The document provides an overview of a Patient Management Process framework presented by the author. It consists of 6 parts: Overview, Clinical Diagnostic Process, Paraclinical Diagnostic Process, Selection of Treatment Process, Advice to Patient Process, and Peculiarities and Limitations of Medical Practice. When a patient consults a physician, the physician's tasks are to establish rapport, make a diagnosis and provide advice, determine treatment and provide advice, and give general advice. The overview describes the clinical diagnostic process of pattern recognition and prevalence to make a diagnosis. It also outlines the processes used to determine if paraclinical diagnosis is needed, select the procedure, interpret results, and determine pretreatment diagnosis before selecting treatment. The goal is

1. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
Welcome all!
MUTE yourself but always
show your video picture.
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account, email address in the
Chat Box!
Use the Chat Box to ask
questions and make
comments while the PEP TALK
is on.
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end of PEP TALK – show your
face in video.
July 10, 2021
1400H – 1500H
Via Zoom

2. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
Reminder:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

3. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
Welcome all!
Mabuhay!
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START IN 2 MINUTES!
Pls. turn on your
video!
Show your face!

4. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

5. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
I launched this PEP
TALK on May 15,
2021 with MODULE
on COVID19.
2nd Module
PATIENT
EMPOWERMENT
3rd Module
PATIENT
MANAGEMENT
PROCESS

6. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
MODULE on
PATIENT
MANAGEMENT
PROCESS
6 Parts
• Overview
• Clinical Diagnostic
Process
• Paraclinical
Diagnostic Process
• Selection of
Treatment Process
• Advice to Patient
Process
• Peculiarities and
Limitations of
Medical Practice

7. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
What I have in mind
in my PEP TALK
which may run for 3
years is to empower
at least 30 persons,
with my family
members and my
patients as a
priority. That is my
key performance
indicator.
I hope you will be in
my group of 30.

8. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
My PEP TALK today
is entitled: Patient
Management
Process, an
Overview.

9. Patient
Management
Process – An
Overview
I will give you one
second to have a quick
glance at the framework
of Patient Management
Process so as to prime
you on my talk but I will
not discuss it yet as I
want first to do a little
introduction and give a
backgrounder to the
framework.

10. Patient
Management
Process – An
Overview
A patient in the medical context is
someone who has a health
concern.
That health concern has to go
through the processes of
problem-solving and decision-
making to know what it is first (or
diagnosis) and then to know what
to do to resolve it (or treatment).
This in essence is the gist of
“Patient Management Process.”

11. Patient
Management
Process – An
Overview
As early as 1989, I formally
formulated a Patient
Management Process framework
or algorithm (PMP) which I have
been using since then in my
private practice and teaching in
health care institutions such as
medical schools and hospitals.
Modesty aside, I find my PMP
simple and practical to follow and
to teach both the health care
professionals and the laypeople.

12. Patient
Management
Process – An
Overview
Although this framework was
originally made with the health
care professionals (physicians and
medical students) in mind,
I honestly think it can be used to
teach and should be taught to
laypeople so that there will be
alignment of expectations from
both parties, meaning the
physicians and patients.

13. Patient
Management
Process – An
Overview
In understanding the Patient
Management Process, laypeople
will know how to participate in
the problem-solving and decision-
making of their health concerns
with their physicians.
First and foremost, they will
know what to ask the healthcare
professionals before they make
decisions on their health
concerns.

14. Patient
Management
Process – An
Overview
Second, they can evaluate
whether the health care
professionals are using proper
and rational processes or not
(such as just using the matching-
type questions and answers) in
their recommendations.
This could serve as a ground to
seek opinion from another
healthcare professional, the so-
called second opinion.

15. Patient
Management
Process – An
Overview
In understanding the Patient
Management Process, even in the
absence of health care
professionals, laypeople may
know what to do with their
health problems, at least the
processes in problem-solving and
decision-making.
With this competence, they can
gain greater control on what to
do with their health concerns and
issues.

16. Patient
Management
Process – An
Overview
Do all the above benefits of
knowing Patient Management
Process remind you of the
concept of Patient
Empowerment?
Pagpapalakas ng Pasyente and
the K4 –
Kaalaman,
Kakayanan,
Karapatan and
Kapangyarihan?

17. Patient
Management
Process – An
Overview
A word about using processes
versus using matching-type
questions and answers in
problem-solving and decision-
making.

18. Patient
Management
Process – An
Overview
In matching-type questions and
answers in solving problems, you
have premises then
straightforward responses.
For example, if you have this symptom
or set of symptoms and signs, then the
diagnosis is this or that.
If you need a paraclinical diagnostic
procedure for a particular diagnosis,
then the procedure should be this or
that.
Likewise, in treatment, it will be this or
that for a particular type of diagnosis.

19. Patient
Management
Process – An
Overview
The problem-solving and
decision-making processes for
health concern are more complex
than performing matching-type
questions and answers as we
shall see later on.
By the way and suffice for me to
say at this moment,
a process is defined as a series of
actions which are carried out in
order to achieve a particular
result.

20. Patient
Management
Process – An
Overview
Here again is the diagram of my
Patient Management Process
framework or algorithm.
For today, I will just present the
gist in each step and the involved
processes.
I will do the detailed discussion in
the next sessions.

21. Patient
Management
Process – An
Overview
A patient consults a physician.
The goal of the physician is resolution of the health problem in such a way
that the patient does not end up dead; as much as possible with no
complications and no disability; in such a manner that the patient is
satisfied. These are the universal goals of all physicians. These are also
rightfully the expectations of the patients.

22. Patient
Management
Process – An
Overview
A patient consults a physician.
What are the four basic categories of functions or tasks expected of a
physician?

23. Patient
Management
Process – An
Overview
What are the four basic categories of functions or tasks expected of a physician?
 Rapport
 Diagnosis – Advice
 Treatment – Advice
 Advice
The general quality standards that can be used for these 4 tasks are
rational, effective, efficient and humane.

24. Patient
Management
Process – An
Overview
After establishing RAPPORT with the patient,
the physician starts accomplishing the task of DIAGNOSIS.

25. Patient
Management
Process – An
Overview
The physician does interview to get symptom data and does physical
examination to get sign data after which he does the clinical diagnostic
processes to come out with the clinical diagnosis.

26. Patient
Management
Process – An
Overview
The clinical diagnostic processes consist of pattern recognition and
prevalence.
Pattern recognition process means realization that the patient’s
presentation conforms to a previously learned picture or pattern of
disease.
Prevalence process means 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. Patient
Management
Process – An
Overview CLINICAL DIAGNOSTIC PROCESS - PROCESSING OF DATA – ILLUSTRATION 1
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

28. Patient
Management
Process – An
Overview
CLINICAL DIAGNOSTIC PROCESS - PROCESSING OF DATA – ILLUSTRATION 2
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

29. Cleft lip?
Cleft lip and
palate?
Patient
Management
Process – An
Overview
Dx and process used?

30. Cleft lip?
Cleft lip and
palate?
PROCESS USED in Dx: PATTERN RECOGNITION
Patient
Management
Process – An
Overview

31. Dx and process used?
Patient
Management
Process – An
Overview

32. Dx: HYPERTHYROIDISM
PROCESS USED in Dx: PATTERN RECOGNITION
Patient
Management
Process – An
Overview

33. Patient has cough, cold, fever and tiredness.
What is your most probable diagnosis and process
used?
• COVID19 (SARS-COV-2 virus)?
• FLU (influenza virus)?
• Common colds (rhinovirus)?
Patient
Management
Process – An
Overview

34. Patient has cough, cold, fever and tiredness.
What is your most probable diagnosis and process
used?
• COVID19 (SARS-COV-2 virus) *** during time of
pandemic / epidemic [PREVALENCE PROCESS]
• FLU (influenza virus)
• Common colds (rhinovirus)
Patient
Management
Process – An
Overview

35. Patient has cough, cold, fever and tiredness.
What is your most probable diagnosis and process
used?
• COVID19 (SARS-COV-2 virus)
• FLU (influenza virus) *** during time of
pandemic / epidemic /outbreak [PREVALENCE
PROCESS]
• Common colds (rhinovirus)
Patient
Management
Process – An
Overview

36. Patient
Management
Process – An
Overview
The outputs of the clinical diagnostic processes are primary clinical
diagnosis (most probable or most likely) and secondary clinical diagnosis
(alternate or second most probable or less likely).

37. Patient
Management
Process – An
Overview
After the clinical diagnostic processes and formulation of clinical diagnosis,
the physician gives advice to the patient, meaning he tells and explains the
findings and diagnosis and entertains and answers questions from the
patient.

38. Patient
Management
Process – An
Overview
After the formulation of the clinical diagnosis,
the physician decides whether he needs a
paraclinical diagnostic procedure or not.
“Paraclinical” here means done after the
clinical diagnosis.
The foremost indication for a paraclinical
diagnostic procedure can be stated this way:
if you are not certain on the primary clinical
diagnosis and you need to be certain or be
more certain before treatment, then go for a
paraclinical diagnostic procedure.

39. Patient
Management
Process – An
Overview
To decide on indication of the paraclinical
diagnostic procedure,
the physician uses two processes –
degree of certainty on the primary clinical
diagnosis and
comparison of the treatment plans for the
primary and secondary clinical diagnoses.

40. Patient
Management
Process – An
Overview
PARACLINICAL DIAGNOSTIC PROCESS –
INDICATION - PROCESSING OF DATA –
ILLUSTRATION
Certainty of Primary Clinical Diagnosis
60% (needed) ---------------------------------------------------
--------------------------- 99% (not needed)
Treatment Plans for Primary and Secondary
Diagnoses
Different (needed) ---------------------------------------------
--------------------------- Same (not needed)

41. Patient
Management
Process – An
Overview
PARACLINICAL DIAGNOSTIC PROCESS –
INDICATION - PROCESSING OF DATA –
ILLUSTRATION 2
Is a paraclinical diagnostic procedure
needed? NO unless there is a strong reason
to do so (exception to the rule)
Certainty Plan of
Treatment
Primary clinical
diagnosis
98% Surgical
Secondary
clinical diagnosis
1-2% Nonsurgical

42. Patient
Management
Process – An
Overview
After analyzing the indication for a paraclinical
diagnostic procedure,
the physician advises the patient on this by
explaining the processes that he uses and the
outcome of his analysis.
He recommends; waits and answers queries
from the patient; allows the patient to decide;
and forges a shared agreement.

43. Patient
Management
Process – An
Overview
If there is a need for a paraclinical diagnostic
procedure, the physician uses the B-R-C-A
processes.
B – stands for benefit; R – risk; C – cost; A –
Availability.

44. Patient
Management
Process – An
Overview
The physician gives or lists the various options
of paraclinical diagnostic procedures and then
gives data on the BRCA.
With the data given, the patient is asked what
he prefers.
Procedures Benefit
(goal – to
be more
definite on
the
diagnosis)
Risk Cost Availability
Option1
Option2
Option3

45. Patient
Management
Process – An
Overview
PARACLINICAL DIAGNOSTIC PROCESS – SELECTION - PROCESSING OF
DATA – ILLUSTRATION
Which will be chosen? OPTION 1 if patient can afford. If not, OPTION 2 can be
chosen because it has a 90% accuracy which is high enough.
Procedures Benefit (goal – to be
more definite on the
diagnosis)
Risk Cost (PhP) Availability
Option1 accuracy 99% acceptable 4000 available
Option2 accuracy 90% acceptable 3000 available
Option3 accuracy 60% acceptable 1000 available

46. Patient
Management
Process – An
Overview
So, the advice given by the physician at this
point consist of explaining the processes of
selection (BRCA) to choose the most cost-
effective paraclinical diagnostic procedure and
to the desire of the patient.
He can recommend. He waits and answers
queries from the patient; allows the patient to
decide; and forges a shared agreement.

47. Patient
Management
Process – An
Overview
Assuming that a paraclinical diagnostic
procedure is done.
The physician has to interpret the results of the
paraclinical diagnostic procedure.
To do this, he uses two processes – assessment
of the accuracy of the report and correlation
with the clinical findings.
Then, he advises the patient on his
interpretation and proceeds to discussion of
treatment.

48. Patient
Management
Process – An
Overview
Before the selection of a treatment
procedure,
the physician decides on the pretreatment
diagnosis which is obtained from repeated
assessment of the accuracy of the clinical
diagnosis and paraclinical diagnosis and
correlation of the two.
He advises the patient on the pretreatment
diagnosis.
He then spells out the objectives or aims of
treatment.

49. Patient
Management
Process – An
Overview
He then gives or lists the various options of
treatment; uses the B-R-C-A processes in the
selection; and gives data on the BRCA.
With the data given, the patient is asked what
he prefers.
Treatment Benefit
(goal of
treatment)
Risk Cost Availability
Option1
Option2
Option3

50. Patient
Management
Process – An
Overview
SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –
ILLUSTRATION
Which should be chosen? OPTION 1
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Option1 greatest survival rate acceptable 5000 available
Option2 rate < 1 > 3 acceptable 6000 available
Option3 least survival rate acceptable 3000 available

51. Patient
Management
Process – An
Overview
So, the advice given by the physician at
this point consist of explaining the
processes of selection (BRCA) to choose
the most cost-effective treatment
procedure and to the desire of the
patient.
He can recommend. He waits and
answers queries from the patient;
allows the patient to decide; and forges
a shared agreement.

52. Patient
Management
Process – An
Overview
Once a shared agreement is arrived at, the
treatment is executed.
Just before, during and right after treatment,
the physician advises patient on preparation,
outcome, things to monitor, etc.

53. Patient
Management
Process – An
Overview
After treatment, the physician advises patient
on health restoration and maintenance.
With this step, one whole cycle of patient
management inclusive of involved processes
is completed by the physician with full
participation from the patient.

54. Patient
Management
Process – An
Overview
That in brief,
is an overview of the ROJoson
Patient Management Process
framework or algorithm.
There are still a lot of nitty-gritty
things to discuss or things to
expound, but these will be done
in subsequent sessions.

55. Patient
Management
Process – An
Overview
Take away in this PEP TALK that
are related to Patient
Empowerment:

56. Patient
Management
Process – An
Overview
Take away in this PEP TALK that
are related to Patient
Empowerment:
Foremost, the ROJoson Patient
Management Process framework
or algorithm clearly spells out the
universal goals of treatment; the 4
basic categories of functions to be
performed by the physician
(Rapport, Diagnosis, Treatment,
and Advice); and the involved
processes that have to be done
within each function.

57. Patient
Management
Process – An
Overview
Take away in this PEP TALK that
are related to Patient
Empowerment:
The problem-solving and decision-
making processes for all health
concerns do not simply utilize
performing matching-type
questions and answers. They are
more complex. They involve a
series of actions which are carried
out in order to achieve a particular
objective or result.

58. Patient
Management
Process – An
Overview
Take away in this PEP TALK that
are related to Patient
Empowerment:
In understanding the Patient
Management Process being done by
physicians, laypeople will know how to
participate in the problem-solving and
decision-making of their health concerns
with their physicians.
With problem-based and self-directed
learning, in the absence of health care
professionals, they may even know what
to do with their health problems within
their capacity and capability.

59. Patient
Management
Process – An
Overview
Take away in this PEP TALK that
are related to Patient
Empowerment:
Understanding the Patient
Management Process will
redound to Patient
Empowerment:
Pagpapalakas ng Pasyente
with its K4 – Kaalaman,
Kakayanan, Karapatan and
Kapangyarihan.

60. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview

61. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
Reminder:
Take the Online Learning
cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.
Link is in Chat Box.

62. Empowerment
objective - for
laypeople to have
an understanding
of the Patient
Management
Process – how a
patient is being
and should be
managed.
Patient
Management
Process – An
Overview
Welcome all!
Mabuhay!
LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
START Q&A AND
INTERACTIONS!
Pls. turn on your
video!
Show your face!