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Dr. Abdelmonem Gado, MS Surgery, FRCSI Consultant Paediatric Surgeon, Division of Paediatric Surgery, Department of Surgery
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Your professional obligations, the expectation placed upon you by the public, the law and your colleagues, start on your first day as a student and continue throughout your working life.
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The qualities that patients look for in a doctor: Humaneness Competence Accuracy Honesty Openness Responsiveness Trusthworthiness Involving the patient in the decision making process Time and listen
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-Language: - Learn to speed read - A good clinician is someone who interested in people - Put yourself in situation of the patient or their relatives - The best doctor are invariably the most humble and - good observer - Dress, Demeanour and confidentiality to establish successful patient – doctor relationship
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Set-up: - Where will you see your patient? - Keep always quite and private space - How long this interview? - How will you sit? Hand washing and Cleanliness: - Is the single most effective way to prevent the spread of infection
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Infections that can be transmitted on the hands of healthcare workers” - Healthcare – acquired infections: -MRSA- Clostridium difficile -Diarrheal infection: -Salmonella - Shigella- E.coli - Noro virus -Respiratory Infection: -Influenza - Common cold - Resp. Syncytial virus (RSV) -Other Infections: Hepatitis A
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Communication Skills, How? - Maintain good eye contact - Active listening, then write - Encourage verbal or non verbal communication - Avoiding jargon - Ability to discuss difficult issues - Going at a place that is comfortable for the patient - Diligent and frequent practice
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Introduce yourself: - I am Mr…., I am 3 rd year medical student - I have been asked to talk to you and examine you with some of my colleagues - It might take 30 minutes - Privacy - Notes (it does not mean I’m not listening to you - Are you happy with all that?
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Things to remember: - Never write while talking - See the patient walking - See the accompanying person (mother, wife, friend) -Can often provide valuable information -However, many patients are inhibited from discussing their problems by the presence of third person
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Guide the conversation: - Explain what you are doing, and why you are doing it, at all stages - patients know more about their complaints than you, but cannot interpret their significance: - Interpreter – short and simple questions - Leading questions - one answer - open questions - Example : Does the pain ever move? - Always ask the questions in the right way.
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Principle of History taking in Surgery: History taking ? the key step in surgical diagnosis. Varies according to the complain ? specific histories ? surgical specialty
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Out-pt or emergency room history ?specific complaint is pinpointed ? diagnosis Clerking of pt admitted for elective surgery object ? to assess that the treatment planned correctly indicated and pt is suitable for that operation.
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Information gathered during patient interview
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- Date and Time- Chief Complaint - Identifying data- Present illness - Source of referral- Past medical and surgical history - Source of history- Family History - Social History - Drug History
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I. Personal Information - Age, Sex, marital status, occupation nationality, residence, etc..
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HISTORY cont..: 2) Present complain: - open question - closed question - write in patients words
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Symptoms that caused patient to seek care Often: Pain Abnormal function Change in normal state Unusual observation made by patient (e.g., heart palpitations)
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3) History of present illness (Complaint) - Provide full, clear, chronological account of symptoms - In scientific term - Similar attacks - Determine the abnormal system
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HISTORY cont..: 4) Remaining question of abnormal system
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HISTORY cont.: 5) Systemic direct question: ◦ it reveals the presence of other disorders of which the patient was unaware, or thought irrelevant ◦ -ve answers are as important as +ve answers
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Appetite- Heartburn Diet- Vomiting Weight- Haematemesis Teeth and Taste- Indigestion Swallowing- Abdominal pain Regurgitation- Defecation Flatulence- Change of skin Color
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- Cough - Sputum - Haemoptysis - Dyspnea - Orthopnea - Chest pain
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- Breathlessness - Orthopnea - Paroxy swal noctural dyspnea - Pain - Palpitations - Cough and sputum - Dizziness and headaches - Ankle swelling
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- Pain- Scrotum & urethra - Oedema- Menstruation - Thirst- Dyspareunia - Micturation- Breast - Urine –haematuria- Secondary sex character
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Nervous system and musculoskeletal system
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General state of health: ◦ Childhood illnesses ◦ Adult illnesses ◦ Accident and injuries ◦ Surgeries or hospitalizations
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Health of immediate family ◦ High blood pressure, heart disease, contagious illnesses Potential for hereditary diseases
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Marital status Occupation Residency The lesiure activities Habits (smoking, alcohol,etc) Travelled abroad.
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Alcohol or drug use Physical abuse or violence Sexual issues
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Respect patient privacy Be direct and firm Avoid confrontation Be nonjudgmental Use appropriate language Document carefully ◦ Use patient’s words when possible
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Silence Overly talkative patients Patients with multiple symptoms Anxious patients
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Anger and hostility Intoxication Crying Depression Sexually attractive or seductive patients Confusing behavior or histories Limited intelligence Developmental disabilities
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May result from: ◦ Social or cultural differences ◦ Sight, speech, or hearing impairments Attempt to find assistance to aid in communication
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Pain Lump
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History of pain -The site -Onset -Duration -Severity -Nature of the pain -Progression of the pain -Relieving and exacerbation factors -Radiation and refering pain
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History of a lump -Site. -Duration. -What made the patient notice the lump. -course of the lump. -Associated symptoms. -Other lumps
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QUIZ
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QUESTIONS?
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THANK YOU!
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