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GeneralIntroductionofPhysicalDiagnosis
PhysicalDiagnosisToday’smedicalstudentsTomorrow’scliniciansPhysicalDiagnosisWhatisthemeaningof“Clinician”?PhysicalDiagnosisWhatisthemainresponsibilityoftheclinician?MakingdiagnosisTreatadiseaseTreatapatientPhysicalDiagnosis
Alinkagebetweenbasicmedicalknowledgeandclinicalmedicine.Adisciplinetousebasicmedicaltheoryandskilltomakeadiagnosis.ObtaininformationFromanyandeverysourcepossible.Straintohearthevoiceofthepatientinthethinreedofhiscrying.Seemostacutelyoutofthecornerofyoureye.Tohearbestwithyourinnerear.Thecontentsofdiagnosis
VerbalobservationorhistorytakingPhysicalobservationorexaminationLaboratoryobservationHistoryTakingObtainasmuchinformationasneededtodiagnoseandtreattheillness.Requirementsforthephysicians:Agenuine,profound,andabsorbinginterestinthepatient'swellbeingAdeep-seated,well-groundedselfconfidenceinabilitiesAthroughknowledgeofthediseasesAbilitytoseetheproblemfromthepatient'sviewpointHistoryTakingObtainingamedicalhistoryisan"art"Talkwith,rathertalktothepatient.Listenattentivelyandguideapatienteffectively.Asksearchingquestions.Interrogationoffamilyandfriendsifnecessary.HistoryTakingKnowallaboutthediseaseSymptomsandsignsSymptoms:patient'scomplaints,orhisrecognitionofsomethingabnormal.Signs:findingselicitedbyphysicalexaminationPasthistoryFamilyhistorySystemsreviewPhysicalExamination
Beginswhengreetingthepatient.Sedulouslypracticingtheartofobservationmakeastudenttoaclinician.
Howtoconductphysicalexamination
Applicationofthesensoryendorgantothepatient.Inarational,thorough,andaccuratefashion.Withefficiencyandminimaldiscomforttothepatient.5componentsofphysicalexamination:inspection,palpation,percussion,auscultationandsmelling.LaboratoryfindingsTodetectpathogenicorfunctioninginformation.Chemical,biologicalandphysiologicaltests.X-film,CT,MR.gastroscopy,angiographyandbronchoscopyetc.InterpretationoflaboratorydataLotsvariablesalterlaboratorytestsresults.Specificityandsensitivityofthetests.Overlappingbetweenthehealthyandthediseasedsubjects.TheIntellectualprocess
ofdiagnosisInformationrequiresclarification
andamplification.Informationmustbecarefullyweighedastoitsclinicalsignificanceanditspossiblerelationshiptothepatient'scomplaints6levelsofintellectualfunctioning:
knowledge,comprehension,application,
analysis,synthesis,andevaluation6levelsofintellectualfunctioningKnowledgeUneditedfactualinformationprovidedbythepatient.Maynotnecessarilybeaccurateorprecise.ComprehensionUnderstandingthefactsrelatedbythepatient.Affirmwhatthepatientsaid.ApplicationRecordingthefactsaccuratelyandinawell-organizedorder
6levelsofintellectualfunctioningAnalysisSortingoutorclassificationoftheobtaineddataintorelatedcategories.SynthesisReassemblethedataobtainedintopatternsofrecognizabledisease.EvaluationAskingquestionsthataredesignedtoeitherconfirmorexcludetentativediagnoses.Predictingthelikelyphysicalandlaboratoryfinding.Theroleofhightechnology
Alwaysbeatool.Canneverreplacetheintellectualprocessofdiagnosis.TheroleofhightechnologyPatientisahumanbeing,notamachine!Physicianisamedicaldetective,notadetector!Conclusion
Communication,observationanddatarecordingaret
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