Management of a Surgical Patient
[Process]
Reynaldo O. Joson, MD, MS Surg
1998; 2001; 2003; 2004
Management of a Surgical Patient [Process]
Introduction
Management of a Surgical Patient [Process]
Introduction
Practice of medicine - essentially management of a patient,
a pers...
Management of a Surgical Patient [Process]
Introduction
Regardless of type of patient or disorder, whether surgical
or non...
Management of a Surgical Patient [Process]
Introduction
All primary health care physicians are expected at least to
know t...
Management of a Surgical Patient [Process]
Learning Objectives
Management of a Surgical Patient [Process]
Learning Objectives
1. State the overall goals in the management of a patient
(...
Management of a Surgical Patient [Process]
Learning Objectives
6. Describe how to interpret results of a paraclinical
diag...
Management of a Surgical Patient [Process]
Learning Objectives
10. Enumerate at least 4 items in the immediate
postoperati...
Management of a Surgical Patient
[Process]
Reynaldo O. Joson, MD, MS Surg
2004
Self-Instructional Program
http://edhedephi...
Facilitator’s
Approach to
Learning Session
Management of a Surgical Patient [Process]
Management of a Surgical Patient [Process]
• I have decided to approach the topic by first presenting
the steps in the man...
Management of a Surgical Patient [Process]
Goals
MANAGEMENT OF A PATIENT
PROBLEM-SOLVING AND DECISION-MAKING
MANAGEMENT OF A PATIENT
PROBLEM-SOLVING AND DECISION-MAKING
GOALS
RESOLUTION OF HEALTH PROBLEM
LIVE PATIENT
NO COMPLICATIO...
Management of a Surgical Patient [Process]
MD’s Tasks
MANAGEMENT OF A PATIENT
PROBLEM-SOLVING AND DECISION-MAKING
TASKS
RAPPORT
DIAGNOSIS
ADVICE
TREATMENT
ADVICE
Quality Standa...
Management of a Surgical Patient [Process]
Rapport
Management of a Surgical Patient [Process]
Rapport
Establishing rapport with the patient and his/her relatives
- best stra...
Management of a Surgical Patient [Process]
Rapport
Some ways of establishing rapport with patient and his/her
relatives:
1...
Management of a Surgical Patient [Process]
Rapport
Some ways of establishing rapport with patient and his/her
relatives:
5...
Management of a Surgical Patient [Process]
Learning Objectives
1. State the overall goals in the management of a patient
(...
Management of a Surgical Patient [Process]
Clinical Diagnostic
Process
Management of a Surgical Patient [Process]
Clinical Diagnostic Process
Diagnosis - label or nature of the health problem
C...
CLINICAL DIAGNOSTIC PROCESS
DATA NEEDED
SYMPTOMS (from interview or history)
SIGNS (from physical examination)
PERSONAL DA...
CLINICAL DIAGNOSTIC PROCESS
PROCESSING OF DATA
PATTERN RECOGNITION
-realization that the patient’s presentation
conforms t...
CLINICAL DIAGNOSTIC PROCESS
OUTPUT EXPECTED
RATIONAL
-PRIMARY CLINICAL DIAGNOSIS
-SECONDARY CLINICAL DIAGNOSIS
CLINICAL DIAGNOSTIC PROCESS
PROCESSING OF DATA
PATTERN RECOGNITION
-realization that the patient’s presentation
conforms t...
CLINICAL DIAGNOSTIC PROCESS
PROCESSING OF DATA
Knowing the common manifestations of 5 different diseases as
follows:
Disea...
CLINICAL DIAGNOSTIC PROCESS
PROCESSING OF DATA
Knowing the common manifestations of 3 different diseases and
relative freq...
CLINICAL DIAGNOSTIC PROCESS
PROCESSING OF DATA
Knowing the most common diagnosis of a thyroid nodule is a benign
colloid a...
CLINICAL DIAGNOSTIC PROCESS
PROCESSING OF DATA
PATTERN RECOGNITION
-realization that the patient’s presentation
conforms t...
Management of a Surgical Patient [Process]
Paraclinical
Diagnostic Process
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process
Indication - to be more definite on the clinica...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Indication
DATA NEEDED
PRIMARY CLINICAL DIAGN...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Indication
PROCESSING OF DATA
CERTAINTY OF CL...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Indication
OUTPUT EXPECTED
DIAGNOSTIC PROCEDU...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Indication
Certainty Plan of Treatment
Primar...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Indication
Certainty Plan of Treatment
Primar...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Indication
Certainty Plan of Treatment
Primar...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Indication
Certainty Plan of Treatment
Primar...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Indication
Certainty Plan of Treatment
Primar...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Indication
Tickler -
Which of the following s...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Selection
DATA NEEDED
OPTIONS OF
DIAGNOSTIC P...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Selection
SELECTION PROCESS
Options Benefit R...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Selection
OUTPUT EXPECTED
MOST COST-EFFECTIVE...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Selection
SELECTION PROCESS
Procedure Benefit...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Selection
SELECTION PROCESS
Procedure Benefit...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Selection
SELECTION PROCESS
Procedure Benefit...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Selection
SELECTION PROCESS
Procedure Benefit...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Interpretation
DATA NEEDED
PRIMARY CLINICAL D...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Interpretation
INTERPRETATION PROCESS
CORRELA...
Management of a Surgical Patient [Process]
Paraclinical Diagnostic Process - Interpretation
Tickler -
Determine which para...
Management of a Surgical Patient [Process]
Learning Objectives
3. Describe the clinical diagnostic process.
4. Describe ho...
Management of a Surgical Patient [Process]
Learning Objectives
7. Describe how a treatment modality should be selected
amo...
Management of a Surgical Patient [Process]
Learning Objectives
10. Enumerate at least 4 items in the immediate
postoperati...
Management of a Surgical Patient [Process]
Treatment Process
Management of a Surgical Patient [Process]
Treatment Process - Selection
DATA NEEDED
PRETREATMENT DIAGNOSIS
SEVERITY OR ST...
Management of a Surgical Patient [Process]
Treatment Process - Selection
SELECTION PROCESS
Options Benefit Risk Cost Avail...
Management of a Surgical Patient [Process]
Treatment Process - Selection
OUTPUT EXPECTED
MOST COST-EFFECTIVE
TREATMENT PRO...
Management of a Surgical Patient [Process]
Treatment Process - Selection
SELECTION PROCESS
Treatment Benefit Risk Cost (Ph...
Management of a Surgical Patient [Process]
Treatment Process - Selection
SELECTION PROCESS
Treatment Benefit Risk Cost (Ph...
Management of a Surgical Patient [Process]
Treatment Process - Selection
SELECTION PROCESS
Treatment Benefit Risk Cost (Ph...
Management of a Surgical Patient [Process]
Treatment Process - Selection
SELECTION PROCESS
Treatment Benefit Risk Cost (Ph...
Management of a Surgical Patient [Process]
Surgical Treatment Process
PREOP PREPARATION
Management of a Surgical Patient [Process]
Surgical Treatment Process - Preop Preparation
•INFORMED CONSENT
•PSYCHOSOCIAL ...
Management of a Surgical Patient [Process]
Surgical Treatment Process
INTRAOP
MANAGEMENT
Management of a Surgical Patient [Process]
Surgical Treatment Process - Intraop Mgt
PHASES
•INCISION
•EXPOSURE
•INTRAOP EV...
Management of a Surgical Patient [Process]
Surgical Treatment Process - Intraop Mgt
Quality Standards:
GENTLE
METICULOUS a...
Management of a Surgical Patient [Process]
Surgical Treatment Process
POSTOP CARE
Management of a Surgical Patient [Process]
Surgical Treatment Process - Postop Care
•SUPPLY BASIC NEEDS OF PATIENT
•COMFOR...
Management of a Surgical Patient [Process]
Surgical Treatment Process
POSTOP FOLLOW-UP
PLAN
Management of a Surgical Patient [Process]
Surgical Treatment Process - Postop Follow-up
Plan
OBJECTIVES:
•EVALUATE TREATM...
Management of a Surgical Patient [Process]
Surgical Treatment Process - Postop Follow-up
Plan
FF-UP FREQUENCY GUIDELINES: ...
Management of a Surgical Patient [Process]
Learning Objectives
7. Describe how a treatment modality should be selected
amo...
Management of a Surgical Patient [Process]
Learning Objectives
10. Enumerate at least 4 items in the immediate
postoperati...
Management of a Surgical Patient [Process]
Learning Objectives
12. Describe how to advice patients on clinical diagnosis,
...
Management of a Surgical Patient [Process]
HOW TO GIVE
ADVICES
Management of a Surgical Patient [Process]
HOW TO GIVE ADVICES
1. Always include the relatives of the patient in the
advis...
Management of a Surgical Patient [Process]
HOW TO GIVE ADVICES
3. Use all kinds of strategies that will make the patient a...
Management of a Surgical Patient [Process]
REFERRAL
WHEN
TO WHOM
Management of a Surgical Patient [Process]
Referral - When to Refer?
All physicians, both certified and not yet certified,...
Management of a Surgical Patient [Process]
Referral - To Whom to Refer?
Referral must be made to somebody
who may or can s...
Management of a Surgical Patient [Process]
Learning Objectives
Management of a Surgical Patient [Process]
Learning Objectives
1. State the overall goals in the management of a patient
(...
Management of a Surgical Patient [Process]
Learning Objectives
6. Describe how to interpret results of a paraclinical
diag...
Management of a Surgical Patient [Process]
Learning Objectives
10. Enumerate at least 4 items in the immediate
postoperati...
Management of a Surgical Patient [Process]
HOPE
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Management of a Surgical Patient (Process)

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Management of Surgical Patient Process - which I wrote in 1998 and still applicable up to this date (2014).

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Management of a Surgical Patient (Process)

  1. 1. Management of a Surgical Patient [Process] Reynaldo O. Joson, MD, MS Surg 1998; 2001; 2003; 2004
  2. 2. Management of a Surgical Patient [Process] Introduction
  3. 3. Management of a Surgical Patient [Process] Introduction Practice of medicine - essentially management of a patient, a person with a health problem Surgical patient - person with a surgical disorder Surgical disorder - health problem or condition that is treated by surgery or an operation Nonsurgical patient - one with a nonsurgical disorder
  4. 4. Management of a Surgical Patient [Process] Introduction Regardless of type of patient or disorder, whether surgical or nonsurgical, basic processes in the management are essentially similar Only difference lies in the specific treatment modality and procedure employed, whether surgical or nonsurgical means
  5. 5. Management of a Surgical Patient [Process] Introduction All primary health care physicians are expected at least to know the basic processes in the management of a surgical patient. This learning session gives an overview of the processes involved in the management of a surgical patient.
  6. 6. Management of a Surgical Patient [Process] Learning Objectives
  7. 7. Management of a Surgical Patient [Process] Learning Objectives 1. State the overall goals in the management of a patient (whether surgical or not). 2. Enumerate the four functions of a physician in the management of a patient (whether surgical or not). 3. Describe the clinical diagnostic process. 4. Describe how to determine the indication for a paraclinical diagnostic procedure. 5. Describe how a paraclinical diagnostic procedure should be selected among several options.
  8. 8. Management of a Surgical Patient [Process] Learning Objectives 6. Describe how to interpret results of a paraclinical diagnostic procedure to come out with a pretreatment diagnosis. 7. Describe how a treatment modality should be selected among several options. 8. Enumerate at least 4 essential items in the preoperative preparation of a surgical patient. 9. Enumerate in correct chronological order 7 phases in the intraoperative management starting from the incision to wound closure.
  9. 9. Management of a Surgical Patient [Process] Learning Objectives 10. Enumerate at least 4 items in the immediate postoperative care of a surgical patient. 11. Enumerate the two objectives of a follow-up plan after treatment of a patient (whether surgical or not). 12. Describe how to advice patients on clinical diagnosis, paraclinical diagnostic procedures, treatment, follow-up, and health promotion and maintenance. 13. Describe when and to whom to refer.
  10. 10. Management of a Surgical Patient [Process] Reynaldo O. Joson, MD, MS Surg 2004 Self-Instructional Program http://edhedephi.tripod.com RJoson’s Writings
  11. 11. Facilitator’s Approach to Learning Session Management of a Surgical Patient [Process]
  12. 12. Management of a Surgical Patient [Process] • I have decided to approach the topic by first presenting the steps in the management of a surgical patient in outline form. Facilitator’s Approach to Learning Session • Then, I will present some simulated patients or exercises to expound on the process.
  13. 13. Management of a Surgical Patient [Process] Goals
  14. 14. MANAGEMENT OF A PATIENT PROBLEM-SOLVING AND DECISION-MAKING
  15. 15. MANAGEMENT OF A PATIENT PROBLEM-SOLVING AND DECISION-MAKING GOALS RESOLUTION OF HEALTH PROBLEM LIVE PATIENT NO COMPLICATION NO DISABILITY SATISFIED PATIENT NO MEDICOLEGAL SUIT
  16. 16. Management of a Surgical Patient [Process] MD’s Tasks
  17. 17. MANAGEMENT OF A PATIENT PROBLEM-SOLVING AND DECISION-MAKING TASKS RAPPORT DIAGNOSIS ADVICE TREATMENT ADVICE Quality Standards: Rational, effective, efficient, humane G O A L S
  18. 18. Management of a Surgical Patient [Process] Rapport
  19. 19. Management of a Surgical Patient [Process] Rapport Establishing rapport with the patient and his/her relatives - best strategy for obtaining satisfaction from patient and his/her relative - strongest strategy in the prevention of medicolegal suit in case of errors of commission and omission
  20. 20. Management of a Surgical Patient [Process] Rapport Some ways of establishing rapport with patient and his/her relatives: 1. Being courteous 2. Showing respect to person and beliefs 3. Giving honest and clear advice on diagnosis, paraclinical diagnostic procedures, and treatment 4. Demonstrating humaneness and compassion
  21. 21. Management of a Surgical Patient [Process] Rapport Some ways of establishing rapport with patient and his/her relatives: 5. Being gentle in words and deeds (physical examination, procedure) 6. Showing the patient and relatives that you are trying your very best 7. Being helpful when it comes to medical expenses 8. Making the patient and relatives feel that you are approachable and easy to talk to
  22. 22. Management of a Surgical Patient [Process] Learning Objectives 1. State the overall goals in the management of a patient (whether surgical or not). 2. Enumerate the four functions of a physician in the management of a patient (whether surgical or not).
  23. 23. Management of a Surgical Patient [Process] Clinical Diagnostic Process
  24. 24. Management of a Surgical Patient [Process] Clinical Diagnostic Process Diagnosis - label or nature of the health problem Clinical Diagnosis - diagnosis derived from interview (history) and physical examination Clinical Diagnostic Process - processing of data from interview and physical examination to arrive to a diagnosis
  25. 25. CLINICAL DIAGNOSTIC PROCESS DATA NEEDED SYMPTOMS (from interview or history) SIGNS (from physical examination) PERSONAL DATA OF PATIENT
  26. 26. CLINICAL DIAGNOSTIC PROCESS PROCESSING OF DATA PATTERN RECOGNITION -realization that the patient’s presentation conforms to a previously learned picture or pattern of disease PREVALENCE - choice of a diagnosis is based on the frequency of occurrence of the disease in a certain locality, in a certain age and sex group, and in the affected organ and system
  27. 27. CLINICAL DIAGNOSTIC PROCESS OUTPUT EXPECTED RATIONAL -PRIMARY CLINICAL DIAGNOSIS -SECONDARY CLINICAL DIAGNOSIS
  28. 28. CLINICAL DIAGNOSTIC PROCESS PROCESSING OF DATA PATTERN RECOGNITION -realization that the patient’s presentation conforms to a previously learned picture or pattern of disease PREVALENCE - choice of a diagnosis is based on the frequency of occurrence of the disease in a certain locality, in a certain age and sex group, and in the affected organ and system
  29. 29. CLINICAL DIAGNOSTIC PROCESS PROCESSING OF DATA Knowing the common manifestations of 5 different diseases as follows: Disease A - abcd (manifestations) Disease B - fghi Disease C - klmn Disease D - pqrs Disease E - uvwx Given a patient manifesting with pqrs, your diagnosis is Disease D. What is the process used? Pattern Recognition
  30. 30. CLINICAL DIAGNOSTIC PROCESS PROCESSING OF DATA Knowing the common manifestations of 3 different diseases and relative frequency of each as follows: Disease A - abcd (manifestations) Least common Disease B - abcd Disease C - abcd Most common Given a patient manifesting with abcd, your diagnosis is Disease C. What is/are processes used? Pattern Recognition but mainly Prevalence
  31. 31. CLINICAL DIAGNOSTIC PROCESS PROCESSING OF DATA Knowing the most common diagnosis of a thyroid nodule is a benign colloid adenomatous goiter, given a patient with a thyroid nodule, you gave the abovementioned diagnosis. What is/are processes used? Prevalence
  32. 32. CLINICAL DIAGNOSTIC PROCESS PROCESSING OF DATA PATTERN RECOGNITION -realization that the patient’s presentation conforms to a previously learned picture or pattern of disease PREVALENCE - choice of a diagnosis is based on the frequency of occurrence of the disease in a certain locality, in a certain age and sex group, and in the affected organ and system
  33. 33. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process
  34. 34. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process Indication - to be more definite on the clinical diagnosis Selection Interpretation
  35. 35. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Indication DATA NEEDED PRIMARY CLINICAL DIAGNOSIS SECONDARY CLINICAL DIAGNOSIS
  36. 36. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Indication PROCESSING OF DATA CERTAINTY OF CLINICAL Dx 1O Dx 60% 99% needed not needed TREATMENT PLAN FOR 1O & 2O Dx Different Same needed not needed
  37. 37. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Indication OUTPUT EXPECTED DIAGNOSTIC PROCEDURE NEEDED or NOT NEEDED
  38. 38. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Indication Certainty Plan of Treatment Primary clinical diagnosis 98% Surgical Secondary clinical diagnosis 1-2% Nonsurgical Is a paraclinical diagnostic procedure needed? NO unless there is a strong reason to do so (exception to the rule)
  39. 39. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Indication Certainty Plan of Treatment Primary clinical diagnosis 60% Surgical Secondary clinical diagnosis 40% Nonsurgical Is a paraclinical diagnostic procedure needed? YES
  40. 40. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Indication Certainty Plan of Treatment Primary clinical diagnosis 60%Surgical Excision Secondary clinical diagnosis 40%Surgical Excision Is a paraclinical diagnostic procedure needed? NO unless there is a strong reason to do so (exception to the rule)
  41. 41. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Indication Certainty Plan of Treatment Primary clinical diagnosis 90% Mutilating Op Secondary clinical diagnosis 10% Nonmutilating Op Is a paraclinical diagnostic procedure needed? YES unless there is a strong reason NOTto do so (exception to the rule)
  42. 42. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Indication Certainty Plan of Treatment Primary clinical diagnosis 70% Chemotherapy Secondary clinical diagnosis 30% Radiotherapy Is a paraclinical diagnostic procedure needed? YES unless there is a strong reason NOTto do so (exception to the rule)
  43. 43. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Indication Tickler - Which of the following statements is the strongest indication for a paraclinical diagnostic procedure? A. You can never be absolutely certain of your clinical diagnosis B. You want to confirm a clinical diagnosis which are certain of C. You want to document a clinical diagnosis which you are certain of D. When you are not certain of your clinical diagnosis Best Answer is D
  44. 44. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Selection DATA NEEDED OPTIONS OF DIAGNOSTIC PROCEDURES
  45. 45. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Selection SELECTION PROCESS Options Benefit Risk Cost Availability 1 2 3
  46. 46. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Selection OUTPUT EXPECTED MOST COST-EFFECTIVE DIAGNOSTIC PROCEDURE
  47. 47. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Selection SELECTION PROCESS Procedure Benefit Risk Cost (PhP) Availability Options 1 most direct acceptable 1000 available 2 indirect acceptable 1500 available 3 indirect acceptable 1000 available Which is the most cost-effective procedure? Option 1
  48. 48. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Selection SELECTION PROCESS Procedure Benefit Risk Cost (PhP) Availability Options 1 accuracy 99% acceptable 5000 available 2 accuracy 90% acceptable 3000 available 3 accuracy 50% acceptable 1000 available Which is the most cost-effective procedure? Option 2 or Option 1?
  49. 49. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Selection SELECTION PROCESS Procedure Benefit Risk Cost (PhP) Availability Options 1 accuracy 95% acceptable 5000 available 2 accuracy 90% acceptable 3000 available 3 accuracy 50% acceptable 1000 available Which is the most cost-effective procedure? Option 2 or Option 1?
  50. 50. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Selection SELECTION PROCESS Procedure Benefit Risk Cost (PhP) Availability Options 1 yield greatest acceptable 4000 available 2 yield 90% acceptable 4000 available 3 yield 80% acceptable 3000 available Which is the most cost-effective procedure? Option 1
  51. 51. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Interpretation DATA NEEDED PRIMARY CLINICAL DIAGNOSIS SECONDARY CLINICAL DIAGNOSIS RESULT OF PARACLINICAL DIAGNOSTIC PROCEDURE
  52. 52. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Interpretation INTERPRETATION PROCESS CORRELATE RESULT OF PARACLINICAL DIAGNOSTIC PROCEDURE WITH PRIMARY AND SECONDARY CLINICAL DIAGNOSIS CONGRUENT - ACCEPT INCONGRUENT - MAKE A DECISION! (Accept or Hold!)
  53. 53. Management of a Surgical Patient [Process] Paraclinical Diagnostic Process - Interpretation Tickler - Determine which paraclinical diagnosis should be accepted as the pretreatment diagnosis and which one should be put on hold for further decision-making. Write (A) for accept and (H) for hold. 7.1 Paraclinical diagnosis is the same as the primary clinical diagnosis. 7.2 Paraclinical diagnosis is the same as the secondary clinical diagnosis 7.3 Paraclinical diagnosis is a clinical diagnosis least considered. 7.4 Paraclinical diagnosis does not jibe with the clinical picture or diagnosis. 7.1 A 7.2 A 7.3 H 7.4 H
  54. 54. Management of a Surgical Patient [Process] Learning Objectives 3. Describe the clinical diagnostic process. 4. Describe how to determine the indication for a paraclinical diagnostic procedure. 5. Describe how a paraclinical diagnostic procedure should be selected among several options. 6. Describe how to interpret results of a paraclinical diagnostic procedure to come out with a pretreatment diagnosis.
  55. 55. Management of a Surgical Patient [Process] Learning Objectives 7. Describe how a treatment modality should be selected among several options. 8. Enumerate at least 4 essential items in the preoperative preparation of a surgical patient. 9. Enumerate in correct chronological order 7 phases in the intraoperative management starting from the incision to wound closure.
  56. 56. Management of a Surgical Patient [Process] Learning Objectives 10. Enumerate at least 4 items in the immediate postoperative care of a surgical patient. 11. Enumerate the two objectives of a follow-up plan after treatment of a patient (whether surgical or not).
  57. 57. Management of a Surgical Patient [Process] Treatment Process
  58. 58. Management of a Surgical Patient [Process] Treatment Process - Selection DATA NEEDED PRETREATMENT DIAGNOSIS SEVERITY OR STAGE GOALS AND OBJECTIVES TREATMENT OPTIONS
  59. 59. Management of a Surgical Patient [Process] Treatment Process - Selection SELECTION PROCESS Options Benefit Risk Cost Availability 1 2 3
  60. 60. Management of a Surgical Patient [Process] Treatment Process - Selection OUTPUT EXPECTED MOST COST-EFFECTIVE TREATMENT PROCEDURE ACHIEVEMENT OF GOALS OF PATIENT MANAGEMENT!
  61. 61. Management of a Surgical Patient [Process] Treatment Process - Selection SELECTION PROCESS Treatment Benefit Risk Cost (PhP) Availability Options 1 greatest surv rate acceptable 5000 available 2 rate < 1 > 3 acceptable 4000 available 3 least surv rate acceptable 3000 available Which is the most cost-effective treatment option? Option 1
  62. 62. Management of a Surgical Patient [Process] Treatment Process - Selection SELECTION PROCESS Treatment Benefit Risk Cost (PhP) Availability Options 1 SR1 = SR2 lesser 5000 available 2 SR2= SR1 more 5000 available Which is the more cost-effective treatment option? Option 1
  63. 63. Management of a Surgical Patient [Process] Treatment Process - Selection SELECTION PROCESS Treatment Benefit Risk Cost (PhP) Availability Options 1 as effective as 2 acceptable 8000 available 2 as effective as 1 acceptable 4000 available Which is the more cost-effective treatment option? Option 2
  64. 64. Management of a Surgical Patient [Process] Treatment Process - Selection SELECTION PROCESS Treatment Benefit Risk Cost (PhP) Availability Options 1 most effective acceptable 2000 available 2 effectivity <1 >3 acceptable 3000 available 3 least effective acceptable 4000 available Which is the most cost-effective treatment option? Option 1
  65. 65. Management of a Surgical Patient [Process] Surgical Treatment Process PREOP PREPARATION
  66. 66. Management of a Surgical Patient [Process] Surgical Treatment Process - Preop Preparation •INFORMED CONSENT •PSYCHOSOCIAL SUPPORT •OPTIMIZATION •SCREENING •OPERATIVE MATERIALS
  67. 67. Management of a Surgical Patient [Process] Surgical Treatment Process INTRAOP MANAGEMENT
  68. 68. Management of a Surgical Patient [Process] Surgical Treatment Process - Intraop Mgt PHASES •INCISION •EXPOSURE •INTRAOP EVALUATION •OPERATIVE PROCEDURE PROPER •HEMOSTASIS CHECK •CORRECT COUNT •WOUND CLOSURE
  69. 69. Management of a Surgical Patient [Process] Surgical Treatment Process - Intraop Mgt Quality Standards: GENTLE METICULOUS and PRECISE NO IATROGENIC INJURIES NO UNNECESSARY MOVES EVERY MOVE HAS A REASON!
  70. 70. Management of a Surgical Patient [Process] Surgical Treatment Process POSTOP CARE
  71. 71. Management of a Surgical Patient [Process] Surgical Treatment Process - Postop Care •SUPPLY BASIC NEEDS OF PATIENT •COMFORT •ANALGESICS •FLUID AND ELECTROLYTES •NUTRITION •SUPPORT ORGAN FUNCTION •WOUND CARE •MONITORING FOR COMPLICATIONS •ADVICE ON •HOME CARE •FOLLOW-UP PLAN
  72. 72. Management of a Surgical Patient [Process] Surgical Treatment Process POSTOP FOLLOW-UP PLAN
  73. 73. Management of a Surgical Patient [Process] Surgical Treatment Process - Postop Follow-up Plan OBJECTIVES: •EVALUATE TREATMENT OUTCOME •PROVIDE PSYCHOSOCIAL SUPPORT MONITORING GUIDELINE: PHYSICAL EXAMINATION SYMPTOM-DIRECTED INVESTIGATION
  74. 74. Management of a Surgical Patient [Process] Surgical Treatment Process - Postop Follow-up Plan FF-UP FREQUENCY GUIDELINES: CONSIDER •USUAL COURSE OF DISEASE •PERSONALITY OF PATIENT •PATIENT’S CONVENIENCE
  75. 75. Management of a Surgical Patient [Process] Learning Objectives 7. Describe how a treatment modality should be selected among several options. 8. Enumerate at least 4 essential items in the preoperative preparation of a surgical patient. 9. Enumerate in correct chronological order 7 phases in the intraoperative management starting from the incision to wound closure.
  76. 76. Management of a Surgical Patient [Process] Learning Objectives 10. Enumerate at least 4 items in the immediate postoperative care of a surgical patient. 11. Enumerate the two objectives of a follow-up plan after treatment of a patient (whether surgical or not).
  77. 77. Management of a Surgical Patient [Process] Learning Objectives 12. Describe how to advice patients on clinical diagnosis, paraclinical diagnostic procedures, treatment, follow-up, and health promotion and maintenance. 13. Describe when and to whom to refer.
  78. 78. Management of a Surgical Patient [Process] HOW TO GIVE ADVICES
  79. 79. Management of a Surgical Patient [Process] HOW TO GIVE ADVICES 1. Always include the relatives of the patient in the advising, if they are available. 2. Assess the psychological make-up, the health beliefs, and the level of competency of the patient and the relatives before making any advice. Make strategies that will promote rapport. 2.1 Be honest but not brutally frank. Example, slowly divulge the diagnosis of an incurable disease or a frightening disease. 2.2 Use terminologies or explanations that can be easily understood by the patient and his relatives.
  80. 80. Management of a Surgical Patient [Process] HOW TO GIVE ADVICES 3. Use all kinds of strategies that will make the patient and his relatives like you. 4. Explain to the patient and relatives the processes you use in arriving to a diagnosis, recommendation for a paraclinical diagnostic procedures and treatment.
  81. 81. Management of a Surgical Patient [Process] REFERRAL WHEN TO WHOM
  82. 82. Management of a Surgical Patient [Process] Referral - When to Refer? All physicians, both certified and not yet certified, must know their limitations. Only they themselves can determine their own limitations. They must realize their limitations so that they do not cause undue harm to their patients and so that they know when to refer to colleagues.
  83. 83. Management of a Surgical Patient [Process] Referral - To Whom to Refer? Referral must be made to somebody who may or can solve the patient’s health problem rationally, effectively, efficiently, and humanely, and who has a good track record of handling the kind of problem on hand.
  84. 84. Management of a Surgical Patient [Process] Learning Objectives
  85. 85. Management of a Surgical Patient [Process] Learning Objectives 1. State the overall goals in the management of a patient (whether surgical or not). 2. Enumerate the four functions of a physician in the management of a patient (whether surgical or not). 3. Describe the clinical diagnostic process. 4. Describe how to determine the indication for a paraclinical diagnostic procedure. 5. Describe how a paraclinical diagnostic procedure should be selected among several options.
  86. 86. Management of a Surgical Patient [Process] Learning Objectives 6. Describe how to interpret results of a paraclinical diagnostic procedure to come out with a pretreatment diagnosis. 7. Describe how a treatment modality should be selected among several options. 8. Enumerate at least 4 essential items in the preoperative preparation of a surgical patient. 9. Enumerate in correct chronological order 7 phases in the intraoperative management starting from the incision to wound closure.
  87. 87. Management of a Surgical Patient [Process] Learning Objectives 10. Enumerate at least 4 items in the immediate postoperative care of a surgical patient. 11. Enumerate the two objectives of a follow-up plan after treatment of a patient (whether surgical or not). 12. Describe how to advice patients on clinical diagnosis, paraclinical diagnostic procedures, treatment, follow-up, and health promotion and maintenance. 13. Describe when and to whom to refer.
  88. 88. Management of a Surgical Patient [Process] HOPE u have enjoyed this learning session! Email me for any feedback and questions: rjoson@maniladoctors.com.ph

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