Connecting the Dots to Improving Patient Care

Proper Care is Contingent upon Correct Diagnoses and Treatment Plans

Jan 17, 2010
Linda Mundorff

Patient-Doctor Relationship - Linda Mundorff

The physical exam, complete patient history, and patient compliancy are factors to a successful diagnosis and treatment plan.

Pinpointing the exact cause of an illness can be challenging. The doctor bases his initial diagnosis on a combination of physical findings and subjective reporting from the patient. Therefore, the first step in developing a care plan is to understand the physiological pathway of an illness. To demonstrate this, one need only look at a simple description of the formation of a urinary tract infection (UTI).

The infectious agent, a bacteria, travels along the urethral lining, against the flow of urine.
Once inside the bladder it takes residency by clinging to the wall.
The bacteria multiples, and lives quite comfortably, in this once sterile environment.
Individual may feel one or more symptoms, like frequent urination, burning sensation, and pain.
Visit to the doctor brings a diagnosis of a UTI.
Antibiotics are prescribed to kill the bacteria.
If taken correctly, the disease is cured; if patient is not compliant and fails to take the medication as directed; only a few bacteria will be killed.
The rest will multiply and the disease reoccurs later.

Acute Illness

An acute illness is a condition with an abrupt onset and short duration. Two common examples of acute illness are the common cold and flu. However, an acute illness can also be life threatening, as found in acute renal failure, which is the sudden cessation of kidney function. It has a number of different causes, and if medical intervention is immediate and swift, it can often be reversed. However, if damage is severe, it can transition into a chronic condition.

Chronic Illness

According to the U.S. National Center for Health Statistics, an illness that last more than three months is classified as a chronic illness. This definition can be confusing as the course of illness need not last three months; it merely must be persistent and reoccurring. For example, smokers are susceptible to respiratory problems, such as bronchitis, and once the condition develops the frequency and risk of reoccurring illness increases exponentially. The smoking irritates the bronchial tubes, providing an avenue for bacteria to infiltrate the airway. Antibiotics are prescribed to destroy the bacteria, since the trigger is the irritants found in cigarettes, the cure is to stop smoking, and not to continually treat the results of the condition.

Treating the Symptoms

A thorough physical exam and patient history is a key factor in determining an accurate diagnosis. If the doctor asks the right questions and the patient responds with full disclosure, an immediate cause and resolution is possible. For example, a patient reports painful burning in the center of his chest immediately after completing lunch. The initial symptoms began a month into a new job, as a supervisor of three in the billing department of a small clinic. If the discussion stopped there, the doctor would miss crucial additional information that the patient rarely takes a break and has a “working lunch,” at his desk. Because of this additional piece of information, an initial diagnosis of stress-related heartburn could be made. The patient could be instructed to take his 45 minute lunch away from the office; eliminate any spicy foods from his diet for six weeks; and to practice deep breathing and relaxation exercises (which he demonstrates) three times a day. Contact the doctor if the condition does not show marked improvement in seven to ten days.

Full Disclosure and Patient Compliancy

The basis of the above scenario is to demonstrate the importance of both a proper patient history and patient compliancy with the treatment. Traditionally, heartburn is treated with over-the-counter medication. In this case, the medication would help with the symptoms, but not cure the underlying cause of the hyper-excretion of stomach acid. The condition started from stress and eating lunch too quickly. Therefore, providing medication is only masking the problem, the cause must be corrected, and then the problem should resolve itself. If not, the condition could possibly worsen and progress into ulcerations of the stomach lining.

In conclusion, understanding the psychological pathway of an illness is an important first step towards a successful treatment plan. Remember cures are a two-prong approach of disclosing a full patient history to uncover the root cause, and then a treatment plan developed by both the doctor and patient to ensure complete patient compliancy.