FURTHER  APPRAISAL IS NEEDED ?

DR. M ABBAS SUBHANI
MBBS DCH

F0R THE MAJORITY OF THE PATIENTS DETAILED (BUT RELEVANT) HISTORY, THOROUGH PHYSICAL EXAMINATION, AND LOGICAL ANALYSIS IS SUFFICIENT.

SOME OF THE PATIENTS NOT ALL REQUIRE FURTHER APPRAISAL. IT MAY BE IN THE FORM
OF SECOND OPINION (SPECIALIST'S OPINION) OR USE OF LABORATORY TESTS OR BOTH
IF REQUIRED IT SHOULD NOT BE DEFERRED OR DELAYED

FURTHER APPRAISAL IS REQUIRED FOR FOLLOWING GROUP OF PATIENTS

•  WORKING DIAGNOSIS NOT POSSIBLE WITHOUT IT (OBSCURE ILLNESS)
•  THERE IS SUSPICION OF POTENTIALLY DANGEROUS ILLNESS (SERIOUS ILLNESS)
•  PATIENT IS NOT IMPROVING BY THE SUGGESTED TREATMENT
•  TO MONITOR THE IMPROVEMENT OBJECTIVELY (TO COMPARE WITH PREVIOUS FINDING)
•  TO RELIEVE THE FALSE BELIEF AND UNDUE FEARS OF PATIENTS (AT TIMES IT MAY BE COUNTER PRODUCTIVE, THEY START THINKING IF TESTS ARE NORMAL THERE IS NO ILLNESS)
•  SUGGESTED BY THE ATTENDANTS, SPECIALLY IF SOME OTHER PHYSICIAN HAS ADVISED IT TO HIM
• LABORATORY TEST RESULT SHOULD BE ANALYZED KEEPING IN VIEW THE ILLNESS AND THE  TREATMENT TAKEN AS BOTH OF THESE MAY ALTER THEM (RESULTS). NORMAL TEST RESULTS DO NOT RULE OUT ILLNESS

ADMISSION IN THE HOSPITAL

Majority of the patients can be managed effectively at the Primary care settings,
but some of them require admission in the hospital.

THE ADVICE ABOUT THE ADMISSION SHOULD BE GIVEN CONSIDERING FOLLOWING FACTORS

SEVERITY OF ILLNESS-----If the illness is severe, e.g.-meningitis/septicemia/severe-pneumonia, patient should be advised admission. Even if the condition is satisfactory at the time of examination, but a potentially dangerous illness is suspected/considered it is better to observe the patient in hospital e.g.-head-injury/convulsion /apnea.

ASSOCIATED PROBLEMS------------Even the minor problems in children suffering from severe malnutrition/congenital-defects/immuno-deficiency may turn out to be serious so it is better to
manage them in the hospital.

TREATMENT AND INVESTIGATIONS NEEDED--------Some of the therapies are possible in the hospitals only e.g.-incubatorcare/phototherapy/continuous oxygen administration/ventilatory support.If the patient requires one of these therapies he/she should be advised admission

Uncommonly the patient may need admission for the investigations, which are not possible in OPD, e.g.-bone marrow examination in suspected leukaemia patients.

24 HOUR ACCESSIBILITY TO HEALTH CARE------Some of the patients reside in far-flung areas or there is nobody to look-after them at home(during illness). These patients may also be advised admission exceptionally.

FEARS AND DEMAND OF THE PATIENT ATTENDANT