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:
What is “The Health Problem”?
What are the possible causes of “The Health Problem”?
Organs/tissues involved General condition/disorder Specific condition/disease
(e.g. trauma, cancer, infection)
________________________ ____________________________ _____________________________
________________________ ____________________________ _____________________________
________________________ ____________________________ _____________________________
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 __________________________ ___________________________
__________________________ ____________________________
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:
What is your primary and secondary diagnosis?
Primary diagnosis: _____________________________________________
Secondary diagnosis: ___________________________________________
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
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.]
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
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
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):
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?
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
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.]
What is your pretreatment primary and secondary diagnoses?
State the goals of treatment for your primary diagnosis?
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)
Describe the things need to be done during the pretreatment, intratreatment, and posttreatment phase.
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:
Advice the patient and relatives on the pathophysiology of the disease. Use diagram.
Advice the patient and relatives on screening of the disease.
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:
Study the case and then decide on the primary and secondary diagnoses.
Give bases for your diagnoses using
pattern recognition with pathophysiology
prevalence
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
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