‘Pain’ in SNOMED CT: Is there an anesthetic?

Abstract

For sure, an unpleasant odor of feet may be categorized as an unpleasant odor. Though foot fetishists (De Block and Adriaens 2013), podiatrists and manufacturers of washing machines might disagree (Question Everything 2015), most people would contend such odor to be classified as an offensive odor. No clinician would have qualms in classifying an unpleasant odor of feet as an odor of feet nor as a foot finding. Perhaps some, in particular the ontology-savvy ones who are therefore able to detect ambiguities in natural language phrases, might doubt a foot odor to be a limb finding or a body odor. But who would argue it to be a finding of sense of smell, i.e. a neurological finding, or a duplicate, and therefore, inactive concept? This question smells of The Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) (Donnelly 2006) all over, does it not? Indeed, the former is what its authors argued to be the case until 2003 when they discovered that there are actually two different sorts of smelly feet: “duplicate concept” ones and “offensive body odor” ones. What this discovery means for patients about whom SNOMED CT-based smelly feet assertions were made in their electronic healthcare records (EHR) is rather unclear. Some might, upon chart inspection, be surprised to find their smelly feet to have changed from a neurological finding to an offensive body odor. Others might find their smelly feet to have become inactive concepts and perhaps therefore conclude they are documented as being successfully treated. But in both cases their feet themselves are as stinky as before.