International Classification of Impairments, Disabilities and Handicaps: exercises in its application in a hospital medical record.
The principles and philosophies of the WHO International Classification of Impairments, Disabilities and Handicaps were enthusiastically espoused by all staff of a large rehabilitation hospital. It was universally seen as an accurate and standardized way of recording and reporting a patient's functional state and opened up opportunities for research between causation and consequences of diseases, the relations of impairments to handicaps, and so on. In short, it promised a hard data base about disability, which presently has been studied only anecdotally, or by large random community samples. The joy of the principle turned into torment when the attempts to apply the system to current and past medical records were made. Retrospective codification of existing records was found to be virtually impossible. Recorded data were patchy, insufficiently precise to translate into IDH codes and the codifier had to make so many value judgements, interpretations and guesses to squeeze what was written on the record into IDH codes. A totally new and disciplined way of making notations in medical records would be required to make this method applicable, and such a discipline presents challenges to the medical administrator which dwarfs the production of the WHO manual.(ABSTRACT TRUNCATED AT 250 WORDS)