HOLISTIC DIAGNOSIS Nita Arisanti

Comprehensive health care by family physician??

Comprehensive health care?? Type Organization of care Focus Approach

Type Primary care Prevention care

STRATIFIKASI PELAYANAN KESEHATAN RUJUKAN YANKES PERORANGAN RUJUKAN YANKES MASYARAKAT PERORANGAN/KELUARGA MASYARAKAT STRATA 1 STRATA 1 STRATA 2 STRATA 3 UPAYA KES KEL MANDIRI KADER POSYANDU, POLINDES PRAKTEK DOKTER,PUSKESMAS, BP, BKIA , PRAKTEK BIDAN PUSKESMAS RS UMUM/KHUSUS KAB/KOTA, BP4, BKMM, BKOM, BKTK , KLINIK SPESIALIS, SPESIALIS DINKES KAB/KOTA , BP4, BKMM, BKOM, BKTK ,BPOM RS UMUM/KHUSUS PUSAT/PROPINSI DINKES PROPINSI , DEPKES RI POSYANDU, POLINDES ,UKBM

Pre-pathogenesis Pathogenesis Interaction of HOST & STIMULUS The health enhancement continuum Pre-pathogenesis Pathogenesis Before man is involved The course of the disease in man Interrelation of the various: - AGENT - HOST - ENVIRONMENT factors (known & unknown) which bring AGENT & HOST together, or produce a disease-provoking STIMULUS in the human HOST Early pathogenesis Discernable early lesions Advanced disease Convalescence Interaction of HOST & STIMULUS HOST reaction STIMULUS & AGENT becomes established & increases by multiplication or increment Tissue & physiologic changes Signs & symptoms Illness Disability Defect Chronic state DEATH RECOVERY Immunity & resistance Health promotion & Spesific protection Early detection & prompt treatment Disability Th/ & Rehabilitation PROMOTIVE CURATIVE PREVENTIVE PROMOTIVE REHABILITATIVE PREVENTIVE CURATIVE REHABILITATIVE

Organization INTEGRATED CONTINUING follow up Consultation and referral Acute, chronic, palliative care

Focus Not organ oriented Patient and Family oriented

Approach HOLISTIC Biopsychosocial

Selama ini pendidikan kedokteran berpusat pada pengenalan anatomi, fisiologi, patologi, farmakologi dari suatu penyakit, tetapi ada hal yang penting yang membantu memahami proses suatu penyakit yaitu individu sebagai pasien

The Patient Centered Clinical Method Exploring both the Disease & illness experience Disease Illness Physical, history, lab Ideas, expectations Feelings, effect on functions Understanding the whole person CONTEXT PERSON Disease Illness Finding Common ground PROBLEMS GOALS ROLES Mutual Decision Patient Presents cues Incorporating Prevention and Health promotion Being realistic Enhancing Patient-doctor relationship The Patient Centered Clinical Method

BIOPSYCHOSOCIAL biopsychosocial  union of body, mind, soul, and social

THINK SYSTEMS!

BIOMEDICAL PERSON Organ system tissues cells molecules atoms Subatomic particles

GLOBAL SOCIETY & NATION COMMUNITY FAMILY COUPLE PSYCHOSOCIAL PERSON

Biosphere  Society nation Culture – subculture Community Family Two person Personal (experience & behavior) System Organs Tissues Cells Organelles Molecules Atoms subatomic Biopsychosocial

Continuum of natural system

Holistic Diagnosis Personal aspect Clinical aspect Internal risk aspect Expernal risk aspect

Differential diagnosis History Basic information Chief complain Present illness Past medical history Past surgical history Medication Allergies history Immunization history Screening history Dietary assessment Genogram and family history Social history and occupational Risk factors Physical examination Differential diagnosis Laboratory assessment depends on the circumstances

Diagnosis holistic Management Prognosis Personal aspect Clinical aspect Internal risk aspect Psychosocial aspect Management Preventive and promotion plan Screening Immunization (if needed) Counseling/ patient education Chemoprophylaxis (if needed) Curative Rehabilitative Follow up Prognosis

PUSTAKA Rakel RE. Textbook of Family Practice. Sixth Edition. WB Saunders Co. Philadelphia. 2002 Paulman PM, Susman JL, Harrison JD, Paulman AA, Finkelstein KM, Zatechka RB. Family Medicine Clerkship Guide. Elsevier Mosby. Philadelphia. 2005. Yu-Maglonzo EI. The Filipino Physician Today. A Practical Guide to Holistic Medicine. UST Publishing House. 2003. Dionisio, A. Counseling Skills for Caring Physicians: Individual Intervention. Department of Family and Community Medicine, University of the Philippines Manila. 2005