What are the concepts of problem
and diagnosis according to physicians?
Class 13
2011/2012
Final Presentation:
25.05.2012
Introdução à Medicina II
Introdução à Medicina II
Class 13 2011/2012
Index
Introduction
Aims
Methods
Results
Discussion
Aknowledgements
2
Introdução à Medicina II
Class 13 2011/2012
Introduction
DIAGNOSIS
PROBLEM
• Everything that requires
diagnosis or acompaniment or
interferes with the patient’s
quality of life in a noticeable
way. [1]
Aims
•
The determination of the nature
of a disease or condition, or the
distinguishing of one disease or
condition from another. [2]
Methods
Results
Discussion
Aknowledge
ments
References:
[1] Kaplan DM, “Perspective: Whither the problem list? Organ-baseddocumentationanddeficientsynthesisbymedicaltrainees”. 2010 Oct; 85(10):
1578-82
[2] Definitionoftheterm“diagnosis” [MeSH] accordingto Pubmed
3
Introdução à Medicina II
Class 13 2011/2012
•
The Origin of the Concept: PROBLEM
Introduction
Lawrence Weed (1969):
-
individuality,
continuity,
present - past dynamic,
information sharing.
• List of Problems:
Active and Passive
Aims
SOAP:
Methods
Subjective,
Objective,
Assessment,
Planning
Results
Discussion
Aknowledge
ments
[4,5]
References:
[3] Weed, L. “Medical Records that Guide and Teach.” New England Journal of Medicine 278, no. 11 (1968): 593–600
[4] Queiroz, MJ; “Os diferentes passos da consulta e os registos clínicos”; Faculdade de Ciências Médicas da
Universidade Nova de Lisboa (2010).
4
Introdução à Medicina II
Class 13 2011/2012
•
The Origin of the Concept: DIAGNOSIS
Introduction
CLINICAL EXAMINATIONS ORIGINS
• Primitive:
“medicine-men” searched for causes of diseases – spiritual and
divine signs. Not methodic, illogical and influenced by beliefs and religion.
Aims
Methods
Results
But… had the same purpose of medical diagnosis:
search for causes of diseases in order to fight them. [5]
Discussion
Aknowledge
ments
BASIS OF MEDICAL DIAGNOSIS
5
References:
[5] Kenneth, D Kule, “The Evolution of Clinical Methods in Medicine” Ed. Citman Medical
Introdução à Medicina II
Class 13 2011/2012
NURSING DIAGNOSIS
Nursing Diagnosis: steps [6]
1.
Decade 20:
Difference Medical Problem – Nursing Problem
2.
Decade 50:
Concept of diagnosis in applied in Nursing Activity
3.
1973:
American Conference: Classification of Nursing Diagnosis
4.
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
1982:
Fundation of NANDA (North American Nursing Diagnosis Association)
References:
[6] Isabel Cristina Fonseca da Cruz, “A Evolução Hitórica do Conceito Diagnóstico de Enfermagem”, Apresentado
no I Simpósio Nacional sobre Diagnósticos de Enfermagem. São Paulo , Nov/1991 e publicado nos Anais.
6
Introdução à Medicina II
Class 13 2011/2012
MEDICAL DIAGNOSIS
Introduction
1. Primitive thinking
2. Developing of different techniques in Ancient Egypth, Greece,
Rome…
Aims
Methods
3. Oslerian Ideal: Relation Natural Human Mechanisms and its
disorders (1900)
4. Separation Medical Problem /Nursing Problem
Results
Discussion
Aknowledge
ments
5. Medical Diagnosis / Nursing Diagnosis
7
Introdução à Medicina II
Class 13 2011/2012
MISMATCH IN MEDICAL PRACTICE
Concept differences
Introduction
Aims
Methods
Results
harm
Discussion
correct flow of the clinical procedures
Aknowledge
ments
delay
Diagnosis, treatment
8
Introdução à Medicina II
Class 13 2011/2012
MISMATCH IN MANAGEMENT OF RESOURCES
Introduction
Concept Differences
Mismatch in Clinical Records
Lack of information in clinical records
Aims
Methods
Results
cause
Discussion
False records of clinical procedures
Statistics Reports with bias and false information
Aknowledge
ments
Lead to
Bad distribution of human and monetary resources
Deficiencies in those procedures development
9
Introdução à Medicina II
Class 13 2011/2012
MISMATCH IN CLINICAL RESEARCH
Introduction
Concept Differences
Aims
Difficulty in defining as diagnosis or problem the outcomes and variables in the investigation
Methods
Results
cause
Discussion
Misrepresentation of the causes and outcomes of the problem in study
Aknowledge
ments
Lead to
Ambiguous and biased conclusions
Waste of resources
10
Introdução à Medicina II
Class 13 2011/2012
So…
Introduction
The clarification of these two concepts is really important to:
Aims
 An appropriate pacient diagnosis and treatment
Methods
Results
 Management of resources
 Correct clinical research
Discussion
Aknowledge
ments
11
Introdução à Medicina II
Class 13 2011/2012
General Aim:
To evaluate the differences between diagnosis and
problem concepts among physicians
Introduction
Aims
Methods
Specific Aims:
To make an association between those differences and:
• Responsable for Encoding
• Workplace environment (hospital/primary care);
• Graduation Institution ( FMUP/ICBAS)
• Graduation Period
Results
Discussion
Aknowledge
ments
12
Introdução à Medicina II
• STUDY PARTICIPANTS:
Class 13 2011/2012
Introduction
Expert Survey:
Aims
4 teachers and specialists
(related to the registry of medical information)
Methods
Field Survey:
Randomized Sampling of Oporto physicians from
Results
• 2 hospitals: HSJ (n=14) and HGSA (n = 28) and 1 primary care: CSSJ (n=7)
• Encoders that didn’t belong to the previous groups (n= 4)
Discussion
Aknowledge
ments
Responses Total: 53
Survey’s delivered: 150
Response Rate ≈ 35 %
Response Rate from: HSJ, (75 questionnaires delivered), ≈ 19%,
HGSA, (60 questionnaires delivered) ≈ 47%
CSSJ, (15 questionnaires delivered), ≈ 47%.
13
Introdução à Medicina II
Class 13 2011/2012
Introduction
•
STUDY DESIGN:
•
Observational;
•
Cross sectional
•
Analytical;
Aims
Methods
Results
Discussion
Aknowledge
ments
14
Introdução à Medicina II
Class 13 2011/2012
• DATA COLLECTION METHODS:
• Expert Survey:
(Face-to-face Interviews)
Introduction
Aims
Methods
• Field Survey:
Self Admnistered Questionnaries
Results
Discussion
Aknowledge
ments
15
Introdução à Medicina II
Class 13 2011/2012
• Interviews’ organization
Introduction
Aims
• Biographical Data
Methods
• The Importance of Concept’s Distinction in Medical Practice
• The Distinction between Problem and Diagnosis
• The Practice Application of the two concepts
• The Most Significant Variables
• Opinions about the Pilot Survey
Results
Discussion
Aknowledge
ments
16
Introdução à Medicina II
Class 13 2011/2012
• Questionnaries’ organization
Introduction
Aims
Group I
• Personal definition of the concepts problem and diagnosis.
Group II
• List of items for diagnosis and problems.
Methods
Results
Discussion
Group III
Aknowledge
ments
• Matching of Concept’s definitions.
Personal Information
17
Introdução à Medicina II
Class 13 2011/2012
•
VARIABLES DESCRIPTION:
Introduction
Aims
• Concept’s definitions
Methods
• List of items for diagnosis and problems
• Matching of Concept’s definitions.
Results
Discussion
•
Responsable for Encoding
•
Workplace environment (hospital/primary care);
•
Graduation Institution ( FMUP/ICBAS)
•
Graduation Period (before 2000/ 2000 and after)
Aknowledge
ments
18
Introdução à Medicina II
Class 13 2011/2012
• STATISTICAL ANALYSIS
Introduction
Aims
Field Survey’s Data  Statistical Package for Social Sciences (SPSS):
Methods
- Analysis of the frequency of each answer;
- Comparison of the answers according to:
- Responsable for Encoding
- Workplace environment (hospital/primary care);
Results
Discussion
Aknowledge
ments
- Graduation Institution ( FMUP/ICBAS)
- Graduation Period
-Qui-Square Test
(Statistical analysis was performed, but no significant result was obtained, due to the lack of data.)
19
Expert’s Survey: INTERVIEWS
Introdução à Medicina II
Class 13 2011/2012
• Respondents
Introduction
Aims
• Dr. Fernando Lopes
Methods
Responsable for clinical encoding in HSJ
Results
• Dr. Altamiro Pereira
Responsable for “Introdução à Medicina” in FMUP
• Dr. Paulo Bettencourt
Responsable for “Semiótica Clínica” in FMUP
Discussion
Aknowledge
ments
• Dr. Amaral Bernardo
Responsable for “Semiologia Médica e Cirúrgica” in ICBAS
20
Expert’s Survey: INTERVIEWS
Introdução à Medicina II
Class 13 2011/2012
Interviews’ Results
Introduction
Aims
• Different Concepts of Problem and Diagnosis
• Lack of consensus
• Different Opinions about the Importance in Clinical Practice
Methods
Results
• Clinical Research
• Encoding
Discussion
• Significant Variables:
Aknowledge
ments
• Profession
• Task and Experience
• Suggestions for the Questionnary
21
Field Survey: QUESTIONNARIES
General Results : Group I, Diagnosis
Introdução à Medicina II
Class 13 2011/2012
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
22
Field Survey: QUESTIONNARIES
General Results : Group I, Problem
Introdução à Medicina II
Class 13 2011/2012
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
23
Field Survey: QUESTIONNARIES
General Results : Group II
Introdução à Medicina II
Class 13 2011/2012
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
24
Field Survey: QUESTIONNARIES
General Results : Group III
Introdução à Medicina II
Class 13 2011/2012
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
25
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Encoders/Non Encoders, Group I, Problem
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
26
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Encoders/Non Encoders, Group I, Diagnosis
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
27
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Encoders/Non-Encoders, Group II
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
28
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Encoders/Non-Encoders, Group III
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
29
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Workplace Environment, Group I, Problem
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
30
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Workplace Environment, Group I, Diagnosis
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
31
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Comparison: Workplace Environment, Group II
Class 13 2011/2012
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
32
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Workplace Environment, Group III
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
33
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Graduation Institution, Group I, Problem
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
34
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Graduation Institution, Group I, Diagnosis
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
35
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Comparison: Graduation Institution, Group II
Class 13 2011/2012
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
36
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Comparison: Graduation Institution, Group III
Class 13 2011/2012
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
37
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Graduation Period, Group I, Problem
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
38
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Class 13 2011/2012
Comparison: Graduation Period, Group I, Diagnosis
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
39
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Comparison: Graduation Period, Group II
Class 13 2011/2012
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
40
Field Survey: QUESTIONNARIES
Introdução à Medicina II
Comparison: Graduation Period, Group III
Class 13 2011/2012
Introduction
Aims
Methods
Results
Discussion
Aknowledge
ments
41
Discussion
• Main Findings:
Introduction
Aims
Methods
• Diagnosis: Myocardial Infarction, CVA (stroke), Asthma, Migraines,
Pulmonary infection, Acute bronchitis, Head Injury, Infected Wound
Results
Discussion
• Problems: Headaches, Chest pain, Fainting, Blurred vision,
Itching and Skin Irritation, Blisters and Rashes, Blood in sputum,
Cough, Vomiting, Prolonged loss of consciousness, Fever,
Shortness of breath, Palpitations, Dandruff, Alcohol abuse,
Indigestion
Aknowledge
ments
42
Discussion
Introduction
Aims
• Different definitions for the concepts: problem and diagnosis
• Concept differences mainly between:
• Encoders/Non-Encoders
Methods
Results
Discussion
• (minor relevance) Graduation Period (before 2000/ 2000 and after)
(Statistical analysis was performed, but no significant result was obtained, due to the lack of data.)
Aknowledge
ments
• No differences observed between:
• FMUP/ICBAS (Graduation Institution)
• Hospital/Primary Care
43
Discussion
Introduction
• Concept differences between:
• Encoders/Non-Encoders
affect
Management of Resources
Aims
Methods
Results
Discussion
Clinical Research
Aknowledge
ments
• Generations (Graduation Period)
affect
Clinical Practice / Data Sharing
44
Discussion
Introduction
Aims
• LIMITATIONS
• Lack of responses
• Lack of simillar work
Methods
Results
Discussion
Aknowledge
ments
45
Acknowledgements
• Dr. Ricardo Correia
Introduction
Aims
Methods
• Dr. Gustavo Bacelar
Results
• Dr. Altamiro Pereira
• Dr. Fernando Lopes
Discussion
Aknowledge
ments
• Dr. Paulo Bettencourt
• Dr. Amaral Bernardo
46