Dimensions to whole person management

In the diagnostic model presented in Chapter 15 the fifth and final question is: 'Is the patient trying to tell me something else?' and this self-posed question should be scrutinised and answered in most instances. This presupposes being tuned in to the patient, watching for cues and listening. An efficient medical record system also helps the process, since following a set routine generally ensures that important facets of the patient's psychosocial history are not omitted. The answer to the above question takes into account the patient's:

• fears or concerns

• expectations of the doctor

• future aspirations

Such an approach may determine whether there is a 'hidden agenda' in the presentation and whether various stressors including interpersonal conflicts are significant factors in the illness. Table 11.1 Whole person diagnosis and management


Disease-centred diagnosis aetiology of disease

Disease-centred management

• intervention

• other invasive techniques

Patient-centred diagnosis

• significance of illness to patient

• effect on family and relationships

• effect on work and income

• psychological effects

— stress and anxiety

— abnormal illness/behaviour

— depression

• effect on sexuality

• effect on attitudes and spirituality

Patient-centred management

• psychological support

• appropriate reassurance

• patient education

• empowering self-responsibility

• anticipatory guidance/special hazards

• prevention

• health promotion

• lifestyle recommendations/ modifications

— diet/nutrition

— stress management

• family and social supports

• self-help groups

• alternative options

• consultation and referral

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