Problem-based Learning in Patient Management - Formats and Template

Problem-based Learning in Patient Management

Some Formats (Models) and a Template for Discussion in Patient Management

Reynaldo O. Joson, MD, MHPEd

(Written circa 1993)

A Template for Discussion in Patient Management Using Chief Complaint as a Trigger

GUIDELINES AND FORMAT

ON

HYPOTHETICAL PATIENT MANAGEMENT

SEQUENTIAL PATIENT MANAGEMENT / CASE STUDY

Format

Trigger 1

Patient with complaint of “The Health Problem” (Chief Complaint)

Questions:

• 1. What is “The Health Problem”?

  2. What are the possible causes of “The Health Problem”?

Organs/tissues involved General condition/disorder Specific condition/disease

(e.g. trauma, cancer, infection)

________________________ ____________________________ _____________________________

________________________ ____________________________ _____________________________

________________________ ____________________________ _____________________________

• 1. What do you think are the more common/least common general and specific condition causing the health problem?

General condition/disorder Specific condition/disease

More common __________________________ ___________________________

__________________________ ___________________________

Least common __________________________ ___________________________

__________________________ ____________________________

• 1. Select one common general or specific condition and diagram the pathophysiology leading to the health problem.

The Health Problem

Trigger 2

Pertinent history

Age, sex / Chief complaint / When noted / Associated symptoms

Physical examination:

Questions:

• 1. What is your primary and secondary diagnosis?

Primary diagnosis: _____________________________________________

Secondary diagnosis: ___________________________________________

• 1. What are the bases for your primary and secondary diagnoses?

Demonstrate use of pattern recognition with pathophysiology and prevalence.

Signs/Symptoms/Pathophysiology Prevalence data

Primary diagnosis

Secondary diagnosis

• 1. Do you need more data (sign/symptom) to firm up your primary and secondary diagnoses?

If yes, what? How will it firm up your diagnosis?

[ Data asked for either not available or normal. Facilitator may supply other data.]

• 1. Do you need a paraclinical diagnostic procedure?

If yes, why? If no, why?

Demonstrate use of

• • certainty/uncertainty of primary and secondary diagnoses

  • plan of management for primary and secondary diagnoses

  • others

• 1. If you need a paraclinical diagnostic procedure, what will you recommend? Why?

Give at least 3 options and then compare using benefit, risk, cost, and availability factors. Then select one demonstrating priority on the primary diagnosis. Shotgun policy is NOT acceptable.

Benefit Risk Cost Availability

Option 1

Option 2

Option 3

• 1. Suppose the patient agreed to your recommendation of the paraclinical diagnostic procedure and suppose it was done.

What results will firm up your primary diagnosis?

What results will make you shift to your secondary diagnosis as the primary diagnosis?

The Health Problem

Trigger 3.

A paraclinical diagnostic procedure was done.

A ___________________________________ was done.

[Here is the picture/reading/result of the paraclinical diagnostic procedure.]

Questions (as applicable):

• 1. Examine the result of the paraclinical diagnostic procedure and then interpret.

Decide whether the result is informative or non-informative.

Informative, why? Non-informative, why?

• 1. After the paraclinical diagnostic procedure, what is now your primary and secondary diagnosis? Why?

Demonstrate use of pattern recognition with pathophysiology and prevalence.

Diagnostic Procedure/Signs/Symptoms/Pathophysiology Prevalence data

Primary diagnosis

Secondary diagnosis

• 1. Do you need to firm up your diagnosis before you proceed to treatment?

If yes, how?

What data do you need?

History?

Physical exam?

Other diagnostic procedure?

Observation and monitoring?

[Data asked for either not available or normal. Facilitator may supply other data.]

• 1. What is your pretreatment primary and secondary diagnoses?

  2. State the goals of treatment for your primary diagnosis?

  3. Decide on a treatment modality after comparing the options based on benefit, risk, cost, and availability factors.

Benefit Risk Cost Availability

Nonoperative

(Specific procedure in mind)

Operative

(Specific procedure in mind)

• 1. Describe the things need to be done during the pretreatment, intratreatment, and posttreatment phase.

  2. Decide how you would evaluate the results or outcome of your proposed treatment.

The Health Problem

Trigger 4

The diagnosis of the patient’s health problem is

____________________________________________

Questions:

• 1. Advice the patient and relatives on the pathophysiology of the disease. Use diagram.

  2. Advice the patient and relatives on screening of the disease.

  3. Advice the patient and relatives on early detection of the disease.

The Health Problem

Trigger 5

A case write-up of a patient with a complaint of “The Health Problem”.

DIAGNOSIS IS NOT SPELLED OUT!

Signs and symptoms

Course in the management

Paraclinical diagnostic procedures done

Treatment

Outcome

Questions:

• 1. Study the case and then decide on the primary and secondary diagnoses.

Give bases for your diagnoses using

pattern recognition with pathophysiology

prevalence

• 1. Study the case and then

2.1 Comment on the outcome of treatment.

Were the goals of treatment achieved? Yes, why? No, why?

2.2 Describe the prognosis after treatment.

Recurrence, survival, quality of life

Pathophysiology of the disease leading to physical disability and death

ROJ@17apr16