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HOLISTIC DIAGNOSISNita Arisanti
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Type
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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
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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
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INTEGRATED
CONTINUING
•follow up •Consultation and referral •Acute, chronic, palliative care
Organization
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Focus
•Not organ oriented•Patient and Family oriented
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Approach
HOLISTIC
• Biopsychosocial
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• 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
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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
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• biopsychosocial union of body, mind, soul, and social
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Subatomic particles
atoms
molecules
cells
tissues
Organ system
PERSON
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PERSON
COUPLE
FAMILY
COMMUNITY
SOCIETY & NATION
GLOBAL
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Biosphere
Society nation
Culture – subculture
Community
Family
Two person
Personal (experience & behavior)
System
Organs
Tissues
Cells
Organelles
Molecules
Atoms
subatomic
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Continuum of natural system
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Holistic Diagnosis
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• 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
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• 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
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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