I am reading Burket's Oral Medicine: Diagnosis and Treatment, Chapter 1 - Evaluation of the Dental Patient: Diagnosis and Medical Risk Assessment.

Under the section 'Establishing The Diagnosis', the author has to say this:

Unfortunately, there is no generally accepted system for identifying and classifying diseases, and diagnoses are often written with concerns related to third-party reimbursement and to medicolegal and local peer review as well as for the patient's disease status*. Most practitioners probably follow the systems of disease classification and nomenclature that they were taught during their training since these usually serve as the framework for the mental models of disease syndromes on which they base their diagnoses.

*The author gives a reference to a study/report by Feinstein AR. ICD,POR, and DRG. Unsolved scientific problems in the nosology of clinical medicine. Arch Intern Med 1988;148:2269.

I couldn't find the above-mentioned study/report on Google.

Along with the main question I would also like to know why are diagnoses written with concerns related to third-party reimbursement, what are these concerns and does it mean falsification of medical records?

  • 3
    It's not surprising that authors writing a book in the 70s wouldn't have been aware that such a classification would be developed in the 80s and begin to be used in the 90s en.wikipedia.org/wiki/ICD-10 – Armatus Jul 19 at 19:56
  • Have quoted from a 2003 edition of the book. Think that would have been updated if there was a universally accepted classification of diseases. – Noeshel Jul 21 at 6:53
  • "third-party reimbursement" probably refers to coverage of medical costs by insurances. I read this sentence as saying that doctors take into account what will be covered by insurance (third-party reimbursement) when they make diagnoses, usually acting in favour of the patient as much as the law (medicolegal) and their supervisory structure (local peer review) allow. As for the absence of a generally accepted system, as far as I am aware there are such systems unless you want to split hairs about what "generally accepted" means (which I suspect this text does, given the second sentence). – Armatus Jul 21 at 22:26

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