The four great cornerstones of diagnostic medicine areanatomy (structure: what is there),physiology (how the structure/s work),pathology (what goes wrong with the anatomy and physiology), andpsychology (mind and behavior). In addition, the physician should consider the patient in their 'well' context rather than simply as a walking medical condition. This means the socio-political context of the patient (family, work, stress, beliefs) should be assessed as it often offers vital clues to the patient's condition and further management.
A patient typically presents a set of complaints (thesymptoms) to the physician, who then performs adiagnostic procedure, which generally includes obtaining further information about the patient's symptoms, previous state of health, living conditions, and so forth. The physician then makes areview of systems (ROS) orsystems inquiry, which is a set of ordered questions about each major body system in order: general (such as weight loss), endocrine, cardio-respiratory, etc. Next comes the actualphysical examination and othermedical tests; the findings are recorded, leading to a list of possiblediagnoses. These will be investigated in order of probability.
The next task is to enlist the patient's agreement to a management plan, which will include treatment as well as plans for follow-up. Importantly, during this process the healthcare provider educates the patient about the causes, progression, outcomes, and possible treatments of his ailments, as well as often providing advice for maintaining health.
The physician's expertise comes from his knowledge of what is healthy and normal contrasted with knowledge and experience of other people who have had similar symptoms (unhealthy and abnormal), and the proven ability to relieve it with medicines (pharmacology) or other therapies about which the patient may initially have little knowledge.
A survey in the United States came to the result that, overall, a physician sees each patient for 13 to 16 minutes.[1]Anesthesiologists,neurologists, andradiologists spend more time with each patient, with 25 minutes or more.[1] On the other hand,primary care physicians spend a median of 13 to 16 minutes per patient, whereasdermatologists andophthalmologists spend the least time, with a median of 9 to 12 minutes per patient.[1] Overall, female physicians spend more time with each patient than do male physicians.[1]
For the patient, the time spent at the hospital can be substantially longer due to various waiting times, administrative steps or additional care from other health personnel. Regarding wait time, patients that are well informed of the necessary procedures in a clinical encounter, and the time it is expected to take, are generally more satisfied even if there is a longer waiting time.[3]
With increasing access to computers and published online medical articles, the internet has increased the ability to performself-diagnosis instead of going to a professional health care provider. Doctors may be fearful of misleading information and being inundated by emails from patients which take time to read and respond to (time for which they are not paid).[4] About three-quarters of the U.S. population reports having aprimary care physician, but the Primary Care Assessment Survey found "a significant erosion" in the quality of primary care from 1996 to 2000, most notably in the interpersonal treatment and thoroughness of physical examinations.[5]
A study systematically assessedadvice given by professionalgeneral practitioners, typically in the form of verbal-only consultation, forweight-loss toobese patients. They found it rarely included effective methods, was mostly generic, and was rarely tailored to patients' existing knowledge and behaviours.[6][7]
TheNational Institute on Aging has produced a list of "Tips for Talking With Your Doctor" that includes asking "if your doctor has anybrochures,fact sheets, DVDs, CDs, cassettes, or videotapes about your health conditions or treatments" – for example if a patient's blood pressure was found to be high, the patient could get "brochures explaining what causes high blood pressure and what [the person] can do about it".[8]
Telemedicine is sometimes used as asynonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap[12] and can even improve retention in treatment[13] as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information andhealth data management and healthcare system integration.[14] Telehealth could include twoclinicians discussing a case overvideo conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.[9][10][14]
Ascientific review indicates that, in general, outcomes of telemedicine are or can be as good as in-person care with health care use staying similar.[15]
Telemedicine as predicted in 1925[16]Advantages of the nonexclusive adoption of already existing telemedicine technologies such as smartphonevideotelephony may include reduced infection risks,[17] increased control of disease during epidemic conditions,[18] improved access to care,[19] reduced stress and exposure to other pathogens[20][21] during illness for better recovery, reduced time[22] and labor costs, efficient more accessible matching of patients with particular symptoms and clinicians who are experts for such, and reduced travel while disadvantages may include privacy breaches (e.g. due to software backdoors and vulnerabilities or sale of data), dependability on Internet access[17] and, depending on various factors, increased health care use.
This may enable increased flexibility, improveddisease surveillance, better medical product safety surveillance,[31] betterpublic health monitoring (such as for evaluation ofhealth policy effectiveness),[32][33] increased quality of care (via guidelines[34] and improved medical history sharing[35][36]), and novel life-saving treatments.
^ab"What is TeleHealth?".Office for the Advancement of Telehealth. The Health Resources and Services Administration. March 2022. Retrieved12 January 2024.
^abMiller EA (July 2007). "Solving the disjuncture between research and practice: telehealth trends in the 21st century".Health Policy.82 (2):133–41.doi:10.1016/j.healthpol.2006.09.011.PMID17046097.
^Albritton J, Ortiz A, Wines R, Booth G, DiBello M, Brown S, Gartlehner G, Crotty K (February 2022). "Video Teleconferencing for Disease Prevention, Diagnosis, and Treatment : A Rapid Review".Annals of Internal Medicine.175 (2):256–266.doi:10.7326/m21-3511.PMID34871056.S2CID244923066.
^Newschaffer CJ, Bush TL, Penberthy LT (June 1997). "Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data".Journal of Clinical Epidemiology.50 (6):725–733.doi:10.1016/S0895-4356(97)00050-4.PMID9250271.
^Spiranovic, Caroline; Matthews, Allison; Scanlan, Joel; Kirkby, Kenneth C. (2 January 2016). "Increasing knowledge of mental illness through secondary research of electronic health records: opportunities and challenges".Advances in Mental Health.14 (1):14–25.doi:10.1080/18387357.2015.1063635.ISSN1838-7357.S2CID57541937.
^Paul, Margaret M.; Greene, Carolyn M.; Newton-Dame, Remle; Thorpe, Lorna E.; Perlman, Sharon E.; McVeigh, Katherine H.; Gourevitch, Marc N. (1 June 2015). "The state of population health surveillance using electronic health records: A narrative review".Population Health Management.18 (3):209–216.doi:10.1089/pop.2014.0093.ISSN1942-7891.PMID25608033.
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