There are many diverse implementers who may prefer many diverse patterns, but having 4 (or more) ways to record a single fact seems to undermine the idea of a 'standard' observation pattern. CCDA began to address this issue with a TermInfo pattern, though it seems to have been forgotten. If we can't say "use pattern 3 only," can we at least provide some rules, e.g.,

>If this pattern is designed to support absence and presence, then both need to be explicit. I.e., use #3, not #4.

>SCT finding codes convey complete semantics and should be used rather than observable+qualifier patterns – i.e., use #1, rather than #2, even if it means some level of redundancy (abdominal exam: abdominal tenderness). (Though this example puts a rather than a questtion in Code, so #3 should still be preferred.)