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Parker Garcia
Parker Garcia

Problem Oriented Medical Diagnosis: Principles, Techniques, and Cases



Problem Oriented Medical Diagnosis Pdf Chm advent sinnesorgane




Are you looking for a way to improve your clinical reasoning and decision making skills? Do you want to learn how to diagnose and manage patients with a variety of medical problems? If so, you might be interested in problem oriented medical diagnosis (POMD), a method that helps you organize and analyze clinical data in a systematic and logical way.




Problem Oriented Medical Diagnosis Pdf Chm advent sinnesorgane



In this article, we will explain what POMD is, how it works, and why it is useful for medical practitioners. We will also show you some examples of how to use POMD for different types of clinical problems, and how to access some of the best books on POMD online or offline. By the end of this article, you will have a better understanding of POMD and how it can help you improve your clinical practice.


Introduction




What is problem oriented medical diagnosis (POMD)?




POMD is a method of clinical reasoning that was developed by Dr. Lawrence Weed in the 1960s. It is based on the idea that every patient encounter should be structured around a list of problems that need to be solved. Each problem is defined by a specific set of data, such as signs, symptoms, history, physical examination, laboratory tests, imaging studies, etc. The data are then analyzed using a process of hypothesis generation and testing, leading to a differential diagnosis and a plan of action.


POMD is not only a way of diagnosing patients, but also a way of documenting and communicating clinical information. By using a standardized format and terminology, POMD allows clinicians to record and share their findings and reasoning in a clear and concise way. This facilitates collaboration and continuity of care among different health care providers.


What are the benefits of using POMD?




Using POMD has several advantages for both clinicians and patients. Some of these benefits are:


  • POMD helps clinicians develop a comprehensive and holistic view of the patient's condition, taking into account all relevant aspects of their health and well-being.



  • POMD helps clinicians avoid cognitive biases and errors that can affect their judgment and decision making. By following a rigorous and structured approach, POMD reduces the risk of missing important data or jumping to premature conclusions.



  • POMD helps clinicians prioritize and focus on the most important or urgent problems that need to be addressed. By ranking the problems according to their severity or impact on the patient's health, POMD helps clinicians allocate their time and resources more efficiently.



  • POMD helps clinicians monitor and evaluate the progress and outcome of their interventions. By comparing the initial data with the follow-up data, POMD helps clinicians assess whether their actions have been effective or not, and whether they need to modify their plan accordingly.



  • POMD helps patients understand their condition and participate in their own care. By explaining the problems and their causes, POMD helps patients gain insight into their health status and their role in managing it. By involving patients in the decision making process, POMD helps patients feel more empowered and satisfied with their care.



What are the challenges of using POMD?




Despite its benefits, POMD also has some limitations and challenges that need to be considered. Some of these challenges are:


  • POMD requires a high level of clinical knowledge and skills. To apply POMD effectively, clinicians need to have a solid foundation of medical knowledge and experience, as well as the ability to critically appraise and synthesize clinical data. POMD also requires a good command of medical terminology and communication skills.



  • POMD can be time-consuming and complex. Depending on the number and nature of the problems, POMD can involve a large amount of data collection and analysis, which can take a lot of time and effort. POMD can also be challenging when dealing with multiple or interrelated problems, or when the data are incomplete or conflicting.



  • POMD can be influenced by external factors. Although POMD aims to be objective and rational, it can still be affected by factors such as availability of resources, patient preferences, ethical issues, legal implications, etc. These factors can sometimes limit or modify the choices and actions of the clinicians.



POMD Methodology




How to apply POMD in clinical practice?




POMD can be applied in any clinical setting or specialty, as long as the clinician has access to the necessary data and tools. The basic steps of POMD are:


  • Identify the problems. The first step is to identify the problems that need to be solved. These can be derived from the chief complaint, the history, the physical examination, or any other source of information. The problems should be stated in clear and specific terms, such as "chest pain", "fever", "anemia", etc.



  • Define the data. The second step is to define the data that are relevant to each problem. These can include signs, symptoms, laboratory tests, imaging studies, etc. The data should be organized in a logical and consistent way, such as by system, by organ, by time, etc.



  • Analyze the data. The third step is to analyze the data for each problem. This involves generating and testing hypotheses about the possible causes or explanations of the problem. The hypotheses should be based on medical knowledge and evidence, and should be ranked according to their likelihood or probability.



  • Make a diagnosis. The fourth step is to make a diagnosis for each problem. This involves selecting the most likely or best hypothesis from the list, based on the available data and criteria. The diagnosis should be stated in precise and accurate terms, such as "acute myocardial infarction", "viral meningitis", "iron deficiency anemia", etc.



  • Plan an action. The fifth step is to plan an action for each problem. This involves deciding what to do next to solve or manage the problem. The action can include further investigations, treatments, referrals, follow-ups, etc. The action should be based on the best available evidence and guidelines, and should take into account the patient's preferences and values.



  • Evaluate the outcome. The sixth step is to evaluate the outcome of each action. This involves comparing the initial data with the follow-up data, and assessing whether the action has been successful or not. The outcome should be measured by objective and subjective indicators, such as laboratory results, symptoms relief, quality of life, etc.



What are the tools and resources for POMD?




To apply POMD effectively, clinicians need to have access to various tools and resources that can help them collect, organize, analyze, and communicate clinical data. Some of these tools and resources are:


  • Clinical forms and templates. These are standardized documents that help clinicians record and structure their findings and reasoning in a consistent way. They can include problem lists, SOAP notes (subjective-objective-assessment-plan), progress notes, discharge summaries, etc.



  • Clinical databases and software. These are electronic systems that help clinicians store and retrieve clinical data in a convenient way. They can include electronic health records (EHR), decision support systems (DSS), clinical calculators, etc.



  • Clinical guidelines and protocols. These are evidence-based recommendations that help clinicians make informed decisions about diagnosis and management of specific conditions or situations. They can include clinical practice guidelines (CPG), algorithms, flowcharts, checklists, etc.



POMD Examples




How to use POMD for common clinical problems?




To illustrate how to use POMD for common clinical problems, let us consider a simple example of a patient presenting with chest pain. Here is how we can apply the steps of POMD:


  • Identify the problem. The problem is chest pain.



Define the data. The data are the following:


  • Subjective data: The patient is a 55-year-old male smoker who complains of sudden onset of severe retrosternal chest pain radiating to the left arm and jaw, associated with dyspnea, diaphoresis, and nausea. The pain started 30 minutes ago while he was mowing the lawn and did not improve with rest or nitroglycerin.



  • Objective data: The patient has a blood pressure of 180/110 mmHg, a pulse of 120 beats per minute, a respiratory rate of 24 breaths per minute, and an oxygen saturation of 92% on room air. His physical examination is remarkable for cold and clammy skin, crackles at the lung bases, and an S4 gallop. His electrocardiogram shows ST segment elevation in leads V1-V6 and aVL.




  • Analyze the data. The data suggest that the patient has an acute coronary syndrome (ACS), most likely a ST segment elevation myocardial infarction (STEMI). The differential diagnosis includes other causes of chest pain such as pulmonary embolism, aortic dissection, pericarditis, esophageal spasm, etc. However, these are less likely given the patient's risk factors, history, and findings.



  • Make a diagnosis. The diagnosis is STEMI.



  • Plan an action. The action is to initiate immediate revascularization therapy with either percutaneous coronary intervention (PCI) or fibrinolytic therapy, depending on the availability and timing of these modalities. In addition, the patient should receive aspirin, clopidogrel, heparin, beta-blockers, nitrates, morphine, oxygen, and statins as part of the standard medical therapy for STEMI.



  • Evaluate the outcome. The outcome is to monitor the patient's vital signs, cardiac enzymes, electrocardiogram, and symptoms for any signs of improvement or complications such as arrhythmias, heart failure, cardiogenic shock, or bleeding.



How to use POMD for complex or rare clinical problems?




For complex or rare clinical problems, POMD can be more challenging and require more data collection and analysis. However, the same steps can be applied with some modifications. For example:


  • The problem list may include more than one problem that are interrelated or independent.



  • The data may include more sources of information such as consultations, referrals, literature reviews, etc.



  • The analysis may involve more hypotheses that are more difficult to test or exclude.



  • The diagnosis may be uncertain or provisional until more evidence is obtained.



  • The action may include more options that are more controversial or experimental.



  • The outcome may be more variable or unpredictable.



To illustrate how to use POMD for complex or rare clinical problems, let us consider an example of a patient presenting with fever of unknown origin (FUO). Here is how we can apply the steps of POMD:


  • Identify the problem. The problem is FUO.



Define the data. The data are the following:


  • Subjective data: The patient is a 35-year-old female who complains of intermittent fever up to 39C for more than three weeks without any localizing signs or symptoms. She denies any recent travel history, animal exposure, drug use, sexual activity, or immunosuppression.



How to use POMD for interdisciplinary or multisystem problems?




For interdisciplinary or multisystem problems, POMD can be more useful and effective when it involves collaboration and consultation among different specialists and disciplines. For example:


  • The problem list may include problems that span across different organ systems or domains of health.



  • The data may include more sources of information such as multidisciplinary assessments, psychosocial evaluations, functional tests, etc.



  • The analysis may involve more hypotheses that are more integrative or holistic.



  • The diagnosis may be multifactorial or syndromic.



  • The action may include more options that are more comprehensive or multidimensional.



  • The outcome may be more diverse or multidetermined.



To illustrate how to use POMD for interdisciplinary or multisystem problems, let us consider an example of a patient presenting with chronic pain. Here is how we can apply the steps of POMD:


  • Identify the problem. The problem is chronic pain.



Define the data. The data are the following:


  • Subjective data: The patient is a 45-year-old female who complains of persistent pain in her lower back, neck, shoulders, and knees for more than six months. She rates her pain as 8/10 on average and says it interferes with her daily activities, sleep, mood, and relationships. She has tried various analgesics, anti-inflammatories, muscle relaxants, and opioids without much relief. She also suffers from depression, anxiety, insomnia, and irritable bowel syndrome.



  • Objective data: The patient has a normal blood pressure, pulse, respiratory rate, and temperature. Her physical examination is remarkable for tenderness in multiple trigger points and reduced range of motion in her spine and joints. Her blood tests are normal except for a mild anemia. Her imaging studies show mild degenerative changes in her spine and osteoarthritis in her knees. Her psychological assessment shows signs of chronic stress, low self-esteem, catastrophizing, and poor coping skills.




  • Analyze the data. The data suggest that the patient has a complex chronic pain syndrome that involves biological, psychological, and social factors. The differential diagnosis includes other causes of chronic pain such as fibromyalgia, rheumatoid arthritis, neuropathic pain, somatization disorder, etc. However, these are less likely given the patient's history and findings.



  • Make a diagnosis. The diagnosis is chronic pain syndrome.



POMD Books




What are some of the best books on POMD?




There are many books on POMD that can help clinicians learn and apply this method in their practice. Some of the best books on POMD are:


  • Problem-Oriented Medical Diagnosis by Henry Harold Friedman. This is a classic book that provides a concise and practical guide to POMD, with case examples and algorithms for common and uncommon problems.



  • Problem Solving in Clinical Medicine: From Data to Diagnosis by Paul Cutler. This is a comprehensive book that covers the principles and techniques of POMD, with an emphasis on clinical reasoning and evidence-based medicine.



  • Clinical Problem Solving in Dentistry by Edward W Odell. This is a specific book that applies POMD to dental practice, with case scenarios and solutions for various oral and dental problems.



How to access POMD books online or offline?




POMD books can be accessed online or offline in various ways. Some of the ways to access POMD books are:


  • Online libraries and databases. These are electronic platforms that provide access to a large collection of books and journals on various topics, including POMD. Some examples are PubMed, Cochrane Library, Google Books, etc.



  • E-books and audiobooks. These are digital versions of books that can be downloaded or streamed on various devices, such as computers, tablets, smartphones, etc. Some examples are Kindle, Audible, Apple Books, etc.



  • Printed books and hard copies. These are physical copies of books that can be purchased or borrowed from various sources, such as bookstores, libraries, colleagues, etc.



Conclusion




POMD is a method of clinical reasoning that helps clinicians diagnose and manage patients with various problems. It involves identifying the problems, defining the data, analyzing the data, making a diagnosis, planning an action, and evaluating the outcome. POMD can be applied to any clinical setting or specialty, as long as the clinician has access to the necessary data and tools. POMD has many benefits for both clinicians and patients, such as improving clinical judgment, decision making, communication, collaboration, continuity of care, patient satisfaction, and health outcomes. However, POMD also has some limitations and challenges that need to be considered, such as requiring a high level of clinical knowledge and skills, being time-consuming and complex, and being influenced by external factors.


If you want to learn more about POMD and how to use it in your practice, we recommend you to read some of the best books on POMD that we have listed above. You can access these books online or offline in various ways that suit your preferences and needs. We hope this article has given you a better understanding of POMD and how it can help you improve your clinical practice.


Frequently Asked Questions




Here are some frequently asked questions about POMD:


  • Who invented POMD?POMD was invented by Dr. Lawrence Weed in the 1960s. He was a professor of medicine at the University of Vermont who pioneered the concept of problem-oriented medical records (POMR) and computerized medical records (CMR).



defining the data, analyzing the data, making a diagnosis, planning an action, and evaluating the outcome. SOAP is a format of documenting clinical information that involves recording the subjective data, objective data, assessment, and plan for each problem.


  • What are some of the common causes of FUO?Some of the common causes of FUO are infections, malignancies, autoimmune diseases, and miscellaneous conditions. However, in some cases, no cause can be found despite extensive investigations.



  • What are some of the nonpharmacological interventions for chronic pain?Some of the nonpharmacological interventions for chronic pain are physical therapy, massage therapy, acupuncture, biofeedback, cognitive-behavioral therapy, relaxation techniques, hypnosis, meditation, yoga, tai chi, etc.



  • How to cite POMD books in APA style?To cite POMD books in APA style, use the following format: Author's last name, initial(s). (Year). Title of book. Publisher. For example: Friedman, H. H. (2000). Problem-oriented medical diagnosis. Lippincott Williams & Wilkins.



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