PART II

Examination(Eliciting signs)

What lies between the ears is more important

(1).General survey :Take time to observe the patient for :

         Gen. appearance and severity of illness, Look for attitude, built,mental status, See for position if pt is sitting , decubitus if he is in bed ,body habitus when standing and gait if walking.    

Observe the external cloak of skin /eyes /nodes /nails for CIPLA-E i.e.

C___cyanosis,clubbing

I___icterus

P___pallor

LA___lymphadenopathy

E___edema ,skin eruption

See for skull-spine-skin

Now take the Vital Parameters_____TPR-BP

Temperature /pulse /respiratory rate and bp.

 

(2.) Specific examination

Local examination__IPPA and movements

Inspection Palpation Percussion Auscultation

Examine other systems now.

AT THIS POINT THE DIAGNOSTIC IMPRESSION SHOULD HAVE NARROWED DOWN .

 

 Investigations

Inv asked for should be carefully selected w.r.t.

         Is it necessary ?

         Is it specific or sensitive ?

         Variance /accuracy /precision ?

         Risk ,cost and benefit ?

Usually these tests should be asked for routinely:

                          BUX

Blood ---Hb,CBC,ESR,PBS….

Urine ---Sugar,Albumin,BSBP….

X-ray---Chest,Bone..... if trauma

-------------------------------------------------------------------------------------------------------------------------------

NOW THE IMPRESSION STILL NARROWS DOWN

SELECT A DIAGNOSIS FROM THE CLUSTER OF DIAGNOSES.

----------------------------------------------------------------------------------------------------------------------------------

"Still if you cant make a Diagnosis , make a Decision .".......Cecil

---------------------------------------------------------------------------------------------------------------------------------

ROLE IN PATIENT EDUCATION

Also called 'Health education' ,it is an important part of guiding the patient.

Every patient has a desire to know about his illness and he feels unimportant when you talk about his illness to his relatives and not to him.

-----------------------------------------------------------------------------------------------------------------------------------------------

TREATMENT AND PRESCRIPTION

Prescription does not necessarily mean only 'medicines'. There are in fact  there are THREE things to prescribe :

        1.Drugs ----should be correct and limited to thee bare minimum i.e. only ESSENTIAL drugs and  not fancy preparations.

        2.Diet------This is very important in EVERY disease and is regularly forgotten by 'specialists'  Both these things treat the BODY.

        3.Assurance-----This is to treat the MIND .Remember that words of  assurance 'infused'          through the ear work more wonders than i.v. fluids infused through the limbs.

-----------------------------------------------------------------------------------------------------------------------------------------------

    PRECAUTIONS WHEN PRESCRIBING

Some important precautions must be taken when writing a prescription :

1. Patient details.......name/age/sex.

2. Drug details........Write both the Generic & Trade names clearly.

3.Dosing details......Specify the exact dose, form & duration of the drug.

4.Follow up & specific precautions.

------------------------------------------------------------------------------------------------------------------------------------------------------

Methods of Diagnosis :

1.On History.
2.On Examination (general/local/focal)
3.On investigation (Lab /Radiology)
4.Sometimes... On treatment !

Methods of treatment :

  The important points to remember are:
0.Establishing the diagnosis first.
1.Supportive treatment.
2.Symptomatic treatment .
3.Specific treatment . (i. e. of cause.)
4.Treatment of complications.
5.Preventive measures.

------------------------------------------------------------------------------------------------------------------------------------------

"Remember to treat the 'patient' not the 'disease' alone !"       ~Dr.P.J.Mehta
 "Treat the patient, not the patient's files , not the X-Ray ! "      ~Dr.Goswami
"Faith is the delicate fiber connecting  a Doctor to his  patient."  

------------------------------- Award winning presentation---------------------------------------------

" Medicine is a science of uncertainty, And an art of probability."      ~Osler

Copyright © 2004 . All rights reserved                                          

  We subscribe to the HONcode principles of the Health On the Net Foundation 

                  {  Guestbook }    

Search:
Keywords:
In Association with Amazon.com

                                                  

--------------------------------------------------------------------------------------------------------------------------

^Top   All contents are copyright protected, you must obtain written approval of owner prior to making any copies

1 1