Correspondence (letter to the editor): Diagnoses as “Currency”

It would be good if the mass of data that the healthcare purchasers are creating could be used for more than just billing purposes.

In practice, healthcare services are legitimized through diagnoses. Longer consultations that exceed the restrictions imposed by flat rates can be bailed only by using “psycho-codes”. For this reason, “psycho-diagnoses” have to be used. Many patients in the practices are stressed but by no means ill in the psychopathological sense. Often they don’t even know that they have had a psychological diagnosis and are therefore a long way from seeking psychotherapy.

During the study period, doctors were instructed to code their diagnoses exceptionally thoroughly, in preparation for the structural compensation for morbidity risk. Diagnoses are “currency,” not only for doctors, but also for the statutory health insurers. In this sense, diagnoses are very far removed from their original purpose—that is, describing the suffering of patients.

Did you use only those diagnoses that were coded as confirmed, or also those that were coded “for the exclusion of” or “suspected”? We try to code “confirmed” (“G”) diagnoses as sparingly as possible, so as not to stigmatize patients inappropriately. We do not know whether this makes a difference.

Your evaluation throws a light on the indefensible situation in the context of diagnosis. I wish that doctors were allowed to provide thorough advice, without a strategic allocation of a diagnosis. Diagnoses should be coded only once they have been confirmed without doubt. Until such time it should be enough for the paying bodies if doctors document “a need for consultation.”