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PRINCIPLES
OF MEDICINE
APPROACH TO
EVALUATION OF
PATIENT
WHAT IS
EXPECTED OF
THE DOCTOR?
MEDICINE IS BOTH
SCIENCE AND ART
 SCIENCE
- technology based on science is the
foundation for solution to clinical
proble...
 ART
- ability to extract contradictory physical signs
- ability to discern and interpret laboratory data
- to know wheth...
“ Tact, sympathy and understanding are
expected of the physician, for the
patient is no mere collection of
symptoms, signs...
PATIENT – PHYSICIAN /
DOCTOR RELATIONSHIP
 Individuals whose problems often
transcends their complaints
 Whatever the pa...
HOW TO
EVALUATE
I. PATIENT HISTORY
• “build” a history rather
than “take” one
OBJECTIVES:
• identify problems
• to establi...
Setting for the interview:
 Make everyone as comfortable as
possible
 Make the patient your focal point
 Maintain eye c...
STRUCTURE OF THE
HISTORY
1. General data
2. Chief complaint
3. History of present illness
4. Past medical history
5. Famil...
 GENERAL DATA
- identifies the name, date, age, gender,
race, occupation
 CHIEF COMPLAINT
- brief statement of the reaso...
History of Present
Illness (HPI)
a complete HPI will include
the following:
• chronologic ordering of
events
• state of he...
• description of a typical attack, including
its persistence
• impact of the illness on the patient’s
usual lifestyle
• me...
Past Medical History
baseline for assessing the present complaint.
• general health and strength
• childhood illnesses: me...
• serious injuries
• medications
• allergies and the nature of reactions
especially to medications
• transfusions: reactio...
Family History
• blood relatives in the immediate or
extended family with illnesses with
features similar to patient’s
• i...
Personal and Social History
• PERSONAL STATUS: birthplace, where
raised, home environment, education,
position in family, ...
• SEXUAL HISTORY
• OCCUPATION: description and
duration of employment; exposures to
toxins (e.g. lead, arsenic, asbestos)
...
Review of Systems
Identify the presence or absence of health-related
issues in each body system.
• general constitutional ...
• GIT: heartburn, nausea, vomiting,
hematemesis, regularity of bowels,
constipation, diarrhea, flatulence,
hemorrhoids
• m...
• female: menarche, pregnancies
• males: puberty onset, erectile
dysfunctions, problem in emissions,
testicular pain, libi...
TYPES OF HISTORIES
1. Complete History – makes you thoroughly
familiar with the patient
- most often recorded the first ti...
• The results should be recorded at the time they
are elicited
• Repeat the physical examination as frequently
as the clin...
PARTS OF PHYSICAL
EXAMINATIONS
1. Measurement of Vital Signs: baseline
indicators of a patient’s health status
• PULSE – m...
• RESPIRATION – observe the rise and
fall of the chest
- Count the respiratory cycles / minute
- Note the depth of respira...
• OXYGEN SATURATION – estimation
of arterial oxygen saturation
- A healthy person with no anemia or lung
disease has O2 sa...
2. Physical Assessment
• INSPECTION
- process of observation
- what is the patient’s gait
- is eye contact made
- is the p...
• PALPATION
- involves the use of the hands and
fingers to gather information through
the sense of touch
- ulnar surface o...
• PERCUSSION
- involves striking one object against
another to produce vibration and
subsequent sound waves
- the more den...
PERCUSSION TONES
TONE
Tympanic
Hyperresonant
Resonant
Dull
Flat
INTENSITY
Loud
Very loud
Loud
Soft to Moderate
Soft
PITCH
...
CORE VALUES
1. Respect the patient.
2. Achieve the complimentary forces of
competence and compassion.
3. The art and skill...
THANK YOU!!!
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Principles of Medicine

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Principles of Medicine

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Principles of Medicine

  1. 1. PRINCIPLES OF MEDICINE
  2. 2. APPROACH TO EVALUATION OF PATIENT
  3. 3. WHAT IS EXPECTED OF THE DOCTOR?
  4. 4. MEDICINE IS BOTH SCIENCE AND ART  SCIENCE - technology based on science is the foundation for solution to clinical problems - advances in biochemical methodology and in biophysical imaging techniques - innovations in therapeutic maneuvers
  5. 5.  ART - ability to extract contradictory physical signs - ability to discern and interpret laboratory data - to know whether to treat or watch - to determine when to pursue a clinical clue or when to dismiss - to decide which is of greater risk: treatment or disease  This combination of medical knowledge, intuition and judgment is the art of medicine
  6. 6. “ Tact, sympathy and understanding are expected of the physician, for the patient is no mere collection of symptoms, signs, disordered functions, damaged organs and disturbed emotions. He is human, fearful and hopeful seeking relief, help and reassurance.” - Harrison’s Principle of Medicine
  7. 7. PATIENT – PHYSICIAN / DOCTOR RELATIONSHIP  Individuals whose problems often transcends their complaints  Whatever the patient’s attitude, the physician needs to consider the terrain in which an illness occurs – family and social background  Approach patients not as “cases” or “diseases”  Primary objective is to discover the root of a patient’s concern and do something about it
  8. 8. HOW TO EVALUATE I. PATIENT HISTORY • “build” a history rather than “take” one OBJECTIVES: • identify problems • to establish a sense of the patient’s reliability • to consider the potential for intentional or unintentional suppression or underreporting of certain experiences
  9. 9. Setting for the interview:  Make everyone as comfortable as possible  Make the patient your focal point  Maintain eye contact and a conversational tone of voice
  10. 10. STRUCTURE OF THE HISTORY 1. General data 2. Chief complaint 3. History of present illness 4. Past medical history 5. Family history 6. Personal and social history 7. Review of systems
  11. 11.  GENERAL DATA - identifies the name, date, age, gender, race, occupation  CHIEF COMPLAINT - brief statement of the reason the patient is seeking care - direct quotes are helpful
  12. 12. History of Present Illness (HPI) a complete HPI will include the following: • chronologic ordering of events • state of health just before the onset of the present problem • complete description of the first symptoms • possible exposure to infection, toxic agents or other environmental hazards
  13. 13. • description of a typical attack, including its persistence • impact of the illness on the patient’s usual lifestyle • medications current and recent including dosage as well as home remedies
  14. 14. Past Medical History baseline for assessing the present complaint. • general health and strength • childhood illnesses: measles, mumps, chickenpox, etc. • major adult illnesses: TB, hepatitis, diabetes, HPN, MI, any surgical or non- surgical hospitalization • immunizations
  15. 15. • serious injuries • medications • allergies and the nature of reactions especially to medications • transfusions: reactions, date and number of units transfused
  16. 16. Family History • blood relatives in the immediate or extended family with illnesses with features similar to patient’s • include in the list of concerns: heart disease, high blood, pressure, diabetes, asthma, epilepsy, allergy, thyroid disease, etc. • history of cancer
  17. 17. Personal and Social History • PERSONAL STATUS: birthplace, where raised, home environment, education, position in family, marital status, hobbies and interests, sources of stress and strain • HABITS: nutrition and diet, regularity and patterns of eating and sleeping, quantity of coffee, tea, tobacco, alcohol, extent of cigarette use reported in “pack- years”
  18. 18. • SEXUAL HISTORY • OCCUPATION: description and duration of employment; exposures to toxins (e.g. lead, arsenic, asbestos) • RELIGIOUS AND CULTURAL PREFERENCES
  19. 19. Review of Systems Identify the presence or absence of health-related issues in each body system. • general constitutional symptoms • head and neck • lymph nodes: enlargement, tenderness • chest and lungs: pain in respiration, dyspnea, wheeze, cyanosis • breasts: development, pain, tenderness, discharge, lumps • heart & blood vessels • peripheral vasculature: thrombosis, thrombophlebitis, claudication
  20. 20. • GIT: heartburn, nausea, vomiting, hematemesis, regularity of bowels, constipation, diarrhea, flatulence, hemorrhoids • musculoskeletal: joint stiffness, pain, restriction of motion, swelling, redness, bone deformity • neurologic: syncope, seizures, weakness or paralysis, tremors, loss of memory • psychiatric: depression, mood changes, difficulty concentrating, anxiety, agitation, suicidal thoughts
  21. 21. • female: menarche, pregnancies • males: puberty onset, erectile dysfunctions, problem in emissions, testicular pain, libido, infertility
  22. 22. TYPES OF HISTORIES 1. Complete History – makes you thoroughly familiar with the patient - most often recorded the first time you see the patient. 2. Inventory History – related to but does not replace the complete history - it touches on the major points without going into detail 3. Problem (or focused) History – taken when the problem is acute possibly life threatening 4. Interim History – chronicles the events that have occurred since your last meeting with the patient
  23. 23. • The results should be recorded at the time they are elicited • Repeat the physical examination as frequently as the clinical situation warrants II. PHYSICAL EXAMINATION • Physical signs are the objective and verifiable marks of disease and represent solid, indisputable facts • Physical examination should be performed methodically and thoroughly
  24. 24. PARTS OF PHYSICAL EXAMINATIONS 1. Measurement of Vital Signs: baseline indicators of a patient’s health status • PULSE – may be palpated in several areas; however, the radial pulse is most often used - note their rhythm, amplitude while counting
  25. 25. • RESPIRATION – observe the rise and fall of the chest - Count the respiratory cycles / minute - Note the depth of respiration and whether the patient uses accessory muscles • BLOOD PRESSURE • TEMPERATURE – oral, rectal, axillary and tympanic - kinds: electronic and tympanic; infrared axillary thermometers for neonates
  26. 26. • OXYGEN SATURATION – estimation of arterial oxygen saturation - A healthy person with no anemia or lung disease has O2 sat. of 97% - 99% • PAIN – because of its ubiquitous nature, its universality as a distress signal, it is more and more often being recognized as part of the vital sign.
  27. 27. 2. Physical Assessment • INSPECTION - process of observation - what is the patient’s gait - is eye contact made - is the patient dressed appropriately for the weather - color and moisture of the skin
  28. 28. • PALPATION - involves the use of the hands and fingers to gather information through the sense of touch - ulnar surface of the hand and fingers is the most sensitive area for distinguishing vibration - dorsal surface of the hand is best for estimating temperature
  29. 29. • PERCUSSION - involves striking one object against another to produce vibration and subsequent sound waves - the more dense the medium, the quieter is the percussion tone - percussion over air is loud, over fluid less loud and over solid areas soft
  30. 30. PERCUSSION TONES TONE Tympanic Hyperresonant Resonant Dull Flat INTENSITY Loud Very loud Loud Soft to Moderate Soft PITCH High Low Low Moderate to High High QUALITY Drumlike Boomlike Hollow Thudlike Very dull Example where heard Gastric Bubble Emphysematous Lung Healthy Lung Liver Over Muscle
  31. 31. CORE VALUES 1. Respect the patient. 2. Achieve the complimentary forces of competence and compassion. 3. The art and skill essential to history taking and physical examination are the bedrock of care; technologic resources are complements 4. The history and physical examination are inseparable – they are one. 5. The computer cannot replace you, it is what you do that builds a trusting, fruitful relationship with the patient. 6. The relationship can be indescribably rewarding.
  32. 32. THANK YOU!!!

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