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HOLISTIC DIAGNOSIS. Nita Arisanti. Type. RUJUKAN YANKES PERORANGAN. RUJUKAN YANKES MASYARAKAT. RS UMUM/KHUSUS PUSAT/PROPINSI. DINKES PROPINSI , DEPKES RI. STRATA 3. STRATA 3. RS UMUM/KHUSUS KAB/KOTA, BP4, BKMM, BKOM, BKTK , KLINIK SPESIALIS, SPESIALIS.
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HOLISTIC DIAGNOSIS Nita Arisanti
RUJUKAN YANKES PERORANGAN RUJUKAN YANKES MASYARAKAT RS UMUM/KHUSUS PUSAT/PROPINSI DINKES PROPINSI , DEPKES RI STRATA 3 STRATA 3 RS UMUM/KHUSUS KAB/KOTA, BP4, BKMM, BKOM, BKTK , KLINIK SPESIALIS, SPESIALIS DINKES KAB/KOTA , BP4, BKMM, BKOM, BKTK ,BPOM STRATA 2 STRATA 2 PRAKTEK DOKTER,PUSKESMAS, BP, BKIA , PRAKTEK BIDAN PUSKESMAS STRATA 1 STRATA 1 POSYANDU, POLINDES MASYARAKAT MASYARAKAT PERORANGAN/KELUARGA PERORANGAN/KELUARGA UPAYA KES KEL MANDIRI KADER UPAYA KES KEL MANDIRI STRATIFIKASI PELAYANAN KESEHATAN POSYANDU, POLINDES ,UKBM
The health enhancement continuum Before man is involved The course of the disease in man DEATH Interrelation of the various: - AGENT - HOST - ENVIRONMENT factors (known & unknown) which bring AGENT & HOST together, or produce a disease-provoking STIMULUS Chronic state Defect Disability Illness Signs & symptoms Tissue & physiologic changes Immunity & resistance STIMULUS & AGENT becomes established & increases by multiplication or increment RECOVERY Interaction of HOST & STIMULUS in the human HOST HOST reaction Advanced disease Discernable early lesions Early pathogenesis Convalescence Pre-pathogenesis Pathogenesis Early detection & prompt treatment Disability Th/ & Rehabilitation Health promotion & Spesific protection PROMOTIVE CURATIVE PREVENTIVE PROMOTIVE REHABILITATIVE PREVENTIVE CURATIVE REHABILITATIVE
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
Exploring both the Disease & illness experience Understanding the whole person Finding Common ground Physical, history, lab Disease CONTEXT PROBLEMS PERSON Mutual Decision GOALS Illness Illness Disease Ideas, expectations Feelings, effect on functions ROLES Enhancing Patient-doctor relationship Incorporating Prevention and Health promotion Being realistic Patient Presents cues The Patient Centered Clinical Method
BIOPSYCHOSOCIAL • biopsychosocial union of body, mind, soul, and social
THINK SYSTEMS!
PERSON Organ system tissues cells molecules BIOMEDICAL atoms Subatomic particles
GLOBAL SOCIETY & NATION COMMUNITY FAMILY COUPLE PSYCHOSOCIAL PERSON
Biosphere Society nation Culture – subculture Community Family Two person Personal (experience & behavior) System Organs Tissues Cells Organelles Molecules Atoms subatomic Biopsychosocial
Holistic Diagnosis • Personal aspect • Clinical aspect • Internal risk aspect • Expernal risk aspect
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