Why are so many men pregnant?

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A lot of reliance is placed on hospital coding, the three or four-letter codes that are used as a shorthand to categorise the conditions suffered by patients. They are used to pay hospitals’ bills, to measure their performance, and as a source for statistical analyses of hospital activity and the changing burden of disease. They’re vitally important, says the Royal College of Physicians.

But a letter in this week’s BMJ indicates that any confidence in the accuracy of codes may be misplaced. A team from Imperial College found that in 2009-10, nearly 20,000 adults were coded as having attended paediatric outpatient services, and 3,000 patients under 19 were apparently treated in geriatric clinics.

Even more striking, between 15,000 and 20,000 men have been admitted to obstetric wards each year since 2003, and almost 10,000 to gynaecology wards. Nearly 20,000 midwife “episodes” – NHS jargon for completed treatments – were with men. The “pregnant man” advertisement created by Saatchi and Saatchi for the Health Education Council in the 1970s (pictured) was evidently prophetic as well as memorable.

“These statistics seem to reveal some interesting service developments” says the team led by Dr Lauren Brennan, “but although we applaud innovation we suspect that the numbers may, at least partly, reflect data errors.”

Coding is notoriously shifty, as we have reported here and here. In one famous case, a hospital coded an entire year’s births as stillbirths and had to be excluded from the statistics altogether. But that, at least, was noticed. One wonders how many cases of miscoding go completely undetected. Plenty, on the basis of this study.

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