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Saudi Diploma in Family Medicine Center of Post Graduate Studies i n F amily M edicine

Principles of Family Medicine The Patient Centered Clinical Method. Saudi Diploma in Family Medicine Center of Post Graduate Studies i n F amily M edicine. Presented by: Dr. Zekeriya Aktürk zekeriya.akturk@gmail.com www.aile.net. Scenario.

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Saudi Diploma in Family Medicine Center of Post Graduate Studies i n F amily M edicine

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  1. Principles of Family Medicine The Patient Centered Clinical Method Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine Presented by: Dr. Zekeriya Aktürk zekeriya.akturk@gmail.com www.aile.net / 17

  2. Scenario • An old lady comes early in the morning complaining of dyspnea. She feels better after opening the window and sitting in front. You have a busy day and she is without appointment. • What is the first diagnosis you would think of? • Physical exam: normal. • What do you think now? • PA chest X-ray: normal • Did you change the order of your differential diagnoses? McWhinney, 1997 / 17

  3. Nex day: you invite the patient with appointment • Detailled history • Main complaint: increased bowel movements • Awaking at night and feeling suffocating • Relieves in front of the window • Intestinal symptoms present since 20 years • Insomnia recently starded • Underwent cholecystectomy years ago: symptoms remained • Mastectomy due to breast CA • What is your first differential diagnosis ? / 17

  4. More detailed history: • Fear of CA. • Widowed since severeal years; living alone • Landlord increased the rent without notice • Feels anger with the landlord • Two children married, living away • What will be your clinical approach? / 17

  5. Objectives • At the end of this session, the participants will have knowledge on the patient centered clinical method • Defend the importance of patient centered clinical metnod in family practice • Express Levenstein’s patient centered clinical method principles • Discuss the diagnostic process • Method: interactice presentation, 15 minutes / 17

  6. Levenstein’s model (1984) • Evaluating both the disease and the illness experience • Differential diagnosis • Extent of disease (effect on the feelings, expectations, ideas and functions of the patient) / 17

  7. Disease Illness • “Differentiated” • Signs and symptoms • Abnormal tests • A “classification” • “Unique personal experience” • Feelings • Expectations • Fuctions… • Illness is a personal perception Doctor waves back and forth / 17

  8. Example: increased cholesterol • Illness • Ideas: no longer a healthy man • Feelings: fear of inability to participate family activities or even a second MI • Expectations: co-operation with doctor regarding diet • Functions: walks 6 km per day. Returned to work. Sexual activity needs to be explored • Disease • CAD, past MI • Obesity • Hypercholesterolemia • Rule out depresssion / 17

  9. Understanding the whole person • “as a person” (life story, personal and developmental conditions) • Context (anybody being effected from the patients condition, physical environment) / 17

  10. Disease Person Illness Environment / 17

  11. Finding common ground with the patient about the problem and its management • Problems and priorities • Treatment goals • Roles of doctor and patient in the treatment / 17

  12. Incorporating prevention and health promotion • Health promotion • Risk reduction • Early diagnosis • Decreasing complications / 17

  13. Enhancing the doctor-patient relationship • Features of the therapeutic relationship • Sharing of power • Care and cure • Self awareness • Transference and countertransference / 17

  14. Being realistic • Time • Resources • Team / 17

  15. / 17

  16. The diagnostic process Clues Hypothesis Unexpected clues Review Investigation Finding commmon ground Management decision Follow up / 17

  17. Clue: nocturnal dyspnea Hypothesis: cardiac asthma No Hypothesis: organic disease leading to sleep disorder Clue : abdominal discomfort, sleep disorder No Hypothesis: functional abdominal symptoms. Disease triggered by personal factors. Clue : recent sleep problem Hypothesis: insomnia decreased the tolerance for abdominal symptoms. Insomnia is related with personal problems Clue : children living away Hypothesis: personal problems with children No Clue : landlord increased the rent Hypothesis: main problem increase of the rent Yes Yes Hypothesis: cancer and op. anxiety Clue : cancer history / 17

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