ROJOSON-PEP-TALK: Pt Mgt Process – Paraclinical Diagnostic Process (Pre-session Recording) - July 2021

1. Empowerment
objective - for
laypeople to have
an understanding
of the
PARACLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Paraclinical
Diagnostic
Process

2. Empowerment
objective - for
laypeople to have
an understanding
of the
PARACLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Paraclinical
Diagnostic
Process
My PEP TALK today
is entitled: Patient
Management
Process –
Paraclinical
Diagnostic Process.

3. Empowerment
objective - for
laypeople to have
an understanding
of the
PARRCLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Paraclinical
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.

4. 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 -
Paraclinical
Diagnostic
Process
Empowerment
objective - for
laypeople to have
an understanding
of the
PARACLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.

5. Empowerment
objective - for
laypeople to have
an understanding
of the
PARACLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Paraclinical
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.

6. This is the Patient
Management Process
Framework.
Patient
Management
Process -
Paraclinical
Diagnostic
Process

7. Patient
Management
Process -
Paraclinical
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

8. Patient
Management
Process -
Paraclinical
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 -
Paraclinical
Diagnostic
Process
My PEP TALK today
will focus on this
part of the Patient
Management
Process –
Paraclinical
Diagnostic Process.

10. Patient
Management
Process -
Paraclinical
Diagnostic
Process
The take-off point for paraclinical diagnostic process is the clinical diagnosis
which consists of the primary and secondary clinical diagnoses.
After the clinical diagnosis, the next step to do is to determine whether a
paraclinical diagnostic procedure is needed or not.

11. Patient
Management
Process -
Paraclinical
Diagnostic
Process
A paraclinical diagnostic procedure is a diagnostic procedure that is done
after the clinical diagnosis is arrived at and its objective is to make the
diagnosis more definite.

12. Patient
Management
Process -
Paraclinical
Diagnostic
Process
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 more certain before treatment, then go for a paraclinical
diagnostic procedure.

13. Patient
Management
Process -
Paraclinical
Diagnostic
Process
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
diagnosis.

14. Patient
Management
Process -
Paraclinical
Diagnostic
Process
A physician should consider the following factors:
o How certain he is with the clinical diagnosis.
o Whether a more definite diagnosis is needed or not for some
reasons or another.

15. Patient
Management
Process -
Paraclinical
Diagnostic
Process
A physician should consider the following factors:
o How certain he is with the clinical diagnosis.
§ If he is quite certain or very certain, in general, a paraclinical
diagnostic procedure is not needed. The quite certain clinical
diagnosis becomes automatically the pretreatment diagnosis.

16. Patient
Management
Process -
Paraclinical
Diagnostic
Process
A physician should consider the following factors:
o How certain he is with the clinical diagnosis.
§ If he is not quite certain or uncertain, in general, a paraclinical
diagnostic procedure is needed.

17. Patient
Management
Process -
Paraclinical
Diagnostic
Process
A physician should consider the following factors:
o How certain he is with the clinical diagnosis.
§ In general, a clinical diagnosis is said to be quite certain if it is
based primarily on signs that are reinforced by the symptoms and
prevalence data.

18. Patient
Management
Process -
Paraclinical
Diagnostic
Process
A physician should consider the following factors:
o How certain he is with the clinical diagnosis.
§ A clinical diagnosis is said to be uncertain if it is based primarily
on symptoms or on prevalence data.

19. Patient
Management
Process -
Paraclinical
Diagnostic
Process
A physician should consider the following factors:
o Whether a more definite diagnosis is needed or not for some
reasons or another.
§ If the contemplated treatment procedure is mutilating, risky, etc.,
then a more definite diagnosis is needed.

20. Patient
Management
Process -
Paraclinical
Diagnostic
Process
A physician should consider the following factors:
o Whether a more definite diagnosis is needed or not for some
reasons or another.
§ If the treatment for the secondary clinical diagnosis is the same as
that for the primary clinical diagnosis, then a paraclinical diagnostic
procedure may not be needed.
If it is different, then a more definite diagnosis is indicated.

21. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – INDICATION - PROCESSING OF DATA
– ILLUSTRATION 1
Certainty of Primary Clinical Diagnosis
60% (needed) --------------------------------------------------------- 99% (not needed)
Treatment Plans for Primary and Secondary Diagnoses
Different (needed) ------------------------------------------------- Same (not needed)

22. Patient
Management
Process -
Paraclinical
Diagnostic
Process
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

23. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – INDICATION - PROCESSING OF DATA
– ILLUSTRATION 3
Is a paraclinical diagnostic procedure needed?
YES
Certainty Plan of Treatment
Primary clinical diagnosis 60% Surgical
Secondary clinical diagnosis 40% Nonsurgical

24. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – INDICATION - PROCESSING OF DATA
– ILLUSTRATION 4
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 60% Surgical Excision
Secondary clinical diagnosis 40% Surgical Excision

25. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – INDICATION - PROCESSING OF DATA
– ILLUSTRATION 5
Is a paraclinical diagnostic procedure needed?
YES unless there is a strong reason NOT to do so (exception to the rule)
Certainty Plan of Treatment
Primary clinical diagnosis 90% Mutilating Operation
Secondary clinical diagnosis 10% Non-mutilating Operation

26. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – INDICATION - PROCESSING OF DATA
– ILLUSTRATION 6
Is a paraclinical diagnostic procedure needed?
YES unless there is a strong reason NOT to do so (exception to the rule)
Certainty Plan of Treatment
Primary clinical diagnosis 70% Chemotherapy
Secondary clinical diagnosis 30% Radiotherapy

27. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – INDICATION
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 you 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
THE BEST ANSWER IS ??????????

28. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – INDICATION
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 you 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
THE BEST ANSWER IS “D”.

29. Patient
Management
Process -
Paraclinical
Diagnostic
Process
After determining whether a paraclinical diagnostic procedure is needed or
not,
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.

30. Patient
Management
Process -
Paraclinical
Diagnostic
Process
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.
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.

31. Patient
Management
Process -
Paraclinical
Diagnostic
Process
The physician tabulates, compares, and analyzes the options and the BRCA
data like this:
Procedures Benefit (goal – to
be more definite on
the diagnosis)
Risk Cost Availability
Option1
Option2
Option3

32. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – SELECTION - PROCESSING OF
DATA – ILLUSTRATION 1
Which is the most cost-effective procedure? OPTION 1
Procedures Benefit (goal – to be
more definite on the
diagnosis)
Risk Cost (PhP) Availability
Option1 most direct acceptable 1000 available
Option2 indirect acceptable 1500 available
Option3 indirect acceptable 1000 available

33. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – SELECTION - PROCESSING OF
DATA – ILLUSTRATION 3
Which is the most cost-effective procedure? OPTION 1
Procedures Benefit (goal – to be
more definite on the
diagnosis)
Risk Cost (PhP) Availability
Option1 yield > 90% acceptable 4000 available
Option2 yield 90% acceptable 4000 available
Option3 yield 80% acceptable 3000 available

34. Patient
Management
Process -
Paraclinical
Diagnostic
Process
At this point, the physician should be 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.

35. Patient
Management
Process -
Paraclinical
Diagnostic
Process
Once a shared agreement is arrived at, an informed consent or informed
refusal is formalized.
If there is an informed refusal, paraclinical procedure is not executed.
If there is an informed consent, paraclinical diagnostic procedure is
executed.
Just before, during and right after paraclinical diagnostic procedure, the
physician advises patient on preparation, possible outcome, things to
monitor, etc.

36. Patient
Management
Process -
Paraclinical
Diagnostic
Process
Assuming that a paraclinical diagnostic procedure is done.
The physician now 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.

37. Patient
Management
Process -
Paraclinical
Diagnostic
Process
If he finds nothing unusual in the reporting of the result, he goes on
correlating the result of the paraclinical diagnostic procedure with the
signs and symptoms of the patient to come out with a pretreatment
diagnosis.
If the result of the paraclinical diagnostic procedure is congruent with the
primary or secondary clinical diagnosis – ACCEPT;
if incongruent – MAKE A DECISION (ACCEPT or HOLD)

38. Patient
Management
Process -
Paraclinical
Diagnostic
Process
PARACLINICAL DIAGNOSTIC PROCESS – INTERPRETATION - PROCESSING OF DATA –
ILLUSTRATION
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.
o Paraclinical diagnosis is the same as the primary clinical diagnosis. (A)
o Paraclinical diagnosis is the same as the secondary clinical diagnosis. (A)
o Paraclinical diagnosis is a clinical diagnosis least considered.(H)
o Paraclinical diagnosis does not jibe with the clinical picture or diagnosis. (H)

39. Patient
Management
Process -
Paraclinical
Diagnostic
Process
At this point, the physician advises the patient on his interpretation and
proceeds to discussion of treatment.

40. Patient
Management
Process -
Paraclinical
Diagnostic
Process
I will end this PEP
TALK at this point
(end of paraclinical
diagnostic
processes) and will
discuss the
subsequent steps in
the Patient
Management
Process in another
session.

41. Patient
Management
Process -
Paraclinical
Diagnostic
Process
Take away in this
PEP TALK that are
related to Patient
Empowerment:
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 paraclinical
diagnostic
processes.

42. Patient
Management
Process -
Paraclinical
Diagnostic
Process
Take away in this
PEP TALK that are
related to Patient
Empowerment:
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.

43. Patient
Management
Process -
Paraclinical
Diagnostic
Process
Take away in this
PEP TALK that are
related to Patient
Empowerment:
Participate actively
and fully in the
problem-solving and
decision-making of
your health concerns
with your physicians
in coming out with
the most cost-
effective paraclinical
diagnostic procedure
and to your desire.

44. Patient
Management
Process -
Paraclinical
Diagnostic
Process
Take away in this
PEP TALK that are
related to Patient
Empowerment:
Master the paraclinical
diagnostic processes as they
may help you in some way in
deciding for your own health
concern - whether there is a
need for a paraclinical
diagnostic procedure; if yes,
how to choose the most cost-
effective one and to your desire.
This is one other way of gaining
greater control in your health
concerns and issues.

45. Empowerment
objective - for
laypeople to have
an understanding
of the
PARACLINICAL
DIAGNOSTIC
PROCESS in the
Patient
Management
Process.
Patient
Management
Process -
Paraclinical
Diagnostic
Process