'Little boxes, little boxes" sang Tom Paxton, who was no fan of them. The song often pops into my head when I contemplate the mysterious world of medical
classification. It started with Linnaeus, who put us all, from the earthworm to the oak tree, into our box and then named us.
The ICD10, or International Statistical Classification of Diseases and Related Health Problems (10th edition), gives every condition you can think of, and a few that you would never have dreamed existed, its own little box . The ICD is run by the World Health Organisation and it describes some 14,000 things that can ail you.
For example, the common cold is J00 and a broken leg is S72. I can now see the benefits of this, especially when the index and codes are easily available on my office computer screen. When I was a junior doctor wading through the shallower waters of psychiatry, I resented the box-filling exercise fiercely, as it involved hunting for hours through a huge manual.
It seemed to me then that it did not matter a damn, and that whatever was the diagnoses and the ICD classification, you got the same treatment, which usually meant the same drugs.
Creative urge
Like much else in the world,
computers have made it easier as you hunt down classifications in a sort of online video game.
Once the classification is given, it festoons the patient’s on-screen notes in bright red, like stars on a child’s homework.
Then, when you send a letter to a consultant they have all that information in a neat line. Or, if you want to prescribe to someone who has, say, glaucoma (H40), up pops the condition, blushing fiercely, and you know that some medications are to be avoided.
After I had finished putting all my patients into their little boxes this year I was filled with a fierce creative urge. So I decided to invent a few categories of my own.
I decided that the world of personality disorders is particularly fertile ground . There is no test for a personality disorder, unlike hypothyroidism for instance (E03).
In the world of personality disorders you are whatever your psychiatrist has decided you are. For instance, if you are cyclothymic, your mood flies up and down like a rook on a windy day. Or you can be impulsive, immature, eccentric, fanatic or even querulant. They are to be found under F60.
So I felt that there were many personality disorders that, like the Higgs particle, should exist if you could only describe them.
The first, and closest to my heart, is artistic personality disorder. Brakes the car on a bend when he sees a field full of spring flowers or a hovering kestrel. Watches late night programmes on which John Kelly discusses books he will never read and plays he will never see. Starts writing novels and listens to Jane Austen in the car.
Dislike of green
Next comes environmental
degradation disorder: a profound and unfounded dislike of anything that seems green, good for you or good for the planet. Encompasses a childlike faith in the beneficence of multinationals. Eats only processed food, preferably from a takeaway chain. Common in television motoring correspondents and small-town politicians. Views nature, in short, as an enemy.
Neological avoidance disorder: refusal to eat anything new, listen to any new ideas, go on holidays anywhere he has not been before and views most of the world with distrust.
Screenophilia: the man who goes into a room, turns on the television, pulls out the laptop, jacks up the phone and plays with them simultaneously. A very common condition in teenagers.
Worshiping of oneself as an authority is a very common disorder in doctors. An extreme example refers to self in third person. This is a hopeless condition and very
common in doctors who attend a lot of meetings.
As you can see, it is great fun categorising yourself and your friends and family into their little boxes. If the World Health Organisation wants to bring me to Geneva any time soon to attribute ICD numbers to these conditions, I would be delighted.
Dr Pat Harrold is a GP in Tipperary.