HOLISTIC DIAGNOSIS

Nita Arisanti
Type
 STRATIFIKASI PELAYANAN KESEHATAN
RUJUKAN RUJUKAN
YANKES YANKES
PERORANGAN MASYARAKAT

RS UMUM/KHUSUS DINKES PROPINSI ,

PUSAT/PROPINSI STRATASTRATA DEPKES RI
3 3
RS UMUM/KHUSUS
KAB/KOTA, BP4, BKMM, DINKES KAB/KOTA , BP4,
BKOM, BKTK , KLINIK STRATA 2 STRATA 2 BKMM, BKOM, BKTK
SPESIALIS, SPESIALIS ,BPOM

PRAKTEK PUSKESMAS
DOKTER,PUSKESMAS, STRATA 1 STRATA 1
BP, BKIA , PRAKTEK
BIDAN
POSYANDU, MASYARAKAT MASYARAKAT POSYANDU,
POLINDES POLINDES ,UKBM

UPAYA KES PERORANGAN PERORANGAN UPAYA KES

KEL MANDIRI /KELUARGA /KELUARGA KEL MANDIRI
KADER
The health enhancement continuum
Before man is involved The course of the disease in man
DEATH
Interrelation of the various: Chronic state
- AGENT Defect
- HOST Disability
- ENVIRONMENT factors Illness
Signs & symptoms
(known & unknown) Tissue & physiologic Immunity &
changes resistance
which STIMULUS & AGENT becomes
established & increases by RECOVERY
multiplication or increment
bring AGENT & HOST in the Interaction of
together, or HOST reaction
human HOST & STIMULUS
produce a disease-provoking HOST Discernable early Advanced
Early pathogenesis Convalescence
STIMULUS lesions disease

Pre-pathogenesis Pathogenesis
Health promotion & Early detection & prompt Disability Th/ &
Spesific protection treatment Rehabilitation

PROMOTIVE
PREVENTIVE CURATIVE
PROMOTIVE
PREVENTIVE REHABILITATIVE
CURATIVE REHABILITATIVE
 Organization

INTEGRATED

CONTINUING

• follow up
• Consultation and referral
• Acute, chronic, palliative care
 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
 Exploring both the Understanding Finding
Disease & illness the whole Common
experience person ground
Physical, history, lab
Disease CONTEXT PROBLEMS
Patient PERSON
Presents GOALS
Mutual
Illness Decision
cues
Illness Disease
Ideas, expectations ROLES
Feelings, effect on
functions

Enhancing Incorporating
Patient-doctor Prevention and Being realistic
relationship Health promotion

The Patient Centered Clinical Method

• biopsychosocial
 union of body, mind, soul, and social
 PERSON

Organ system

tissues

cells

molecules

atoms

Subatomic particles
 GLOBAL

SOCIETY & NATION

COMMUNITY

FAMILY

COUPLE

PERSON
 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
• 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