Diagnostik Holistik (Dr. Yudhi)

DIAGNOSIS HOLISTIK (MULTI ASPEK)
DAN PENANGANAN KOMPREHENSIF

(PARIPURNA)
dr. YUDHI WIBOWO, M.PH

Daftar Pustaka
⚫ Azwar.A. Pengantar Ilmu Kedokteran Keluarga. UI

⚫ Rakel. Textbook of Family Practice 6th
ed.Pennsylvania.2001.
⚫ Goh, Azwar, Sugito.(2004) A Primer on Family
Practice. Singapore.
⚫ Kekalih.(2008) Diagnostik Holistik. UI.
⚫ Murtagh, J. General Practice 3rd Ed.
INTRODUCTION
• INGAT PRINSIP FAMMED :
1. PERSONAL CARE
2. PRIMARY CARE & POST HOSPITALIZATION
3. COMPREHENSIVE CARE
4. CONTINUING CARE
• Sir William Gull (1816-1890) :
– “never forget that it is not a pneumonia, but a
pneumonic man who is your patient”
DEFINISI
• COMPREHENSIVE :
1. Melayanai semua kelompok umur
2. Spektrum dari promotif s/d paliatif
3. Whole person medicine
• Whole person≈ the holistic approach
Whole-person dx
• Whole person diagnosis is based
on two components:
❖1. the disease-centred diagnosis
❖2. the patient-centred diagnosis
The disease-centred consultation :
• is the traditional medical model based on the
history, examination and special
investigations, with the emphasis on making
a diagnosis and treating the disease.
• The disease-centred diagnosis, which is typical
of hospital-based medicine, is defined in
terms of pathology and does not focus
significantly on the feelings of the person
suffering from the disease
The patient centred
• The patient-centred consultation not only takes into
account the diagnosed disease and its management but
also adds another dimension—that of the psychosocial
hallmarks of the patient including details about:
❑ the patient as a person
❑ emotional reactions to the illness
❑ the family
❑ the effect on relationships
❑ work and leisure
❑ lifestyle
❑ the environment
Dimensions to whole person
management
• In the diagnostic model presented final question is: 'Is the
patient trying to tell me some thing else?‘
• An efficient medical record system also helps the process, since
following a set routine generally ensures that important facets
of the patient's psychosocial history are not omitted (hilang)
• The answer to the above question takes into account the
patient's:
▪ Tahu reason for encounter dengan:
▪ feelings
▪ fears or concerns
▪ expectations of the doctor
▪ future aspirations
STEPS OF AN EFFECTIVE CONSULTATION
Pendleton in the 1980
• (1) Find out why the patient has come, also
called the reason for encounter (rfe) and from
there go on to take a history which covers the
following:
– (a) the nature and history of the problem.
– (b) the patient's ideas, concerns and expectations.
– (c) the effects of the problem on the patient and
significant others
• (2) Consider the other problems that the
patient may have:
– (a) continuing problems.
– (b) risk factors.
• (3) Choose with the patient as appropriate
action for each problem. In general practice,
there is a need to prioritise the action to take
if the patient has more than one problem.
• (4) Achieve a shared understanding of the
problems with the patient.
• (5) Involve the patient in the management and
encourage him to accept appropriate
responsibility,
• (6) Use time and resources to good advantage.
• (7) Establish or maintain a relationship with
the patient that helps to achieve other tasks.
•Steps (1) and (2) together correspond to what we sometimes

refer to as the approach to the problem and
•The remaining steps (3) to (7) correspond to the management
of the patient and his problem.
•Note the steps (3), (4) and (5). These are crucial steps
⚫ As many as 50-75% of patients utilising primary care
clinics have a psychosocial
The psychosocial hallmarks of the patient
⚫The patient as a person

⚫Emotional reactions to the illness
⚫The family
⚫The effect on relationships
⚫Work and leisure
⚫Lifestyle
⚫The environment
How to evaluate the family dynamics
⚫Carefully observe family

members interacting.
⚫Invite the whole family to a
counselling session (if possible).
⚫Visit the home
⚫Prepare a genogram
DEFINISI DX HOLISTIK (MULTI ASPEK)
⚫Kegiatan identifikasi & menentukan :

⚪ Dasar & penyebab penyakit, injury serta
kegawatan
⚪ Yang diperoleh dari :
⯍Anamnesis
⯍Observasi
⯍Penilaian risiko
⚪ Dalam kehidupan pasien & keluarganya
TUJUAN
1. Penyembuhan penyakit dgn pengobatan yang tepat

2. Hilangnya keluhan yang dirasakan pasien
3. Pembatasan kecacatan lanjut
4. Penyelesaian pemicu dalam keluarga
(masalah sosial)
5. Jangka waktu pengobatan pendek
6. Percepatan perbaikan fungsi sosial
7. Terproteksi dari risiko yang ditemukan
8. Terwujudnya partisipasi keluarga untuk
penyelesaian masalah
WHOLE PERSON APPROACH
Another dimension
(psychosocial hallmark):
Emphasis on •The patient as a person
making dx &
treating the disease •Emotional reactions to
the illness
•The family
Etiology of disease •The effect on relationship
•Work
•Lifestyle
History
Exam
•The environment
Special inves
The disease-centred The patient centred dx

dx
18
How the diagnostic process could focus on the implemented
holistic patient daily life ?
1.Interview; complains, reasons of encounter, hopes, and worries

2.Clinical Observation; physical examination findings, supporting
tests
3.Analysis; clinical data, individual & family health problems &
risk factors
• What kind of diseases
• Who gets the disease
• Why it happened (confounding & determinant factor)
• What the functional status (based on physical disability)
• What is the decision (based on evidence)
4.Diagnosis Holistic
20
Holistic diagnosis
(multi aspects& multidisciplinary approach)
• 1 aspect:
st
• Chief complain
• Fear
• Wishes/ hope
• 2nd aspect:
• Clinical diagnosis & differential diagnosis
• 3rd aspect:
• Health behavior & perception (internal risk/confounding fs)
• 4th aspect:
• Family’s psychosocial & economy problems, occupation & environment
factors (external risk factors/determinant)
• 5th aspect:
• Social function scale
21
PENANGANAN KOMPREHENSIF
⚫ PATIENT – CENTERED
⚪ PLAN PENEGAKKAN DIAGNOSIS DEFINITIF
⚪ PLAN KIE
⚪ PLAN PENGOBATAN
⚪ PLAN MONEV
⚫ FOCUS FAMILY
⚪ PLAN KIE
⚪ FOKUS PENCEGAHAN RISK FACTOR
⚪ SUPPORT KELUARGA
⚫ FOCUS LOCAL COMMUNITY
⚪ PLAN KIE
⚪ PENCEGAHAN
Example
case: Mr.A.36 yo, security in Kelurahan Office, unmarried, live with his sister who married
with 3 children
I: - Productive cough no blood-tinged since 1 month

- going to be worst condition
- possible to cure
II: - Pulmonum tuberculosis with acid-fast bacili (+), broad lesion & left lung
fibrosis
- Obesity
- Suspect Diabetes Mellitus
III: - drop out from anti-tuberculosis treatment after 1 month
- lack motivation and supporting behavior
- unmarried & dependent
IV: - less harmony interpersonal relationship with brother in law
- no family participation in patient management
- high risk transmitted in the family
- un-comfort living for patient and family
V: functional scale: 2 (partly willingness, provider dependency)
23
comprehensive planning
• A. Patient-centered:
– Therapy of PTB by long term 3 combinations drug therapy (package 2)
– Special diet with adjusting of family capacity (lower calorie, high protein
& zinc)
– Supportive therapy by vitamin B6
– Special attention on blood glucose
– Special attention on PTB complication and drug compliance per 2 weeks
in 2 month, and monthly on 3rd -6th months after.
– Chest exercise after treatment when necessary
– Regular exercise
– B.......
24
comprehensive planning
• B. Family-focused:
– Assigned possible caregiver in the family
– PTB guidance of treatment to his caregivers
– Active screening of PTB of all family member to find the contact source and
in purpose of early detection
– Nutrition guidance for all family member with adjusting of family resources
– Preventive care guidance for all family member
• C. Community-oriented:
– Circulation and ventilation guidance at house
– Case infectious disease report to local government to be active screening for
PTB in the living area of the patient
2 25

Diagnostik Holistik (Dr. Yudhi)

Uploaded by

Copyright:

Available Formats

Diagnostik Holistik (Dr. Yudhi)

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Diagnostik Holistik (Dr. Yudhi)

Uploaded by

Copyright:

Available Formats

DIAGNOSIS HOLISTIK (MULTI ASPEK)

DAN PENANGANAN KOMPREHENSIF

dr. YUDHI WIBOWO, M.PH

⚫ Azwar.A. Pengantar Ilmu Kedokteran Keluarga. UI

•Steps (1) and (2) together correspond to what we sometimes

⚫The patient as a person

⚫Carefully observe family

⚫Kegiatan identifikasi & menentukan :

1. Penyembuhan penyakit dgn pengobatan yang tepat

The disease-centred The patient centred dx

1.Interview; complains, reasons of encounter, hopes, and worries

I: - Productive cough no blood-tinged since 1 month

You might also like