DR. M ABBAS SUBHANI
MBBS DCH

1  ASSESS THE ILLNESS AND PATIENT BOTH

Assessment and management are not separate. Effective management requires thorough and logical assessment. Primary care physicians should develop and rely on their clinical skills, as laboratory support is neither available nor required for all patients in primary care setting. Laboratory support should not be considered replacement of clinical skills. Even if the laboratory support is available it should be used judiciously (as it is quite time consuming and costly) the results should be interpreted logically.
Assessment should not be focused on illness only. Assessment should be done of the patients, who are human beings and have got sufferings, fears, wishes limitations and on top of it their own thinking

TAKE DETAILED HISTORY (LEARN LOCAL LANGUAGE IT HELPS). BE THOROUGH IN CLINICAL EXAMINATION. USE LABORATORY SUPPORT JUDICIOUSLY AND INTERPRET IT LOGICALLY (INTERPRET FINDINGS BOTH PHYSICAL AND LABORATORY ACCORDING TO THE AGE OF CHILD AND AGE OF ILLNESS). DON'T FORGET THE POSSIBILITY OF FALSE POSITIVE/ FALSE NEGATIVE RESULTS.

EVALUATE THE PATIENTS FOR

               VALIDITY OF STATEMENT (DON'T ACCEPT OR REJECT STATEMENT WITHOUT SCRUTINY) .*ATTRIBUTES *FEARS *WISHES * LIMITATIONS *COMPLIANCE

EVALUATE THE CLINICAL OR LABORATORY FINDINGS

IS IT ABNORMAL ?

EVALUATE THE ILLNESS FOR

             WHAT HAS HAPPENED (illness)  * WHY DID IT OCCUR (cause) * SEVERITY OF ILLNESS * CHANCES OF CURE, COMPLICATIONS, AND RECURRENCE

2    DEVELOP A PLAN, BASED ON THE ASSESSMENT  Develop the plan and modify it considering the human factors of the patient (if possible) without deviating from its scientific aspect.

DECIDE  ABOUT * Need for second opinion, further appraisal, and follow up

 *Is admission required?  * Are drugs required? (Ideally drugs should be used only if the illness is not self limiting, but some of the patients are not receptive to advice only. To exert "placebo effect " use harmless drugs  (as far as possible) for these patients.
SAYING THAT" SYMPTOMATIC TREATMENT SHOULD NOT BE DONE IS CORRECT BUT MISUNDERSTOOD BY SOME OF US . DRUG USAGE FOR SYMPTOMATIC RELIEF IS NOT PROHIBITED RATHER IT IS THE DUTY OF THE PHYSICIAN TO RELIEVE THE SUFFERINGS OF THE PATIENT. BUT THIS SHOULD NOT BE THE ONLY AIM OF THE TREATMENT. ALL EFFORTS SHOULD BE MADE TO ERADICATE/CONTROL THE DISEASE PROCESS.

3   IMPLEMENT THE PLAN AND EXPLAIN IT

      Implementation is taken care of but the some of the physicians overlooks explanation. Explain and discuss your assessment and plan with the attendants about illness, cause/contributing factors, and chances of cure, recurrence/complications, need for admission, second opinion, laboratory tests, follow-up, duration and cost of treatment and possible side effects of the suggested treatment.

4   EDUCATE THE PATIENTS FOR
what to do and what not to do   *removal of misconceptions ( if any )  *behavior modification (if required ) e.g.: food habits, smoking , hygiene