October 1988

The Nosology of Clinical Medicine

Author Affiliations

Director of Continuing Care Hospital of St Raphael 1450 Chapel St New Haven, CT 06511

Arch Intern Med. 1988;148(10):2114-2115. doi:10.1001/archinte.1988.00380100012003

Dr Alvan Feinstein in his article, "ICD, POR, and DRG: Unsolved Scientific Problems in Nosology of Clinical Medicine," in this issue of the Archives,1 has quite clearly and quite succinctly discussed an extremely important problem. Diagnoses and procedures coding systems are the basic building blocks for the development of almost any type of patient classification system. Problems in the coding system are translated directly to the classification system. I agree that most physicians have never heard of nosology, and, also, most have no knowledge at all of the currently used coding system or of the various rules, guidelines, and interpretations applied to the system.

See pp 2269-2274.

The present coding system in this country, which is mandated by the federal government for all hospital patients, is the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).2 In spite of the fact that this is a "clinical modification," there

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