Being a medical doctor

Why do you want to become a

doctor?

Medical Ethics

Historical background
Hippocratic oath
World Medical Association, Geneva
1949
Sydney 1968

Case
Patient has presented with HIV, which
he wishes to have treated
confidentially. His wife is also your
patient. What do you do?

Principles
1. Beneficence
A physician should act in the best interest of
the patient
2. Non Malficience
Do no harm
3. Respect for Autonomy
A patient has the right to refuse or accept
treatment
4. Justice
Treat patients with fairness and equality
5. Respect for persons
6. Honesty and truthfulness

 Two patients are admitted to the ICU with

respiratory failure, both patients need
ventilators and only one is available. Patient
A is a poor elderly woman with low chance of
survival but the family wishes her to be
ventilated. Patient B, who arrives 5 minutes
later, is a VVIP with substantially better
prognosis.
1.Which ethical dilemma is presented here?
2.What do you do?

Basics of Medical Practice

Case
A 43 year old man is admitted to the
ER with acute abdominal pain in the
right lower abdomen.
How do you manage this patient?

Management of non
emergency medical cases
Every patient presenting with non
emergency complaint is managed in
this order
Patient History
Physical Examination
Supporting Examination (Radiology,
Lab etc.)
Treatment

Patient History (Anamnesis)

A practitioner asks questions in sequential order to obtain the following information about
the patient:
Identification and demographics: name, age, height, weight.
The "chief complaint (CC)" - the major health problem or concern, and its time course (e.g. chest pain
for past 4 hours).
History of the present illness (HPI) - details about the complaints, enumerated in the CC.
Past medical history (PMH) (including major illnesses, any previous surgery/operations (sometimes
distinguished as "Past Surgical History" or PSH), any current ongoing illness, e.g. diabetes).
Review of systems (ROS) Systematic questioning about different organ systems
Family diseases - especially those relevant to the patient's chief complaint.
Childhood diseases Important in pediatrics.
Social history (medicine) - including living arrangements, occupation, marital status, number of children,
life style (including tobacco, alcohol, other recreational drug use), recent foreign travel, and exposure to
environmental pathogens through recreational activities or pets.
Regular and acute medications (including those prescribed by doctors, and others obtained over-thecounter or alternative medicine)
Allergies - to medications, food, latex, and other environmental factors
Sexual history, obstetric/gynecological history, and so on, as appropriate.
Conclusion & closure
Questions can be asked to the patient (alloanamnesis) or anyone with sufficient knowledge on patient
condition (heteroanamnesis)

Onset when?
Location where?
Duration how long?
Characteristics description of symptoms (e.g pain
can be dull, sharp, stabbing, radiating etc)

Aggravating conditions that worsen symptoms

Relieving conditions that relieve symptoms
Treatment any prior treatment to alleviate symptom
After anamnesis a differential diagnosis
is made

Physical Examination
Examination that checks/verifies chief
complaint and other constitutional
symptoms to exclude or include
differential diagnosis Consists of:
Vital Sign Examination
Local examination
General head to toe examination
General check up examination

Physical Examination
Vital Sign Examination
Blood pressure
Heart rate
Respiratory rate
Body temperature
Local Examination
Inspection = Looking
Palpation = Feeling
Percussion = Percussing
Auscultation = Listening
General Head to Toe Examination
Head, neck, thorax, heart, lungs, abdomen, and extremities
After physical examination a working diagnosis is made

Supporting Examination
Examination that verify working diagnosis
and further exclude any other differential
diagnosis. Must be with indication
Supporting examination modalities are:
Laboratory Routine blood test,
Urinalysis, Blood sugar test
Radiology Xray, CT-Scan, USG, MRI etc
Pathological Anatomy FNAB, Biopsy

Treatment
After a final diagnosis is achieved, treatment
(pharmacological or non-pharmacological) is
given to either alleviate symptoms and/or treat
illness
Symptomatic treatment given to alleviate
symptoms and improve quality of life (e.g pain,
fever, swelling etc)
Definitive treatment Treats illness causing
patient sign and symptoms (e.g antibiotics for
bacterial infection, surgery for appendicitis etc.)
Treatment must be with indication and should
be effective and efficient, and pertain to medical
ethics

Case
A 20 year old male, through physical
examination is diagnosed with acute upper
respiratory tract infection. The primary
care center doctor prescribes
Dexamethasone for fever and sore throat,
vitamin C, Complex B vitamins, Amoxicillin
(antibiotic), glyceryl guaiacolate for cough,
acetylcysteine (expectorant).
Was the patient managed well? If yes why
and if no what should have been done?

MEDICAL EMERGENCIES

Understanding Medical
Emergencies
Any situation in which a person
becomes ill or sustains an injury
requiring immediate care
Prompt action may prevent disability
or death
Can occur within or outside the
health-care setting

Understanding Medical
Emergencies
Quick response using
first aid is vital
First aid can

Save a life
Reduce pain
Prevent further injury
Reduce risk of
permanent disability
Increase the chance
of early recovery

Patient education
First aid
Proper way to
respond in an
emergency

Preparing for Emergencies:

Guidelines

A medical emergency requires certain steps

Medical assistant provides only first aid

Six steps to initial assessment

1. General impression
2. Level of responsiveness
3. Assess ABCs
4.
Urgency of condition
5.
Focused exam, vital sign
6.
Document

Accidental Injuries:
Animal bites

Bites and Stings

Bruise, tear, or
puncture
Cleanse wound,
apply ointment, and
dry, sterile dressing

Insect stings
Remove stinger, if
present
Wash area, apply ice

Snake bites
Poisonous bite will need
antivenin
Immobilize and position
below heart

Spider bites
Refer patient to
physician
Wash area, apply ice,
and keep below heart
level

Accidental Injuries:
Thermal
Hot liquids, steam,
flame, etc.
Water, wet cloth, or
blanket

Burns

Chemical
Remove chemical
Wash with cool water
for 15 minutes
Cover with dry,
sterile dressing

Electrical
Entry and exit sites
Tissue damage along
currents pathway

Accidental Injuries:

Open

Wounds
Skin or mucous membrane is damaged
Incisions and lacerations Amputations
Control bleeding
Clean and dress
wound

Abrasion

Elevate extremity
Transport body
part with patient

Punctures

Wash with soap and water

Clean, dress
Remove debris, dressing
Tetanus toxoid
if needed
immunization

Accidental Injuries:
Wounds
Injury occurring inside
the body without
breaking the skin
Caused by blunt trauma
Contusions bruises
Cold compresses
Color changes are normal

Closed

Apply Your Knowledge

Yeah
!

1. What is the universal sign of

choking?
ANSWER:
The patient holds his hand to his throat and
looks afraid.
2. A patient arrives at the clinic with severe

hemorrhaging from the left thigh. What steps should

you take to control the bleeding?
ANSWER: The steps are:
1. Apply direct pressure with sterile gauze
2. Add additional dressing as necessary
3. Elevate the leg
4. Apply pressure to the left femoral artery

Common Illnesses
Abdominal pain a
variety of causes
Asthma spasmodic
narrowing of bronchi
Dehydration lack
of adequate water
in the body

Diarrhea can result

in dehydration and
electrolyte
imbalance

Common Illnesses
Fainting syncope:
partial or complete
loss of
consciousness
Fever usually
indicates infection
Hyperventilation
breathing too rapidly
and too deeply

(cont.)

Nosebleed epistaxis
Tachycardia heart
rate greater than 100
bpm
Vomiting can result
in dehydration and
electrolyte imbalance

Thank you. any

questions?