HOLISTIC DIAGNOSISNita Arisanti

Type

STRATIFIKASI PELAYANAN KESEHATAN

POSYANDU, POLINDES ,UKBM

RUJUKAN YANKES PERORANGAN

RUJUKAN YANKES MASYARAKAT

PERORANGAN/KELUARGA

PERORANGAN/KELUARGA

MASYARAKAT MASYARAKAT

STRATA 1 STRATA 1

STRATA 2 STRATA 2

STRATA

3

STRATA

3

UPAYA KES KEL MANDIRI

UPAYA KES KEL MANDIRI

KADER

POSYANDU, POLINDES

PRAKTEK DOKTER,PUSKESMAS, BP, BKIA , PRAKTEK BIDAN

PUSKESMAS

RS UMUM/KHUSUS KAB/KOTA, BP4, BKMM, BKOM, BKTK , KLINIK SPESIALIS, SPESIALIS

DINKES KAB/KOTA , BP4, BKMM, BKOM, BKTK ,BPOM

RS UMUM/KHUSUS PUSAT/PROPINSI

DINKES PROPINSI , DEPKES RI

Pre-pathogenesis Pathogenesis

Before man is involved The course of the disease in man

Interrelation of the various: - AGENT - HOST - ENVIRONMENT factors

(known & unknown) which

bring AGENT & HOSTtogether, orproduce a disease-provokingSTIMULUS

in the human HOSTEarly pathogenesis Discernable early

lesionsAdvanceddisease Convalescence

Interaction ofHOST & STIMULUS

HOST reaction

STIMULUS & AGENT becomesestablished & increases bymultiplication or increment

Tissue & physiologicchanges

Signs & symptoms

IllnessDisability

DefectChronic state

DEATH

RECOVERY

Immunity & resistance

Health promotion & Spesific protection

Early detection & prompt treatment

Disability Th/ & Rehabilitation

PROMOTIVE

PREVENTIVECURATIVE REHABILITATIVE

PROMOTIVEPREVENTIVE CURATIVE

REHABILITATIVE

The health enhancement continuum

INTEGRATED

CONTINUING

•follow up •Consultation and referral •Acute, chronic, palliative care

Organization

Focus

•Not organ oriented•Patient and Family oriented

Approach

HOLISTIC

• Biopsychosocial

• Selama ini pendidikan kedokteran berpusat pada pengenalan anatomi, fisiologi, patologi, farmakologi dari suatu penyakit, tetapi ada hal yang penting yang membantu memahami proses suatu penyakit yaitu individu sebagai pasien

Understandingthe wholeperson

CONTEXT

PERSON

Disease

Illness

FindingCommonground

PROBLEMS

GOALS

ROLES

MutualDecision

PatientPresentscues

EnhancingPatient-doctorrelationship

The Patient Centered Clinical Method

Exploring both the Disease & illness experience

Disease

Illness

Physical, history, lab

Ideas, expectations

Feelings, effect on

functions

IncorporatingPrevention andHealth promotion

Being realistic

• biopsychosocial union of body, mind, soul, and social

Subatomic particles

atoms

molecules

cells

tissues

Organ system

PERSON

PERSON

COUPLE

FAMILY

COMMUNITY

SOCIETY & NATION

GLOBAL

Biosphere

Society nation

Culture – subculture

Community

Family

Two person

Personal (experience & behavior)

System

Organs

Tissues

Cells

Organelles

Molecules

Atoms

subatomic

Continuum of natural system

Holistic Diagnosis

• History– Basic information– Chief complain– Present illness – Past medical history– Past surgical history– Medication – Allergies history– Immunization history– Screening history– Dietary assessment– Genogram and family history– Social history and occupational – Risk factors

• Physical examination• Differential diagnosis• Laboratory assessment depends on the circumstances

• Diagnosis holistic – Personal aspect– Clinical aspect– Internal risk aspect– Psychosocial aspect

• Management – Preventive and promotion plan

• Screening• Immunization (if needed)• Counseling/ patient education • Chemoprophylaxis (if needed)

– Curative – Rehabilitative – Follow up

• Prognosis

PUSTAKA• Rakel RE. Textbook of Family Practice. Sixth Edition.

WB Saunders Co. Philadelphia. 2002• Paulman PM, Susman JL, Harrison JD, Paulman AA,

Finkelstein KM, Zatechka RB. Family Medicine Clerkship Guide. Elsevier Mosby. Philadelphia. 2005.

• Yu-Maglonzo EI. The Filipino Physician Today. A Practical Guide to Holistic Medicine. UST Publishing House. 2003.

• Dionisio, A. Counseling Skills for Caring Physicians: Individual Intervention. Department of Family and Community Medicine, University of the Philippines Manila. 2005