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psyc
• Poverty
• Unemployment • Natural course of the psychosocial aspects of
• Other sickness in disease
• the family • Knowledge of the trajectory allows the physician to
disor
• Chronic family predict, anticipate, and deal with a family’s
• dispute response to illness
• Poor nutritional habit • Indicates normal and pathologic responses thus
• Inadequate housing condition enabling physicians to formulate special
therapeutic plans
• Labo
Major Illnesses Involves Loss of the Following
• Body parts
• Ability to carry out normal and treasured activities
• Sense of self-esteem
Case # 1
• Stage I • OnN
experiencing
• Explore aspects
patients and families
of pre-diagnostic phase of
• Stage II • Im
• Roberto, 32, father of 3 small children, applied Stage II- REACTION TO DIAGNOSIS:
N
as a seaman 1 year ago. After 6 months of being IMPACT PHASE
away from his family, he died of fatal arrhythmia
while aboard his ship. • Describe disease and treatment according to
patient’s level of comprehension and
Di
• C
understanding
• Make a clinical judgment about the amount of
information to give and be absorbed by the patient
• Give small doses of information over time
• Stage IV Re
o
Case # 2
• Ad
Im
messenger for 2 years. He encountered a
motorcycle accident 1 year ago which left half of EMOTIONAL PLANE
his body, from the waist down, paralyzed. His • Denial, disbelief, anxiety (min to hrs)
• • Nature
Stage of
V illn
Ad
Page 2 of 6
• Emotional upheaval such as anger, anxiety and • Make clear about the nature of illness by helping
depression (wks) the family maintain openness that allows sharing
• Accommodation and acceptance and support
• Know that the feeling of guilt is a natural response
COGNITIVE PLANE to stress of grief and loss, anticipate such feelings,
• Phase 1: Tension and confusion, lack of capacity and make realistic goals to correct the feeling
for problem solving • Help the family assess the likely effect of the
• Phase 2: Repeated failure in deriving the illness on the family
diagnosis leading to increased distress • Assess the capability of the family to cope with
• Phase 3: Receptivity of family to new approach stress
for relief of distress • Offer alternative interpretation of proposed
• Phase 4: Eventual acceptance of diagnosis therapeutics
Case # 3
Mae, 21, with a 18 month old old child, was
diagnosed with Lymphoma 6 months ago. Due to
lack of funds, her mother, who is also the Stage III- Major Therapeutic Efforts
caregiver, has tried several faith healers and other
therapeutic modalities to comfort Mae’s symptoms. • Represents one of the most challenging and
When asked about Mae’s family history of rewarding part of medical practice
cancer, her mother said that her husband, Mae’s • Physician should deal with multiple variables
father, died of liver CA in the hospital where Mae o work in harmony with the wishes of
was diagnosed with Lymphoma. She expressed the patient and family
her fears regarding the management and the o Coordinate all aspect of the therapy
appropriateness of care in the hospital.
Mae continued to have anorexia and
vomiting, back pain, cough, and difficulty of
breathing.
Also, she has been depressed for the last
three months because aside from her illness, her
husband was rumored to be having another girl,
limiting his time in caring for Mae.
• One or more family members are present about the patient’s illness; Educate family about
the illness
• Common medical Situation: Well-child and
• Establishing a Plan- develop a mutually agreed
prenatal care, diagnosis of a chronic illness
upon treatment plan and clarify each person’s role
• Length of visit: 15-20 min
in carrying it out
• How scheduled: Request family member
attendance
• Family Interviewing
Involving F
• Psychological state and preparedness of the
patient and family
• Assume responsibility of care very early in the
treatment plan. Define roles
• Economic status
o Economic impact of illness
Routin
Emotional trauma
Social dislocation
Economic catastrophe
• Lifestyle and cultural characteristics of the family
Involving F
• Effects of hospitalization, surgery, and other
therapeutic methods are emotionally stressful to
the family
DO’s
• Hospitalization gives rise to stressful logistic
problems
o Father- special economic burden
Routin
o Mother- greatest impact on other
family members; high risk of family
member
• A specially arranged meeting requested by the o Parents- helpless, guilt, frustrated, or
physician, patient or family to discuss the hurt
patient’s health problem in more depth than can o Geriatric- vulnerable to fears of
be addressed during a routine office visit death, rejection, abandonment;
• Acknowledge any
• Medical Situation: Terminal Illness loneliness and helplessness
DO’s
o Institutionalization
• Length of visit: 30-40min RESPONSIBILITIES OF THE PHYSICIAN
emotions express
• Joining Phase- develop rapport with family
• create a sense of trust • Remain open and work in harmony with the patient
• Goal Setting- why the family has been convened and his family
•• Emphasize indiv
• Deal with multiple variables; consider all factors
Encourage family
Trans Com: TEODOSIO, MARCELO
Page 4 of 6
• Coordinate all aspects of therapy o Followed by a period of waiting to
• Anticipate pathologic responses and be able to see if illness will return
deal with them o Fear of death
o Constant sense of vulnerability
Case # 4 • Permanent disability
56/M, married with 3 children, came in due to
cough for 1 month. RESPONSIBILITIES OF THE PHYSICIAN
CXR: Cavitary lesion at right apex
• Deal with immediate effects of trauma
Diagnosis: Pulmonary Tuberculosis
• Alleviate anxiety and assure adequate rest
Tx: 2 months HRZE, 4 months HR
• Psychological support
• Explore level of understanding of patient and
How will you present your diagnosis, and
family
educate the patient about the disease?
How will you present your management and
Stage V- Adjustment to the Permanency of the
convince the patient to adhere to the
Outcome
prescribed medicines?
• Family’s adjustment to crisis
• Second crisis occurs as family realizes that they
Case# 5
must accept and adjust to a permanent disability
49/M, married with 4 children, works as a seaman.
• FOR ACUTE ILLNESS: Potential for crisis when
He was supposed to board back to his ship when
routines are suspended
his agency did not allow him him due to high blood
o Physician can facilitate acceptance
sugar
of diagnosis
FBS: 235mg/dl
• FOR CHRONIC ILLNESS: Prolonged fear and
History:polyuria, polydipsia, polyphagia
anxiety leads to higher incidence of illness in other
Family History of DM
members of the family
o Feeling of guilt brings about anger
How will you present your diagnosis, and
and resentment
educate the patient about the disease?
o Physician should encourage
How will you present your management and ventilation of feelings, give
• Return from the hospital or major therapy o If family is functional: members are
• Gradual movement from the role of being sick to drawn close together
some form of recovery or adaptation o If family is dysfunctional: seed for
• Adjustment of relation within the family future family discord and breakdown
o Physician should provide quality
Types of Outcomes home care
• Return to full health
o Gains from illness experience
o Patient allowed to take over
abandoned obligation
• Partial recovery