Yusuf Alam Romadhon

 Health: a state of complete physical, mental, and

social well being, not merely the absence of disease
(WHO)
 Illness: the unique response of a person to a disease
 Wellness: an active state, oriented toward maximizing
the potential of the individual
 Sehat : Kondisi sedang baik (well being) yang
meliputi aspek fisik, mental dan sosial
 Sakit (Illness) adalah penilaian individu terhadap
pengalaman menderita suatu penyakit
 Penyakit (disease) yaitu gangguan fungsi fisiologis
dari seorang individu atau organisme sebagai akibat
dari sesuatu
 Physical dimension — genetic inheritance, age,
developmental level, race, and gender
 Emotional dimension — how the mind affects body
function and responds to body conditions
 Intellectual dimension — cognitive abilities,
educational background, and past experiences
 Environmental dimension — housing, sanitation,
climate, pollution of air, food, and water
 Sociocultural dimension — economic level, lifestyle,
family, and culture
 Spiritual dimension — spiritual beliefs and values
Linking Emotions with Physical Symptoms

“The good physician treats the disease,

but the great physician treats the
person.”

William Osler
 The agent-host-environment model: The agent, host,
and environment interact in ways that create risk
factors.
 The health-illness continuum: Views health as a
constantly changing state with high-level wellness and
death on opposite sides of a continuum
 The high-level wellness model
 The health belief model
 The health promotion model
 Host

Environmen
Agent
t
 Risk factors for illness
 Factors in the human dimensions that
influence health-illness status
 Beliefs and practice
 Basic human needs
 Self-concept
 Past experiences
 Interpersonal interactions
 Physical and cultural influences
 Education
 Acute illness
 Generally has a rapid onset of symptoms and lasts only a
relatively short time
 Examples: appendicitis, pneumonia, diarrhea, common
cold
 Chronic illness
 A broad term that encompasses many different physical
and mental alterations
 Examples: diabetes mellitus, lung disease, arthritis, lupus
 Experiencing symptoms
 Assuming the sick role
 Assuming a dependent role
 Achieving recovery and rehabilitation
 Health(and illness) are caused/influenced by many
factors.
 Mind and body are not separate
 Relationships are significant to health
Linking Emotions with Physical Symptoms

“The good physician treats the disease,

but the great physician treats the
person.”

William Osler
 Consider biological, psychological, and social
factors
 Relationships are significant to health
 Patient and doctor
 Patient and family, friends, others
 Keep
people healthy rather than wait to treat them
when they become ill.
 Poverty as underlying issue
 Lack of resources, education
 Behavior and/or lifestyle
 Misuse of antibiotics
 Gaps in immunizations
 Lack of access to healthcare
 New diseases and re-emerging strains
 Biology
•Age, sex Psychology
•Disease state •Attitudes/beliefs
•Genetics/heredity •Mood state
•Physical symptoms •Behaviors
•Meds/drugs/addicti •Religiosity/spiritualit
on y

Environment
•School/work place Social
•Church •Support:
•Social norms / cultural norms formal/informal
•Community / Health services •Roles:
•Neighborhoods / National work/family/peers
economy •Physician-patient
•Mass media relationship
•Policy / laws •Socioeconomic status
 Biology
•Diabetes
•No family history
•Skin bumps, fuzzy vision,
fatigue, burning feet,
pruritis, erectile
dysfunction •“I just miss eating junk”
•Agent Orange exposure
Environment
•Healthcare at VA, has to travel
•Diabetes class offered
•Fast food everywhere;
supersized portions
•2nd hand smoke triggers desire
to smoke
•Cultural norm – embarrassed
by weight
•Gov’t will not compensate for
agent orange exposure
Psychology
•“It’s always in the back
of my mind”
•Guilt: can’t work as
much
•Depression, stress
Social
•Marriage suffering
•Doesn’t trust doctor
(non-compliant)
•Boss did not promote
•Can’t play with
grandkids
 Psychology
Biology •Depression
•Female •Information seeker
•Fatigue •Difficult to get motivated
•Joint stiffness •Uses stress management
•Tender points
•Widespread aches

Social
•Supportive
Environment friends/family
•Good access to health care members
•Environment is conducive to •However, husband is
exercise not very supportive
•She tries to surround herself •Work role is stressful
with a healthy environment. •Teaches water
aerobics
 Emphasizes personal development assuming
 All types of health and disease are psychosomatic
 There is a communication between body, mind and
soul
 Diseases arise from inability to adapt to different
situations
 Gives
importance to personal care, education and
prevention
 Natural nutrition,
 Herbal therapy,
 Acupuncture
…

23
 Itencourages the clinician to observe the
feelings, life objectives, attitude towards the
disease, social environment, biochemical and
morphologic changes.
 The person is a complex of body, mind and
social environment. Environmental and
psychological conflicts are potential
pathologies for the individual.
 Feelings can affect physiological functions of
the body (Zegans, 1983).
 Instead of dealing primarily with biological
factors, considering psychological and social
factors as well will enable understanding
disease processes.
24
 Biologic
Factors Social
•Immune Factors
System •Community
•Endocrine ORG ANI SM •Family
System •Culture
•Organ •...
Systems
Psychologica
•Tissues
l Factors
•…
•Anxiety
•Depression
•...

25
 35 y, male
 Married
 3 kids
 Laborer in a factory
 Gets injured at work
 Unable to work for 3 months

26
 Inadequate
Drop in
organized
income
environment (social)
(social)

Drop in
Occupational Organ trauma
blood
injury (biologic)
glucose
(biologic)

Stress
Inattentive (psychological)
(psychological)

27
 LOSS of JOB
(A social factor)

DEPRESSION P. ULCER AGGREVATION

(Psychological) (Biological factor)

For an effective patient management, the interaction

between all factors should be taken into acount
28
- Listen with empathy the patients view to his/her
problem
- Explain the patient on his/her words the view and
opinions of the doctor
- Acknowledge the differences between the doctor
and patients thoughts
- Recommend a model integrating the patients as well
as doctors opinions
- Negotiate to a common solution with medical, ethic,
legal acceptability covering the patients expectations

Berlin and Fowkes (1983)

29
 “Nothing about me without me.”

- Valerie Billingham, Through the Patient's Eyes, Salzburg Seminar Session 356, 1998
• The Picker Institute identified eight characteristics of care as
the most important indicators of quality and safety, from the
perspective of patients:
– respect for the patient's values, preferences, and expressed
needs
– coordinated and integrated care
– clear, high-quality information and education for the patient and
family
– physical comfort, including pain management
– emotional support and alleviation of fear and anxiety
– involvement of family members and friends, as appropriate
– continuity, including through care-site transitions
– access to care.

- Gerteis M, Edgman-Levitan S, Daley J, Delbanco T. Through the patient's eyes. San Francisco: Jossey-
Bass, 1993.
 As a form of practice, patient centered care seeks
to focus medical attention on the individual
patient's needs and concerns, rather than the
clinician's.
 Patient centered care has a focus on a patient's
individual health goals within or across a variety of
dimensions (e.g., symptoms; physical functional
status, including mobility;
and social and role functions) rather than disease
specific outcomes.

- Bardes CL N Engl J Med 2012; 366:782-783 March 1, 2012

- Reuben DB, Tinetti ME.N Engl J Med 2012; 366:777-779 March 1, 2012
- Reuben DB, Tinetti ME. N Engl J Med 2012;366:777-779.
Health care that is:
• safe
• effective
• patient-centered
• timely
• efficient
• effective

Institute of Medicine Committee on Quality of Health Care in America.

Crossing the Quality Chasm: A New Health System for the 21st Century.
Washington, DC: National Academies Press, 2001
Tatanan yang menghimpun berbagai Upaya
Kesehatan Masyarakat (UKM) dan Upaya
Kesehatan Perorangan (UKP) secara terpadu
dan saling mendukung guna menjamin
tercapainya derajat kesehatan masyarakat
yang setinggi-tingginya
 Faktor Sosial, Ekonomi, Politik dan
Budaya
KETURUNAN Paparan Pelayanan Kesehatan Perilaku
Lingkungan

Henrik L
Blumm
Family, socioeconomic and prenatal factors associated with failure to
thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC)
PS Blair, RF Drewett, PM Emmett, A Ness, AM Emond and the ALSPAC Study
Team

International Journal of Epidemiology 2004;33:839–847

Melakukan penelitian kohor longitudinal pada orang tua

dan anak dengan melibatkan 11.718 bayi yang lahir
aterm di tahun 1991 – 1992.Penelitian ini
menghubungkan antara gagal tumbuh dengan faktor
sosioekonomi dan prenatal. Kriteria gagal tumbuh yang
digunakan yakni, berat badan di bawah persentil 5
dengan mengacu rujukan negara Inggris atau z – score
dibawah –1,645 dalam dua periode waktu pengukuran;
lahir sampai 6 – 8 minggu, 6 – 8 minggu sampai 9 bulan.
Acute hepatitis C virus infections attributed to unsafe injection practice at an
endoscopy clinic Nevada, 2007 MMWR. Morbidity and Mortality Weekly Report;
May 16, 2008; 57, 19
 “TO ERR IS HUMAN” CORRIGAN, KOHN AND DONALDSON
US ACADEMY OF SCIENCES / INSTITUTE OF MEDICINE,
2000
• 1984 New York -2.9% of admissions suffered an adverse event, 58% of
which were preventable

• 1992 Colorado and Utah - 3.7% of admissions suffered an adverse event,

53% of which were avoidable

• Over 33.6Mn US hospital admissions pa between 44,000 and 98,000

avoidable deaths occur
8th most frequent cause of death
ahead of AIDS (16,516 deaths pa),
breast cancer (42,297 deaths pa) and
motor car accidents (43,458 deaths pa)

• Total cost to the US economy of avoidable deaths due to

healthcare error $17 - $29 Bn pa

HRRI.Healthcare Risk Resources International

Perilaku mempunyai dampak yang besar pada status
kesehatan seseorang
 dispepsia tidak dispepsia
100
90
Persen dispepsia

80
70
60
50
40
30
20
10
0
tidak minum
minum kopi
kopi
tidak dispepsia 56 83
dispepsia 44 17
Kebiasaan minum kopi
Cacat kandungan Sakit jantung

Gangguan Kerusakan Penyebab kasus

lambung hati bunuh diri
Merusak Sebab “buyuten” Rusak sistem
intelektual /parkinson saraf

Sex pra nikah Penyebab kasus

remaja pria pembunuhan
Perilaku tak bertanggung Sebab pelecehan Dosis ringan turunkan kolesteraol
jawab dan antisosial seksual &
tapi tidak ada jaminan tidak
kekerasan anak
Penyebab kematian akibat
ketagihan dalam jangka panjang
kebakaran Muntah
Ketegangan rumah tangga yang paling darah dan
menyakitkan dan berujung cerai berak darah
1/3 penyebab kasus masuk Penyebab
rumah sakit kasus
Kecelakaan lalu lintas tenggelam
yang mematikan
Kematian dini
 Income Pendidika Umur
Kausa distal n
(kecuali
umur)

Kausa
proksima
Merokok Alkohol Indeks Asupan Aktivita
l
Massa lemak s fisik
Tubuh

Kausa fisiologis Tekanan Kolesterol Diabetes

dan
darah LDL Melitus
patofisiologis
diastolik

Variabel Penyakit Jantung

hasil Koroner (PJK)
 Income Pendidika Umur
Kausa distal n
(kecuali
umur)

Kausa
proksima
Merokok Alkohol Indeks Asupan Aktivita
l
Massa lemak s fisik
Tubuh

Kausa fisiologis Tekanan Kolesterol Diabetes

dan
darah LDL Melitus
patofisiologis
diastolik

Variabel Penyakit Jantung

hasil Koroner (PJK)
 Faktor Sosial, Ekonomi, Politik dan
Budaya
KETURUNAN Paparan Lingkungan Pelayanan Kesehatan Perilaku

“Patroli” Surveilan
epidemiologi

Sehat Berisiko Gangguan SAKIT Ketidak- Kecacatan Sekara

Kesehatan mampuan t

Promosi Proteksi Diagnosis Pengobata Rehabilita Legislasi Paliasi

kesehatan spesifik dini n tepat si
 Primary prevention — e.g., diet, exercise,
immunizations
 Secondary prevention — e.g., screenings,
mammograms, family counseling
 Tertiary prevention — e.g., medications, surgical
treatment, rehabilitation