英文诊断学总论.pptx

General Introduction of Physical Diagnosis Liu Jian-minLiu Jian-min Department of Physical DiagnosisDepartment of Physical DiagnosisDepartment of Endocrine and Metabolic DiseasesDepartment of Endocrine and Metabolic DiseasesRui-jin Clinical College Rui-jin Clinical College Shanghai Jiao-tong University School of Medicine Shanghai Jiao-tong University School of Medicine Physical DiagnosisTodays medical studentsTomorrows cliniciansPhysical DiagnosisWhat is the meaning of “Clinician”?Physical DiagnosisWhat is the main responsibility of the clinician?Making diagnosis Treat a disease Treat a patientPhysical DiagnosisA linkage between basic medical knowledge and clinical medicine.A discipline to use basic medical theory and skill to make a diagnosis.Obtain informationFrom any and every source possible.Strain to hear the voice of the patient in the thin reed of his crying.See most acutely out of the corner of your eye.To hear best with your inner ear.The contents of diagnosisVerbal observation or history takingPhysical observation or examinationLaboratory observationHistory TakingObtain as much information as needed to diagnose and treat the illness.Requirements for the physicians:A genuine,profound,and absorbing interest in the patients well beingA deep-seated,well-grounded self confidence in abilities A through knowledge of the diseases Ability to see the problem from the patients viewpointHistory TakingObtaining a medical history is an artTalk with,rather talk to the patient.Listen attentively and guide a patient effectively.Ask searching questions.Interrogation of family and friends if necessary.History TakingKnow all about the diseaseSymptoms and signsSymptoms:patients complaints,or his recognition of something abnormal.Signs:findings elicited by physical examinationPast historyFamily history Systems reviewPhysical ExaminationBegins when greeting the patient.Sedulously practicing the art of observation make a student to a clinician.How to conduct physical examinationApplication of the sensory end organ to the patient.In a rational,thorough,and accurate fashion.With efficiency and minimal discomfort to the patient.5 components of physical examination:inspection,palpation,percussion,auscultation and smelling.Laboratory findingsTo detect pathogenic or functioning information.Chemical,biological and physiological tests.X-film,CT,MR.gastroscopy,angiography and bronchoscopy etc.Interpretation of laboratory dataLots variables alter laboratory tests results.Specificity and sensitivity of the tests.Overlapping between the healthy and the diseased subjects.The Intellectual process of diagnosisInformation requires clarification and amplification.Information must be carefully weighed as to its clinical significance and its possible relationship to the patients complaints6 levels of intellectual functioning：knowledge,comprehension,application,analysis,synthesis,and evaluation6 levels of intellectual functioningKnowledgeUnedited factual information provided by the patient.May not necessarily be accurate or precise.ComprehensionUnderstanding the facts related by the patient.Affirm what the patient said.ApplicationRecording the facts accurately and in a well-organized order6 levels of intellectual functioningAnalysisSorting out or classification of the obtained data into related categories.SynthesisReassemble the data obtained into patterns of recognizable disease.EvaluationAsking questions that are designed to either confirm or exclude tentative diagnoses.Predicting the likely physical and laboratory finding.The role of high technologyAlways be a tool.Can never replace the intellectual process of diagnosis.The role of high technologyPatient is a human being,not a machine!Physician is a medical detective,not a detector!ConclusionCommunication，observation and data recording are the key demands in medicine.Profound knowledge and smart intellectual process of thinking of medicine is the key for success of a clinician.Only as a clinician does one become a clinician