Diagnosing Disease

through
&

in Primary Care

Susi Oktowaty

Diagnosing Disease
through
&

in Primary Care

Susi Oktowaty

Tertiary

Secondary

Primary Care

Tertiary Care

Rumah Sakit

Dokter Spesialis

Klinik
Puskesmas
Dokter Keluarga

Self Care

Sistem Pelayanan Kesehatan Terstruktur atau Berjenjang

Layanan Kesehatan Primer

Primary Care

General Appoach
Take MR
Greetings
Communication

Introduce Your Self

Eye contact
Questioning
Listening

History Taking
70-80% : Diagnosis
Accurate history
Basic since

Idiophatic or Psychiatric

Vasular (Hypoxia, ischemia, infarct)

Infectious/ inflamation/ invasive (systemic or non)

Neoplastic

Degenerative

Iatrogenic

Congenital

Allergic/ Autoimune

Trauma

Endocrine/ Metabolic

The Patient-Centered
Clinical Approach
The physicians attempt to fulfill a twofold task:
understanding the patient and the disease
Faster symptom resolution
Improved Patient recall
Improved medication adherence
Fewer test and referrals
Less doctor shopping
Lower risk of malpractice lawsuits
Greater patient satisfaction

Exploring Both
The Illness and
The Disease
experience

The Patient-Centered
Clinical Approach

Feelings
Expectations
Functions
personal perception

Illness

Disease

Sign &
Symptoms
Abnormal test
classifications

Patient-Centered Medicine: Transforming the Clinical

Method 2nd Ed. Stewart, M. Brown, JB et al. 2003.

Exploring Both The Disease and The Illness

experience
Illness

Disease

Feelings
Expectations
Functions

illness is a personal
perception

Sign & Symptoms

Abnormal test
Classifications
Doctor waves
back and forth

Differentiated
Diagnosis

Unique personal
experience

Integrated Understanding

Exploring Both
The Illness and
The Disease
experience

The Patient-Centered
Clinical Approach
Understanding The
Whole Person

Feelings
Expectations
Functions
personal perception

Illness

Disease

Sign &
Symptoms
Abnormal test
classifications

Patient-Centered Medicine: Transforming the Clinical

Method 2nd Ed. Stewart, M. Brown, JB et al. 2003.

Exploring Both
The Illness and
The Disease
experience

The Patient-Centered
Clinical Approach
Understanding The
Whole Person

Finding Common
Ground
Regarding
Management

Feelings
Expectations
Functions
personal perception

Illness

Problems
Goals

Disease

Roles

Sign &
Symptoms
Abnormal test
classifications

Patient-Centered Medicine: Transforming the Clinical

Method 2nd Ed. Stewart, M. Brown, JB et al. 2003.

Exploring Both
The Illness and
The Disease
experience

The Patient-Centered
Clinical Approach
Understanding The
Whole Person

Finding Common
Ground
Regarding
Management

Feelings
Expectations
Functions
personal perception

Illness

Problems
Goals

Disease

Roles

Sign &
Symptoms
Abnormal test
classifications

Incorporating
prevention and health
promotion
Patient-Centered Medicine: Transforming the Clinical
Method 2nd Ed. Stewart, M. Brown, JB et al. 2003.

Exploring Both
The Illness and
The Disease
experience

The Patient-Centered
Clinical Approach
Understanding The
Whole Person

Finding Common
Ground
Regarding
Management

Feelings
Expectations
Functions
personal perception

Illness

Problems
Goals
Roles

Disease

Sign &
Symptoms
Abnormal test
classifications

Incorporating
prevention and health
promotion
Enhancing the patientphysician relationship

Patient-Centered Medicine: Transforming the Clinical

Method 2nd Ed. Stewart, M. Brown, JB et al. 2003.

Exploring Both
The Illness and
The Disease
experience

The Patient-Centered
Clinical Approach
Understanding The
Whole Person

Finding Common
Ground
Regarding
Management

Feelings
Expectations
Functions
personal perception

Illness

Problems
Goals
Roles

Disease

Sign &
Symptoms
Abnormal test
classifications

Incorporating
prevention and health
promotion

Being Realistic

Enhancing the patientphysician relationship

Patient-Centered Medicine: Transforming the Clinical

Method 2nd Ed. Stewart, M. Brown, JB et al. 2003.

Exploring Both
The Illness and
The Disease
experience

The Patient-Centered
Clinical Approach
Understanding The
Whole Person

Finding Common
Ground
Regarding
Management

Feelings
Expectations
Functions
personal perception

Illness

Problems
Goals

Mutual
Decision

Roles

Disease

Sign &
Symptoms
Abnormal test
classifications

Incorporating
prevention and health
promotion

Being Realistic

Enhancing the patientphysician relationship

Patient-Centered Medicine: Transforming the Clinical

Method 2nd Ed. Stewart, M. Brown, JB et al. 2003.

Biopsychosocial

Cues
(clinical, behavioral)

Hyphotesis

Unexpected
cues

Search
(interview, history,
examination, investigation)

Search for common

ground

Management decision

Follow-up
The Diagnostic Process. (Elstein, Shulman, Sprfha)1978

Revise

Take Home Message

1.Komunikasi efektif dokter pasien
2.Patient-centered Approach : pelayanan
kesehatan yang lebih menghargai dan tanggap
terhadap keinginan, kebutuhan dan nilai-nilai
individual pasien
3.Berawal dari symptom atau masalah yang
dikemukakan pasien : biopsikososial
4.Menyusun secara detail akar masalah pasien
dalam membuat diagnosis holistik