GeneralIntroductionofGeneralIntroductionofPhysicalDiagnosisPhysicalDiagnosisLiuJian-minLiuJian-minDepartmentofPhysicalDiagnosisDepartmentofPhysicalDiagnosisDepartmentofEndocrineandMetabolicDiseasesDepartmentofEndocrineandMetabolicDiseasesRui-jinClinicalCollegeRui-jinClinicalCollegeShanghaiJiao-tongUniversitySchoolofMedicineShanghaiJiao-tongUniversitySchoolofMedicinePhysicalDiagnosis•Today’smedicalstudentsToday’smedicalstudents•Tomorrow’scliniciansTomorrow’scliniciansPhysicalDiagnosis•Whatisthemeaningof“Clinician”?PhysicalDiagnosis•Whatisthemainresponsibilityoftheclinician?•Makingdiagnosis•Treatadisease•TreatapatientPhysicalDiagnosis•Alinkagebetweenbasicmedicalknowledgeandclinicalmedicine.•Adisciplinetousebasicmedicaltheoryandskilltomakeadiagnosis.Obtaininformation•Fromanyandeverysourcepossible.•Straintohearthevoiceofthepatientinthethinreedofhiscrying.•Seemostacutelyoutofthecornerofyoureye.•Tohearbestwithyourinnerear.Thecontentsofdiagnosis•Verbalobservationorhistorytaking•Physicalobservationorexamination•LaboratoryobservationHistoryTaking•Obtainasmuchinformationasneededtodiagnoseandtreattheillness.•Requirementsforthephysicians:•Agenuine,profound,andabsorbinginterestinthepatient'swellbeing•Adeep-seated,well-groundedselfconfidenceinabilities•Athroughknowledgeofthediseases•Abilitytoseetheproblemfromthepatient'sviewpointHistoryTaking•Obtainingamedicalhistoryisan"art"•Talkwith,rathertalktothepatient.•Listenattentivelyandguideapatienteffectively.•Asksearchingquestions.•Interrogationoffamilyandfriendsifnecessary.HistoryTaking•Knowallaboutthedisease•Symptomsandsigns–Symptoms:patient'scomplaints,orhisrecognitionofsomethingabnormal.–Signs:findingselicitedbyphysicalexamination•Pasthistory•Familyhistory•SystemsreviewPhysicalExamination•Beginswhengreetingthepatient.•Sedulouslypracticingtheartofobservationmakeastudenttoaclinician.Howtoconductphysicalexamination•Applicationofthesensoryendorgantothepatient.•Inarational,thorough,andaccuratefashion.•Withefficiencyandminimaldiscomforttothepatient.•5componentsofphysicalexamination:inspection,palpation,percussion,auscultationandsmelling.Laboratoryfindings•Todetectpathogenicorfunctioninginformation.•Chemical,biologicalandphysiologicaltests.•X-film,CT,MR.•gastroscopy,angiographyandbronchoscopyetc.Interpretationoflaboratorydata•Lotsvariablesalterlaboratorytestsresults.•Specificityandsensitivityofthetests.•Overlappingbetweenthehealthyandthediseasedsubjects.TheIntellectualprocessofdiagnosis•Informationrequiresclarificationandamplification.•Informationmustbecarefullyweighedastoitsclinicalsignificanceanditspossiblerelationshiptothepatient'scomplaints•6levelsofintellectualfunctioning：knowledge,comprehension,application,analysis,synthesis,andevaluation6levelsofintellectualfunctioning•Knowledge–Uneditedfactualinformationprovidedbythepatient.–Maynotnecessarilybeaccurateorprecise.•Comprehension–Understandingthefactsrelatedbythepatient.–Affirmwhatthepatientsaid.•Application–Recordingthefactsaccuratelyandinawell-organizedorder6levelsofintellectualfunctioning•Analysis–Sortingoutorclassificationoftheobtaineddataintorelatedcategories.•Synthesis–Reassemblethedataobtainedintopatternsofrecognizabledisease.•Evaluation–Askingquestionsthataredesignedtoeitherconfirmorexcludetentativediagnoses.–Predictingthelikelyphysicalandlaboratoryfinding.Theroleofhightechnology•Alwaysbeatool.•Canneverreplacetheintellectualprocessofdiagnosis.Theroleofhightechnology•Patientisahumanbeing,notaPatientisahumanbeing,notamachine!machine!•Physicianisamedicaldetective,notPhysicianisamedicaldetective,notadetector!adetector!Conclusion•Communication，observationanddatarecordingarethekeydemandsinmedicine.•Profoundknowledgeandsmartintellectualprocessofthinkingofmedicineisthekeyforsuccessofaclinician.Onlyasacliniciandoesonebecomeaclinician
