became quickly apparent that a simple retrospective view of record entries that mentioned respiratory symptoms would lead to more accurate diagnoses. We went on to create a filter for all symptoms into their respective WHO ICD chapter headings - ICD-10-CM Chapters List <> - creating a system based record. Tests and investigations related to that system were digitally linked to the appropriate system when appropriate. This was useful for continuity of care, for managing co-morbidities for patient navigation and also as we coded all entries using IC chapter headings for linking patient coded entries to quality assured explanatory information.

Some symptoms have causes in more than one ICD system and retrospective reviews allowe the symptoms to be removed from one system to another or even duplicated in both. ("Cardiac asthma" also causes cough, wheeze and


We used the Read code equivalent of these (Read Codes are a coded thesaurus of clinical terms. They have been used in the NHS since 1985. There are two versions: version 2 (v2) and version 3 (CTV3 or v3). Both versions provide

a standard vocabulary for clinicians to record patient findings and procedures, in health and social care IT systems across primary and secondary care.)

[*see note below]

HIFA profile: Richard Fitton is a retired family doctor - GP, British Medical Association. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data

Email address: richardpeterfitton7 AT

[*Note from HIFA moderator (Neil PW): Thank you Richard. The original message contained a list of 21 references. Please contact Richard if you would like to receive this.]