«Начинающий врач, если он не усвоил себе метода… расспрашивает как попало… увлекается первым
впечатлением…надеется быстро решить дело,
предложив больному несколько относящихся сюда вопросов, но не исчерпав расспросом состояние всего
организма…единственно верный хотя и более медленный
и тяжелый путь если соблюдение полноты и известного однажды принятого порядка в исследовании»
Григорий Антонович Захарьин 1909
Parameters of non-verbal behavior
Poses
Desirable pose asymmetrical natural
open
Establishment of contact
Verbal signals
Distinct greeting
Adressing a person by his name
Invitation to sit down
Patient listening
Small talk
Use of complements
It is good for the doctor to «know» the information about the life of the patients not only about the diagnosis
Active listening
Be an «active listener», to hear what bothers the patient
Orientation in the problem
Classification of the questions
• Open
• Close
• Alternative
• Pressing
• Neutral
• About fact
• About opinion
Orientation in the problem
Questions
Questions that require short simple answers (close questions)
Your name, surname?
When has your diagnosis been established?
Do you know what is hypoglycemia?
Do you take this drug in the morning and in the evening?
Questions that require detailed answer (open questions)
In which circumstances your diabetes has been revealed?
What are the signs of low blood sugar level?
At what time do you take this drug?
Diagnostics
•Diagnosticos – способный распознавать (греч.)
•The part of clinical medicine studying the contents, methods and consecutive steps in determining the diseases or specific physiologic conditions
•Real process that is performed by the doctor at the bedside of the patient
Symptom
Separate sign of the disease
• Subjective – all symptoms that the patient tells by himself:
Really subjective Nominally subjective
•Objective – All revealed symptoms
•Parts of the symptoms: clinical, pathophysiological, morphological
Relatively pathognomonic signs
«Carotid dance» |
Aortic insufficiency |
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Clubbing |
Respiratory failure |
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«Caput medusae» |
Portal hypertension |
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Thickening of temporal |
Giant cell vasculitis |
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arteries |
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Syndrome
A syndrome is a set of medical signs and symptoms that are correlated with each other and united by the common pathogenesis
Syndromic principle
•Performing the accurate differential diagnosis
•Knowledge of maximal amount of the diseases that may manifest by this syndrome
•Importance of defining the leading syndrome for the assessment of the prognosis and treatment