Symptoms, reasons for encounter and diagnoses. Family practice is an international discipline

‘There is no disease, respecting which it can be said that the symptoms which mark its very outset and its course, the symptoms which mark its decline, the symptoms which enable us to tell at the outset what will be its course, the effects which follow after the disease has apparently ended and the influence which pre-existing conditions of health and disease as well as that which drugs and other therapeutic agents exert on its progress, termination and sequelae are perfectly known’ (Jenner 1875).1 For the organization of primary health care and family practice to be optimal, it is necessary to know whom we are seeing and why they see us. The average number of consultations per family physician is 5.3 per year2 and patients may present three to four symptoms per consultation.3 Frequently, the consultation cannot be encapsulated in one diagnostic code and requires several discreet symptoms at that time without a diagnostic or any other label. Soler has gathered together data from three very distinct countries, Malta, Netherlands and Serbia, looking at precisely this aspect of the consultation.4–7 He has systematically collected data on the patient's ‘reason for encounter’ (RfE) and structured data in the form of ‘episodes of care’ (EoCs). An EoC is defined as a health problem from its first presentation by the patient until the completion of the last encounter for it. It may be modified over time.