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1、INTRODUCTION TO INTERNAL MEDICINE,Jiyao Wang, MD. MSC. Professor & Chair Dept. of Internal Medicine Shanghai Medical College, Fu Dan University,Internal Medicine,Surgery,Pediatrics,gynecology,Pathology,Microbiology,Genetics,Biochemistry,Pharmacology,Pathologic-physiology,Diagnostics,Immunology,How t
2、o learn,1. To combine internal medicine with basic scientific knowledge 2. To combine theory with practice,Lectures,Introduction Pathogenesis Pathology Pathophysiology Clinical features Diagnosis Treatment, Prevention,Basic theory,Basic knowledge,Essential skill,Bedside Teaching,What is expected of
3、the physician,No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. Tact, sympathy and understanding are expected of physician.,Te be a good Doctor,In the care of the suffering, physician needs technical skill, scientific knowledge, an
4、d human understanding. The combination of medical knowledge, intuition, experience, and judgment defines the art of medicine, which is essential to the practice of medicine.,The patient-physician relationship,Physicians need to approach patients not as “cases” or “diseases”, but as individuals who i
5、s human, fearful, and hopeful, seeking relief, help and reassurance.,Ideal patient-physician relationship,Based on: Thorough knowledge of the patient Mutual trust Ability to communicate,Clinical Skills,Taking informative history; Performing thorough physical examination; Using diagnostic tools judic
6、iously, always asking whether the results will alter the management and benefit the patient.,History taken,In listening to the history, the physician discovers not only something about the disease but also something about the patient. The process of history-taking provides an opportunity to observe
7、the patients behavior and to watch for features to be pursued more. thoroughly during the physical examination.,To develop effective reasoning skills,Information gathering (informative history, thorough physical examination ) Problem synthesis Hypothesis generation Decision making,Essential skill,Le
8、arning of Essential Skills,Inquiry skills Thinking skills Problem solving skills,Essential skill,Dealing with clinical problems,Making diagnosis Identify the severity of the disease According to the severity of disease, to make therapeutic protocol Follow up the results of the treatment,Evidence-bas
9、ed medicine, EBM,Defined as: The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients,Principles of Patient Care,Evidence-based medicine, EBM,Best research evidence basic sciences of medicine patient-centered clinical research C
10、linical expertise ability to use our clinical skills and past experience to rapidly identify each patients unique health state and diagnosis, their individual risks and benefits of potential interventions Patient values the unique preferences, concerns and expectations each patient brings to a clini
11、cal encounter and which must be integrated into clinical decisions if they are to serve the patient,When these three elements are integrated, clinicians and patients form a diagnostic and therapeutic alliance which optimizes clinical outcomes and quality of life.,Principles of Patient Care,* Means a
12、ny other letters,AND means both terms required,Check the question type,Check the emphasis,Practice Guidelines,Evidence base clinical guidelines can provide a useful framework for managing patients with particular diagnoses or symptoms.,Principles of Patient Care,The Grade & Level of Evidence,Grades
13、of level of Recommendation evidence Etiology/Therapy/Prevention A 1a SR of RCTs 1b Individual RCT with narrow CI 1c All or none B 2a SR of Cohort studies 2b Individual Cohort study/low quality RCT 2c Outcome Research 3a SR of Case-control Study 3b Individual Case-control Study C 4 Case series/poor q
14、uality cohort study/ case-control study D 5 Expert opinion without critical appraisal,.when a relevant evidence base is unavailable, clinical knowledge and experience together with an understanding of the patients needs, supplemented by diagnostic tools, still represent the best approach to practici
15、ng medicine.,Medical Decision-Making,ordering of additional tests, requests for consults, decisions regarding prognosis and treatment Medical decision-making should be evidence-based,Principles of Patient Care,History,Physical Examination,Laboratory Tests, imaging,Special diagnostic studies,Diagnosi
16、s,Estimation,Right decision making,necessary,selected,Diagnostic tests serve to reduce uncertainty about a diagnosis in a particular individual and to help the physician decide how best to manage that individuals condition.,The Principles of Diagnostic Thinking,One etiology Common disease first Organic diseases first, then functional disorders Excluding methods to do differential diagnosis,The Principles for sel
