英文诊断学总论.ppt

英文诊断学总论.ppt

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GeneralIntroductionofPhysicalDiagnosisLiuLiuJianJian-min-minDepartmentofPhysicalDiagnosisDepartmentofPhysicalDiagnosisDepartmentofEndocrineandMetabolicDiseasesDepartmentofEndocrineandMetabolicDiseasesRui-jinRui-jinClinicalCollegeClinicalCollegeShanghaiJiao-tongUniversitySchoolofMedicineShanghaiJiao-tongUniversitySchoolofMedicinePhysicalDiagnosisTodaysmedicalstudentsTomorrowscliniciansPhysicalDiagnosisWhatisthemeaningof“Clinician”?

PhysicalDiagnosisWhatisthemainresponsibilityoftheclinician?

MakingdiagnosisTreatadiseaseTreatapatientPhysicalDiagnosisAlinkagebetweenbasicmedicalknowledgeandclinicalmedicine.Adisciplinetousebasicmedicaltheoryandskilltomakeadiagnosis.ObtaininformationFromanyandeverysourcepossible.Straintohearthevoiceofthepatientinthethinreedofhiscrying.Seemostacutelyoutofthecornerofyoureye.Tohearbestwithyourinnerear.ThecontentsofdiagnosisVerbalobservationorhistorytakingPhysicalobservationorexaminationLaboratoryobservationHistoryTakingObtainasmuchinformationasneededtodiagnoseandtreattheillness.Requirementsforthephysicians:

Agenuine,profound,andabsorbinginterestinthepatientswellbeingAdeep-seated,well-groundedselfconfidenceinabilitiesAthroughknowledgeofthediseasesAbilitytoseetheproblemfromthepatientsviewpointHistoryTakingObtainingamedicalhistoryisanartTalkwith,rathertalktothepatient.Listenattentivelyandguideapatienteffectively.Asksearchingquestions.Interrogationoffamilyandfriendsifnecessary.HistoryTakingKnowallaboutthediseaseSymptomsandsignsSymptoms:

patientscomplaints,orhisrecognitionofsomethingabnormal.Signs:

findingselicitedbyphysicalexaminationPasthistoryFamilyhistorySystemsreviewPhysicalExaminationBeginswhengreetingthepatient.Sedulouslypracticingtheartofobservationmakeastudenttoaclinician.HowtoconductphysicalexaminationApplicationofthesensoryendorgantothepatient.Inarational,thorough,andaccuratefashion.Withefficiencyandminimaldiscomforttothepatient.5componentsofphysicalexamination:

inspection,palpation,percussion,auscultationandsmelling.LaboratoryfindingsTodetectpathogenicorfunctioninginformation.Chemical,biologicalandphysiologicaltests.X-film,CT,MR.gastroscopy,angiographyandbronchoscopyetc.InterpretationoflaboratorydataLotsvariablesalterlaboratorytestsresults.Specificityandsensitivityofthetests.Overlappingbetweenthehealthyandthediseasedsubjects.TheIntellectualprocessofdiagnosisInformationrequiresclarificationandamplification.Informationmustbecarefullyweighedastoitsclinicalsignificanceanditspossiblerelationshiptothepatientscomplaints6levelsofintellectualfunctioning：

knowledge,comprehension,application,analysis,synthesis,andevaluation6levelsofintellectualfunctioningKnowledgeUneditedfactualinformationprovidedbythepatient.Maynotnecessarilybeaccurateorprecise.ComprehensionUnderstandingthefactsrelatedbythepatient.Affirmwhatthepatientsaid.ApplicationRecordingthefactsaccuratelyandinawell-organizedorder6levelsofintellectualfunctioningAnalysisSortingoutorclassificationoftheobtaineddataintorelatedcategories.SynthesisReassemblethedataobtainedintopatternsofrecognizabledisease.EvaluationAskingquestionsthataredesignedtoeitherconfirmorexcludetentativediagnoses.Predictingthelikelyphysicalandlaboratoryfinding.TheroleofhightechnologyAlwaysbeatool.Canneverreplacetheintellectualprocessofdiagnosis.TheroleofhightechnologyPatientisahumanbeing,notamachine!

Physicianisamedicaldetective,notadetector!

ConclusionCommunication，observationanddatarecordingarethekeydemandsinmedicine.Profoundknowledgeandsmartintellectualprocessofthinkingofmedicineisthekeyforsuccessofaclinician.Onlyasacliniciandoesonebecomeaclinician