内科学-绪论-PPT课件

1、INTRODUCTION TO INTERNAL MEDICINE Jiyao Wang, MD. MSC.Professor & ChairDept. of Internal MedicineShanghai Medical College,Fu Dan UniversityInternal MedicineSurgeryPediatricsgynecologyPathologyMicrobiologyGeneticsBiochemistryPharmacologyPathologic-physiologyDiagnosticsImmunologyHow to learn1. To comb

2、ine internal medicine with basic scientific knowledge2. To combine theory with practiceLecturesIntroductionPathogenesisPathologyPathophysiology Clinical featuresDiagnosis Treatment, PreventionBasic theoryBasic knowledgeEssential skillBedside TeachingWhat is expected of the physicianNo greater opport

3、unity, responsibility, or obligation can fall to the lot of a human being than to become a physician. Tact, sympathy and understanding are expected of physician.Te be a good Doctor In the care of the suffering, physician needs technical skill, scientific knowledge, and human understanding. The combi

4、nation of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is essential to the practice of medicine. The patient-physician relationshipPhysicians need to approach patients not as “cases” or “diseases”, but as individuals who is human, fearful, and hopeful, se

5、eking relief, help and reassurance.Ideal patient-physician relationshipBased on:Thorough knowledge of the patientMutual trustAbility to communicate Clinical Skills Taking informative history; Performing thorough physical examination;Using diagnostic tools judiciously, always asking whether the resul

6、ts will alter the management and benefit the patient. History takenIn listening to the history, the physician discovers not only something about the disease but also something about the patient. The process of history-taking provides an opportunity to observe the patients behavior and to watch for f

7、eatures to be pursued more. thoroughly during the physical examination.To develop effective reasoning skills Information gathering (informative history, thorough physical examination )Problem synthesisHypothesis generation Decision makingEssential skillLearning of Essential SkillsInquiry skillsThink

8、ing skillsProblem solving skillsEssential skillDealing with clinical problemsMaking diagnosisIdentify the severity of the diseaseAccording to the severity of disease, to make therapeutic protocolFollow up the results of the treatmentEvidence-based medicine, EBMDefined as: The conscientious, explicit

9、 and judicious use of current best evidence in making decisions about the care of individual patientsPrinciples of Patient CareEvidence-based medicine, EBMBest research evidencebasic sciences of medicinepatient-centered clinical researchClinical expertiseability to use our clinical skills and past e

10、xperience to rapidly identify each patients unique health state and diagnosis, their individual risks and benefits of potential interventionsPatient valuesthe unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decision

11、s if they are to serve the patientWhen these three elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life.Principles of Patient Care * Means any other lettersAND means both terms requiredCheck the question typ

12、eCheck the emphasisPractice Guidelines Evidence base clinical guidelines can provide a useful framework for managing patients with particular diagnoses or symptoms. Principles of Patient CareThe Grade & Level of EvidenceGrades of level ofRecommendation evidenceEtiology/Therapy/Prevention A 1aSR of R

13、CTs 1bIndividual RCT with narrow CI 1cAll or none B 2aSR of Cohort studies 2b Individual Cohort study/low quality RCT 2cOutcome Research 3aSR of Case-control Study 3b Individual Case-control Study C 4 Case series/poor quality cohort study/ case-control study D 5 Expert opinion without critical appra

14、isal.when a relevant evidence base is unavailable, clinical knowledge and experience together with an understanding of the patients needs, supplemented by diagnostic tools, still represent the best approach to practicing medicine.Medical Decision-Making ordering of additional tests, requests for con

15、sults, decisions regarding prognosis and treatment Medical decision-making should be evidence-based Principles of Patient CareHistoryPhysical ExaminationLaboratory Tests, imagingSpecial diagnostic studiesDiagnosisEstimationRight decision makingnecessaryselectedDiagnostic tests serve to reduce uncert

16、ainty about a diagnosis in a particular individual and to help the physician decide how best to manage that individuals condition. The Principles of Diagnostic Thinking One etiologyCommon disease firstOrganic diseases first, then functional disordersExcluding methods to do differential diagnosis The

17、 Principles for selecting Diagnostic tests & Imaging studyEffectiveness, safety and priceSelect test with high sensitivity to exclude diagnosisSelect test with high specificity to confirm diagnosisNon-invasive procedures firstIf the results from test is not fit the clinical considerations, detailed

18、analysis is needed.The Principles of Therapeutic ThinkingTreat the most severe case firstIn general, therapeutic protocol following confirmed diagnosis of diseaseFor life-threatened disease, save life first, then to confirm the diagnosisFor treatment, the simple, the best.Pay attention to drug side-

19、effects and cross-over effectsThe Principles of Therapeutic ThinkingTreat curable disease as soon as possibleDiagnostic therapy could used to confirm the clinical diagnosisAccording to principles of evidence-based medicine to make decision for treatmentAssessing the Outcome of Treatment Use objective and readily measurable parameters to judge the outcome of a therapeutic intervention. The practice of medicine requires consideration and integration of both objective and subjective outcomes.