HOLISTIC DIAGNOSIS

Nita Arisanti
Comprehensive
health care by
family physician??

Comprehensive
health care??
Type
Organization of
care
Focus
Approach
Type
Primary care
Prevention care
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 & HOST
together, or
produce a disease-provoking
STIMULUS
in the
human
HOST
Early pathogenesis
Discernable early
lesions
Advanced
disease
Convalescence
Interaction of
HOST & STIMULUS
HOST reaction
STIMULUS & AGENT becomes
established & increases by
multiplication or increment
Tissue & physiologic
changes
Signs & symptoms
Illness
Disability
Defect
Chronic state
DEATH
RECOVERY
Immunity &
resistance
Health promotion &
Spesific protection
Early detection & prompt
treatment
Disability Th/ &
Rehabilitation
PROMOTIVE
PREVENTIVE
CURATIVE REHABILITATIVE
PROMOTIVE
PREVENTIVE
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
Understanding
the whole
person
CONTEXT
PERSON
Disease
Illness
Finding
Common
ground
PROBLEMS
GOALS
ROLES
Mutual
Decision
Patient
Presents
cues
Enhancing
Patient-doctor
relationship
The Patient Centered Clinical Method
Exploring both the
Disease & illness
experience
Disease
Illness
Physical, history, lab
Ideas, expectations
Feelings, effect on
functions
Incorporating
Prevention and
Health 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
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