DASAR DASAR

ANAMNESIS
dr. Joseph P. Sibarani

Good Communication Skills

Studies have shown that good communication

improves health outcomes by resolving
symptoms and reducing patients'
psychological distress and anxiety.
Technologic medicine cannot substitute for
words and behavior in the service of the ill.
The quality of patient care depends greatly on
the skills of interviewing, because the
relationship that a patient has with a physician
is probably the most extraordinary relationship
between two human beings.

Good Communication Skills

The art of speaking and listening continues to

be the central part of the doctor-patient
interaction
to listen more,
talk less, and
interrupt infrequently

The best interview is conducted by an interviewer

who is cheerful, friendly, and genuinely
concerned about the patient (full of LOVE)
The interviewer's use of a warm, soft tone is
soothing to the patient and enhances the
communication.

Good Communication Skills

An appearance of attention demonstrates an

interest in what the patient is describing.
Facial expressions to facilitate the interview. An
appearance of attention demonstrates an interest in what
the patient is describing.
Attentiveness on the part of the interviewer is also
indicated by leaning slightly forward toward the patient.
It is poor form to write extensive notes during the
interview

Walk with good posture to a patient's bedside can

hope to gain the patient's respect and confidence.
An interviewer who maintains eye contact with the
patient conveys interest in the patient.

Symptoms & Signs

Symptom refers to what the patient feels.

Described by the patient to clarify the nature of the illness.

Shortness of breath, chest pain, nausea, diarrhea, and
double vision are all symptoms.
Symptoms are not absolute; Patients have different
thresholds of pain.

Constitutional symptoms refer to those symptoms that

commonly occur with problems in any of the body
systems, such as fever, chills, weight loss, or
excessive sweating.
Sign refers to that which the examiner finds. Signs can
be observed and quantified. Certain signs are also
symptoms (ex. Wheezing complained by the patient
and heard by the clinician)

Questioning Techniques

Bodily location
Onset
Precipitating factors
Palliating factors
Quality
Radiation
Severity
Temporal
Associated manifestations

Questioning Techniques

Bodily location

"Where in your back?"

"Can you tell me where you feel the pain?"
"Do you feel it anywhere else?"

Onset

"When did you first notice it?"

"How long did it last?"
"Have you had the pain since that time?"
"Then what happened?"
"Have you noticed that it is worse during your menstrual
period?"
"When you get the pain, is it steady, or does it change?"

Questioning Techniques

Precipitating factors
"What makes it worse?"
"What seems to bring on the pain?"
"Have you noticed that it occurs at a certain time of day?"
"Is there anything else besides exercise that makes it worse?"
"Does exercise increase the shortness of breath?"
"Does stress precipitate the pain?"

Palliating factors
"What do you do to get more comfortable?"
"Does lying quietly in bed help you?"
"Does rest help?"
"Does aspirin help the headache?"
"Does eating make it better?"

Questioning Techniques

Quality
"What does it feel like?"
"Can you describe the pain?"
"What do you mean by a 'sticking pain'?"
"Was it sharp, dull, or aching?"

Radiation
"When you get the pain in your chest, do you feel
it in any other part of your body?"
"When you experience your abdominal pain, do
you have pain in any other area of your body?"

Questioning Techniques

Severity

"How many sanitary napkins do you use?"

"What do you mean by 'a lot'?"
"How many times did you vomit?"
"What kind of effect does the pain have on your work?"
"How does the pain compare with the time you broke your
leg?"
"Can you fall asleep with the pain?"
"How has the pain affected your lifestyle?"
"On a scale from 1 to 10, with 10 the worst pain you can
imagine, how would you rate this pain?"

Temporal
Associated manifestations

Questioning Techniques

Temporal

"Does it ever occur at rest?"

"Do you ever get the pain when you are emotionally upset?"
"Where were you when it occurred?"
"Does the pain occur with your menstrual cycle?"
"Does it awaken you from sleep?"
"Have you noticed any relationship to eating?"

Associated manifestations

"Do you ever have nausea with the pain?"

"Have you noticed other changes that happen when you
start to sweat?"
"Before you get the headache, do you ever experience a
strange taste or smell?"

TERIMA
KASIH

PHYSICAL DIAGNOSIS
"teach the eye to see, the finger to feel, and
the ear to hear.
Inspection
Palpation
Percussion
Auscultation

PHYSICAL DIAGNOSIS
"teach the eye to see, the finger to feel, and
the ear to hear.
Inspection
Palpation
Percussion
Auscultation