同濟醫(yī)學院診斷學課件

1、DIAGNOSISCASE HISTORY AND INQUIRYWU SHUMING MDImportance of InquiryGaining clinical information and collecting case history based on systemic inquiry Base of clinical practice6080% diagnosis could be induced from interview between patient and physicianNew form：consultation by phone, in internet Succ

2、essful treatment is reinforced by a confidently established and maintained doctor-patient relationship benefits to patients compliance benefits to improve doctors clinical skill and confidence世界醫(yī)學教育聯(lián)合組織愛丁堡宣言（1988） 每個病人都有權利希望醫(yī)生被訓練成為注意力集中的傾聽者、仔細的觀察者、感情細膩的交談者和高效的臨床醫(yī)生。OBJECTIVE OF INQUIRY The medical in

3、terview serves three functions: to collect information, to respond to the patients emotional state, to educate the patient and influence patient behavior. 發(fā) 熱頭痛關節(jié)痛 咽喉痛皮疹 腰背痛咳嗽小便腹痛熱輻射氣急咳痰前傾惡心嘔吐眩暈意識病毒感染發(fā)疹性疾病尿感腎盂腎炎中暑急腹疹肺炎支氣管炎關節(jié)痛病毒感染腦膜炎腦炎腹瀉胃腸炎wsm:腹 痛 類似發(fā)作腹瀉腰背部放射痛右季肋部痛燒灼痛伴皮膚壓痛暴飲暴食疼痛嘔吐發(fā)熱腹痛腹塊胃腸炎IBS發(fā)熱膽石癥帶狀泡

4、疹皮膚過敏胰腺炎胃炎腸梗阻闌尾炎穿孔膽石癥腎盂腎炎尿石癥GERDPUFDIBD膽囊炎CONTENTSGeneral itemChief complainPresent his.：onset of illness,characteristic of main symptoms, etcPast his.Systemic reviewIndividual life Marriage status月經(jīng)史生育史家屬史METHODS &SKILLSkill of communicationSuitable environmentGreeting patientActive listenerLanguag

5、e & termNon-language communicationEnding talkrespectSkill of collectionEmphasis chief complainOpening & closing questioningSimple to complicateAvoiding med. termAvoiding irritable termSkillful induce sensitive topicKind & carefulGuiding PrinciplesEthical principles that guide the successful approach

6、 to diagnosis and treatment are honesty, beneficence, justice, avoidance of conflict of interest, and the pledge to do no harm. Increasingly, Western medicine involves patients in important decisions about medical care, including how far to proceed with treatment of patients with terminal illnessesT

7、he importance of the empathic clinician in helping patients and their families bear the burden of serious illness and death cannot be overemphasized. To cure sometimes, to relieve often, and to comfort always The secret of the care of the patient is in caring for the patient. Discussing psychosocial issues and forgoing clinician domination of the encounter increase patient satisfaction. Any diagnostic procedures ordered at this time should be chosen after consideration of the test ch