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Saudi Diploma in Family Medicine

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Presentation on theme: "Saudi Diploma in Family Medicine"— Presentation transcript:

1 Saudi Diploma in Family Medicine
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 / 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 “Unique personal experience” Feelings Expectations Fuctions…
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
Disease CAD, past MI Obesity Hypercholesterolemia Rule out depresssion 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 / 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
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
Clue : abdominal discomfort, sleep disorder Hypothesis : organic disease leading to 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 Clue : cancer history Hypothesis : cancer and op. anxiety / 17 Yes

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