ROJOSON-PEP-TALK: Pt Mgt Process – Clinical Diagnostic Process (Talk July 17, 2021)

1. Empowerment
objective - for
laypeople to have
an understanding
of the GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Clinical
Diagnostic
Process
July 17, 2021
1400H – 1500H
Via Zoom
Welcome all!
MUTE yourself but always
show your video picture.
Sign in your name, FB
account, email address in the
Chat Box!
Use the Chat Box to ask
questions and make
comments while the PEP TALK
is on.
Group pictures at start and
end of PEP TALK – show your
face in video.

2. Empowerment
objective - for
laypeople to have
an understanding
of the GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Clinical
Diagnostic
Process
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 GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Clinical
Diagnostic
Process
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 GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Clinical
Diagnostic
Process
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. I launched this PEP
TALK on May 15,
2021 with MODULE
on COVID19.
2nd Module
PATIENT
EMPOWERMENT
3rd Module
PATIENT
MANAGEMENT
PROCESS
Patient
Management
Process -
Clinical
Diagnostic
Process
Empowerment
objective - for
laypeople to have
an understanding
of the GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.

6. Empowerment
objective - for
laypeople to have
an understanding
of the GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Clinical
Diagnostic
Process
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.

7. This is the Patient
Management Process
Framework.
Patient
Management
Process -
Clinical
Diagnostic
Process

8. Patient
Management
Process -
Clinical
Diagnostic
Process
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

9. Patient
Management
Process -
Clinical
Diagnostic
Process
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

10. Patient
Management
Process -
Clinical
Diagnostic
Process
My PEP TALK today
will focus on this
part of the Patient
Management
Process – Goals and
the Clinical
Diagnostic Process.

11. Patient
Management
Process -
Clinical
Diagnostic
Process
Empowerment
objective - for
laypeople to have
an understanding
of the GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.

12. The Patient Management Process (PMP) starts with a patient consulting a
physician for a health concern.
Patient
Management
Process -
Clinical
Diagnostic
Process

13. There are two categories of reasons for medical consultation. One is
consulting for management of a symptom or set of symptoms. The other is
consulting for screening for a disease or diseases.
Although the PMP is applicable to both categories of medical consultation,
I will focus on the management of a patient with a health problem so that I
can easily give scenarios or examples for illustrative purpose, scenarios
that you are familiar with.
Patient
Management
Process -
Clinical
Diagnostic
Process

14. A patient consults a physician.
The goals of the physician are 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.
Patient
Management
Process -
Clinical
Diagnostic
Process

15. There are caveats in these goal statements.
Medicine is an inexact science with nothing absolute, nothing
guaranteed with no perfect achievement of goals all the time.
Despite these harsh realities, an idealistic goal should be set to
guide the physicians, their fighting target.
Patient
Management
Process -
Clinical
Diagnostic
Process

16. What is most important is that physicians exert their best,
rational, honest and humane or compassionate efforts in
managing patients to the satisfaction or delight of the patients
and relatives even in the absence of complete resolution of the
health problem.
Patient
Management
Process -
Clinical
Diagnostic
Process

17. As mentioned earlier, these goals of the physicians are rightfully the
expectations of the patients but the latter should understand the
limitations of medicine and also, their physicians, when the goals are not
completely achieved.
They should appreciate the physicians as long as they exert best, rational,
honest and humane or compassionate efforts in caring for them.
Patient
Management
Process -
Clinical
Diagnostic
Process

18. To achieve the goals, a physician performs four basic categories of
functions or tasks. These are:
 Rapport
 Diagnosis – Advice
 Treatment – Advice
 Advice
Patient
Management
Process -
Clinical
Diagnostic
Process
The general quality standards that can be
used for these 4 tasks are rational,
effective, efficient and humane.

19. After establishing rapport with the patient,
the physician starts accomplishing the task of DIAGNOSIS.
Patient
Management
Process -
Clinical
Diagnostic
Process

20. Diagnosis means coming out with statement of what a patient has at the
current moment after evaluating the symptoms and signs.
If the patient comes in with reports from laboratory examinations and
procedures done prior to consult, they are included in the evaluation.
Patient
Management
Process -
Clinical
Diagnostic
Process

21. Before coming out with a diagnosis, the physician interviews and does
physical examination on the patient.
The data gotten from the interview are called symptoms (what the patient
feels or observe in/on his body which can be a manifestation of a medical
condition or disease). The data gotten from the physical examination are
called signs (defined as findings obtained by a physician after doing a
physical examination).
Patient
Management
Process -
Clinical
Diagnostic
Process

22. A diagnosis just derived from symptoms and signs is called a clinical
diagnosis.
In some instances, a patient consults a physician bringing along reports of
diagnostic procedures done earlier. In such instances, the physician will
incorporate the data from the diagnostic reports in the clinical diagnosis.
Patient
Management
Process -
Clinical
Diagnostic
Process

23. In processing the symptom and sign data and other
data for that matter,
the physician uses the clinical diagnostic processes
called pattern recognition and prevalence.
Patient
Management
Process -
Clinical
Diagnostic
Process

24. Pattern recognition process means realization that the patient’s
presentation conforms to a previously learned picture or pattern of
disease. Pattern recognition is essentially the same as a matching process.
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.
Patient
Management
Process -
Clinical
Diagnostic
Process

25. Patient
Management
Process -
Clinical
Diagnostic
Process
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

26. Patient
Management
Process -
Clinical
Diagnostic
Process
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

27. Patient
Management
Process -
Clinical
Diagnostic
Process
CLINICAL DIAGNOSTIC PROCESS - PROCESSING OF DATA –
ILLUSTRATION 3
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

28. Patient
Management
Process -
Clinical
Diagnostic
Process Cleft lip?
Cleft lip and
palate?
Dx and process used?

29. Patient
Management
Process -
Clinical
Diagnostic
Process Cleft lip?
Cleft lip and
palate?
PROCESS USED in Dx: PATTERN RECOGNITION

30. Patient
Management
Process -
Clinical
Diagnostic
Process
Dx and process used?

31. Patient
Management
Process -
Clinical
Diagnostic
Process
Dx: HYPERTHYROIDISM
PROCESS USED in Dx: PATTERN RECOGNITION

32. Patient
Management
Process -
Clinical
Diagnostic
Process
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)

33. Patient
Management
Process -
Clinical
Diagnostic
Process
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 [PREVALENT PROCESS]
• FLU (influenza virus)
• Common colds (rhinovirus)

34. Patient
Management
Process -
Clinical
Diagnostic
Process
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 [PREVALENT
PROCESS]
• Common colds (rhinovirus)

35. Patient
Management
Process -
Clinical
Diagnostic
Process
At this point, I like to insert something, still related
to our discussion on the clinical diagnostic process
but which I advise you to remember for the rest of
your life and be empowered by knowing, for
chances, you will be confronted with it, now and in
the future, on yourself and on your loved ones.
HOW TO DIAGNOSE A MASS ON THE BODY
SURFACE using PATTERN RECOGNITION

36. Patient
Management
Process -
Clinical
Diagnostic
Process
Foremost question to ask is the body surface mass CANCER OR NOT
CANCER.
Using pattern recognition, know and look for signs of CANCER and signs of
NOT CANCER.
HOW TO DIAGNOSE A MASS ON THE BODY SURFACE using PATTERN
RECOGNITION

37. Patient
Management
Process -
Clinical
Diagnostic
Process
If signs of CANCER are present, the primary diagnosis is CANCER.
If NO CANCER SIGNS are present, more likely, NOT CANCER, especially if
there are signs of NOT CANCER.
HOW TO DIAGNOSE A MASS ON THE BODY SURFACE using PATTERN
RECOGNITION

38. Patient
Management
Process -
Clinical
Diagnostic
Process
SIGNS OF CANCER for Pattern Recognition:
• Hard solid
• Fixed
• Skin changes
• Lymph nodes
• Distant mass suggestive of spread
HOW TO DIAGNOSE A MASS ON THE BODY SURFACE using PATTERN
RECOGNITION
SIGNS OF NOT CANCER
for Pattern Recognition:
• Cystic mass
• Signs of inflammation /
infection – pus, redness,
tenderness, etc.

39. Patient
Management
Process -
Clinical
Diagnostic
Process
The output of the clinical diagnostic processes is a
DIAGNOSIS.
As mentioned, a diagnosis is an identification label
of the patient’s health problem.

40. Patient
Management
Process -
Clinical
Diagnostic
Process
The elemental steps in making a diagnosis or a diagnostic statement
consist of the following:
o Identify which organ or tissue or system is involved.
o Then, identify the disease in general terms, such as inflammation,
infection, tumor, trauma, endocrine, etc.
o Then, try to be more specific in identifying the disease, if possible,
such as malignant neoplasm, abscess, etc.

41. Patient
Management
Process -
Clinical
Diagnostic
Process
Examples of diagnostic statements:
Right breast mass, malignant
Left thyroid lobe mass, malignant
Skin lesion, trauma; lacerations
Elements of a diagnostic
statement:
o organ or tissue or system
o disease in general
o specific disease, if
possible

42. Patient
Management
Process -
Clinical
Diagnostic
Process Knowing the nomenclature of diseases facilitates diagnostic labeling.
Note, however, the diagnostic labelling does not always have to contain
the name of a disease.

43. Patient
Management
Process -
Clinical
Diagnostic
Process The patient may not have a disease after all or may just have a medical
condition that is not equivalent to a disease.
In such situations, the diagnosis may contain a statement like “essentially
normal findings”; “normal anatomical variation”; “a medical condition
(state the symptom) that will most likely resolve spontaneously in time”;
etc.

44. Patient
Management
Process -
Clinical
Diagnostic
Process Since medicine is an inexact science with nothing absolute, there is usually
no such thing as one absolutely certain diagnosis after an evaluation.
There is usually an alternate diagnosis.
Thus, in the end, the outputs of the clinical diagnostic processes are at
least 2 diagnoses: primary clinical diagnosis (most probable or most likely)
and secondary clinical diagnosis (alternate or second most probable or less
likely).

45. Patient
Management
Process -
Clinical
Diagnostic
Process With the harsh reality and limitation of medicine, a diagnosis is almost
always an educated guess. Note the adjective for the guess – “educated.”
It has to be educated to be acceptable in the medical profession and to the
laypeople and patients as well.
To come out with an educated guess, a process or processes should be
used.

46. Patient
Management
Process -
Clinical
Diagnostic
Process The clinical diagnostic processes must be rational for the clinical diagnosis
to be acceptable.
There is an adage that states:
a diagnosis that is based on a rational process is not always correct.
However, a diagnosis is more often correct than wrong if it is rationally
arrived at.

47. Patient
Management
Process -
Clinical
Diagnostic
Process Going back to the primary and secondary clinical diagnoses, the physician
must quantitate his degree of uncertainty or certainty as this will serve as
a guide in deciding whether a paraclinical diagnostic procedure will be
needed or not.
As a rule, if primary clinical diagnosis is certain already, no need.
If it is not certain, there is a need for paraclinical diagnostic procedure.

48. Patient
Management
Process -
Clinical
Diagnostic
Process How to quantitate? At the moment, there is no universal agreement on
this.
I will just share with you my practice which I find practical in determination
and in explaining to patients.

49. Patient
Management
Process -
Clinical
Diagnostic
Process •Use 2 dichotomous terms: certain and not certain.
•At times 4 - very uncertain; not certain; certain; very certain (for patient’s
better understanding)

50. Patient
Management
Process -
Clinical
Diagnostic
Process •Use a subjective probability percentage for cut-off in the dichotomy: 90%.
• Certain – for 90% probability and above.
• Not certain – for less than 90% probability.

51. Patient
Management
Process -
Clinical
Diagnostic
Process •The subjective probability percentages can be given as 60 to 40%; 70 to
30%; 80 to 20%; 90 to 10%; 95 to 5%; 98 to 2%; and 99 to 1%.
•The first percentage is for the primary clinical diagnosis and the second
percentage, for the secondary clinical diagnosis.
•Thus, the range of uncertainty is from 60% to below 90% and the range
for certainty is from 90% to 99%.

52. Patient
Management
Process -
Clinical
Diagnostic
Process Examples:
•99 to 1% means 99% probability for the primary clinical diagnosis and 1%
for the secondary clinical diagnosis
•60 to 40% means 60% probability for the primary clinical diagnosis and
40% for the secondary clinical diagnosis.

53. Patient
Management
Process -
Clinical
Diagnostic
Process •If there are published frequential probability statistics, use them but place
them in either of the two categories of certain and not certain.

54. Patient
Management
Process -
Clinical
Diagnostic
Process •Use the relative strength of the symptoms and signs and the processes
used.
•A clinical diagnosis is considered to be certain if it is based primarily on
signs supported by symptoms and prevalence data.
•A clinical diagnosis is considered to be uncertain if it is based primarily on
symptoms or on just prevalence data.

55. Patient
Management
Process -
Clinical
Diagnostic
Process Notes:
1) Signs (data gotten by the physician after examining the patients) are
more reliable than symptoms (data gotten from the patients – their feeling
and observation).
2) Diagnosis based on pattern recognition supported by prevalence is more
reliable than that based on prevalence alone.

56. Patient
Management
Process -
Clinical
Diagnostic
Process Examples of Diagnostic Statements with quantification of probability %
Patient 1:
Primary clinical diagnosis: Right breast mass, malignant (99%)
Secondary clinical diagnosis: Right breast mass, non-malignant (1%)
Patient 2:
Primary clinical diagnosis: Right breast mass, malignant (80%)
Secondary clinical diagnosis: Right breast mass, non-malignant (20%)

57. Patient
Management
Process -
Clinical
Diagnostic
Process
After the clinical diagnostic processes and formulation of clinical diagnosis,
the physician gives advice to the patient, meaning he gives and explains
the findings and diagnosis and entertains and answers questions from the
patient.

58. Patient
Management
Process -
Clinical
Diagnostic
Process
After the clinical diagnostic processes and formulation of clinical diagnosis,
the physician gives advice to the patient, meaning he gives and explains
the findings and diagnosis and entertains and answers questions from the
patient.
The Clinical
Diagnostic Process
in the Patient
Management
Process ends at this
ADVICE box.
So, we stop here for
the moment.

59. Patient
Management
Process -
Clinical
Diagnostic
Process
At this point of the PEP TALK, understand the Patient Management Process
framework in terms of what the physicians are doing and should be doing
in the goal setting and in the clinical diagnostic processes.
Take away in this
PEP TALK that are
related to Patient
Empowerment:

60. Patient
Management
Process -
Clinical
Diagnostic
Process
Be ready to ask questions based on the requirements of the processes,
particularly when a physician is not using the processes or is not clear and
full in explanation.
Take away in this
PEP TALK that are
related to Patient
Empowerment:

61. Patient
Management
Process -
Clinical
Diagnostic
Process
Participate actively and fully in the problem-solving and decision-making
of your health concerns with your physicians in coming out with a clinical
diagnosis.
Take away in this
PEP TALK that are
related to Patient
Empowerment:

62. Patient
Management
Process -
Clinical
Diagnostic
Process
Master the clinical diagnostic processes as they may help you in some way
in doing self-diagnosis of your symptoms in the absence of health care
professionals.
This is another way of gaining greater control in your health concerns and
issues.
Take away in this
PEP TALK that are
related to Patient
Empowerment:

63. Empowerment
objective - for
laypeople to have
an understanding
of the GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Clinical
Diagnostic
Process

64. Empowerment
objective - for
laypeople to have
an understanding
of the GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Clinical
Diagnostic
Process
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.

65. Empowerment
objective - for
laypeople to have
an understanding
of the GOALS
AND CLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Clinical
Diagnostic
Process
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!
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!