Reynaldo O.

Joson, MD
Education for Health Development in
the Philippines

ROJoson
Patient Management Process –
An Overview
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

A patient consults a physician.

The goal of the physician is resolution of the health problem in such
a way that the patient does not end up dead; as much as possible
with no complications and no disability; in such a manner that the
patient is satisfied. These are the universal goals of all physicians.
These are also rightfully the expectations of the patients.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

A patient consults a physician.

What are the four basic categories of functions or tasks expected of a
physician?
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

What are the four basic categories of functions or tasks expected of a physician?
 Rapport
 Diagnosis – Advice
 Treatment – Advice
 Advice
The general quality standards that can be used for these 4 tasks are
rational, effective, efficient and humane.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

After establishing RAPPORT with the patient,

the physician starts accomplishing the task of DIAGNOSIS.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

The physician does interview to get symptom data and does physical
examination to get sign data after which he does the clinical
diagnostic processes to come out with the clinical diagnosis.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

The clinical diagnostic processes consist of pattern recognition and

prevalence.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

Pattern recognition process means realization that the patient’s

presentation conforms to a previously learned picture or pattern of
disease.
Prevalence process means choice of a diagnosis is based on the
frequency of occurrence of the disease in a certain locality, in a
certain age and sex group, and in the affected organ and system.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
CLINICAL DIAGNOSTIC PROCESS - PROCESSING OF DATA –
ILLUSTRATION 1
Knowing the common manifestations of 5 different diseases as
follows:
                                Disease A - abcd (manifestations)
                                Disease B - fghi
                                Disease C - klmn
                                Disease D - pqrs
                                Disease E - uvwx
Given a patient manifesting with pqrs, your diagnosis is Disease
D. 
What is the process used? PATTERN RECOGNITION
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
CLINICAL DIAGNOSTIC PROCESS - PROCESSING OF DATA –
ILLUSTRATION 2
Knowing the common manifestations of 3 different diseases and
relative frequency of each as follows:
               Disease A -  abcd (manifestations)           Least common
               Disease B -  abcd
               Disease C -  abcd                                      Most common
Given a patient manifesting with abcd, your diagnosis is
Disease C. 
What is/are processes used? Pattern Recognition but mainly
PREVALENCE
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

Cleft lip?

Cleft lip and palate?

Diagnosis and process used?

 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

Cleft lip?

Cleft lip and palate?

PROCESS USED in Diagnosis: PATTERN RECOGNITION

 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

Diagnosis and process used?

 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

Dx: HYPERTHYROIDISM

PROCESS USED in Diagnosis: PATTERN RECOGNITION

 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

Patient has cough, cold, fever and tiredness.

What is your most probable diagnosis and process used?
• COVID19 (SARS-COV-2 virus)?
• FLU (influenza virus)?
• Common colds (rhinovirus)?
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

Patient has cough, cold, fever and tiredness.

What is your most probable diagnosis and process used?
• COVID19 (SARS-COV-2 virus) *** during time of pandemic /
epidemic [PREVALENCE PROCESS]
• FLU (influenza virus)
• Common colds (rhinovirus)
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

Patient has cough, cold, fever and tiredness.

What is your most probable diagnosis and process used?
• COVID19 (SARS-COV-2 virus)
• FLU (influenza virus) *** during time of pandemic / epidemic
/outbreak [PREVALENCE PROCESS]
• Common colds (rhinovirus)
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

The outputs of the clinical diagnostic processes are primary clinical

diagnosis (most probable or most likely) and secondary clinical
diagnosis (alternate or second most probable or less likely).
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

After the clinical diagnostic processes and formulation of clinical

diagnosis, the physician gives advice to the patient, meaning he tells
and explains the findings and diagnosis and entertains and answers
questions from the patient.
 Reynaldo O.After
Joson, MD
the formulation of the
clinical diagnosis, the physician
Education for Health Development in
decides whether he needs a
the Philippines
paraclinical diagnostic procedure
or not.
“Paraclinical” here means done
after the clinical diagnosis.

The foremost indication for a

paraclinical diagnostic procedure
can be stated this way:

if you are not certain on the

primary clinical diagnosis and you
need to be certain or be more
certain before treatment, then go
for a paraclinical diagnostic
procedure.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
To decide on indication of the
paraclinical diagnostic procedure,

the physician uses two processes –

degree of certainty on the primary

clinical diagnosis and
comparison of the treatment plans
for the primary and secondary
clinical diagnoses.
 Reynaldo O.PARACLINICAL
Joson, MDDIAGNOSTIC
PROCESS
Education for Health – INDICATIONin
Development -
PROCESSING OF DATA –
the Philippines
ILLUSTRATION 1

Certainty of Primary Clinical

Diagnosis
60% (needed)
-----------------------------------------------
- 99% (not needed)

Treatment Plans for Primary and

Secondary Diagnoses
Different (needed)
------------------------------------------Sa
 
ReynaldoCertainty
O. Joson,Plan
MD of Treatment

Education
Primary clinical for Health
98% Development
Surgical in
diagnosis
the Philippines
Secondary clinical 2% Nonsurgical
diagnosis

PARACLINICAL DIAGNOSTIC
PROCESS – INDICATION -
PROCESSING OF DATA –
ILLUSTRATION 2

Is a paraclinical diagnostic
procedure needed? NO unless
there is a strong reason to do so
(exception to the rule)
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
After analyzing the indication for a
paraclinical diagnostic procedure,
the physician advises the patient
on this by explaining the processes
that he uses and the outcome of
his analysis.

He recommends; waits and

answers queries from the patient;
allows the patient to decide; and
forges a shared agreement.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
If there is a need for a paraclinical
diagnostic procedure, the
physician uses the B-R-C-A
processes.
B – stands for benefit; R – risk; C –
cost; A – Availability.
 ReynaldoRiskO. Joson,
Procedures Benefit
(goal – to
Cost
MD Availability
Education for Health Development in
be more
definite on
the Philippines
the
diagnosis)

Option1        
Option2        
Option3        

The physician gives or lists the

various options of paraclinical
diagnostic procedures and then
gives data on the BRCA.
With the data given, the patient is
asked what he prefers.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

PARACLINICAL DIAGNOSTIC PROCESS – SELECTION - PROCESSING OF

DATA – ILLUSTRATION
Procedures Benefit (goal – to be Risk Cost (PhP) Availability
more definite on the The physician gives or lists the
diagnosis) various options of paraclinical
Option1 accuracy 99% acceptable
diagnostic 4000
proceduresavailable
and then
Option2 accuracy 90% acceptable
gives data 3000 available
on the BRCA.
Option3 accuracy 60% acceptable 1000 available
With the data given, the patient is
Which will be chosen? OPTION 1 if patient can afford. If not, OPTION 2
asked what he prefers.
can be chosen because it has a 90% accuracy which is high enough.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
So, the advice given by the
physician at this point consist of
explaining the processes of
selection (BRCA) to choose the
most cost-effective paraclinical
diagnostic procedure and to the
desire of the patient.

He can recommend. He waits and

answers queries from the patient;
allows the patient to decide; and
forges a shared agreement.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
Assuming that a paraclinical
diagnostic procedure is done.
The physician has to interpret the
results of the paraclinical
diagnostic procedure.
To do this, he uses two processes –
assessment of the accuracy of the
report and correlation with the
clinical findings.
Then, he advises the patient on his
interpretation and proceeds to
discussion of treatment.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
Before the selection of a treatment
procedure,
the physician decides on the
pretreatment diagnosis which is
obtained from repeated assessment
of the accuracy of the clinical
diagnosis and paraclinical diagnosis
and correlation of the two.
He advises the patient on the
pretreatment diagnosis.
He then spells out the objectives or
aims of treatment.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
He then gives or lists the various
options of treatment; uses the B-R-
C-A processes in the selection; and
gives data on the BRCA.
With the data given, the patient is
asked what he prefers.

Treatment Benefit Risk Cost Availability

(goal of
treatment)
Option1        
Option2        
Option3        
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

SELECTION OF TREATMENT PROCESS – PROCESSING OF DATA –

ILLUSTRATION
Procedures Benefit (goal of Risk Cost (PhP) Availability
treatment)
Option1 greatest survival rate acceptable 5000 available
Option2 rate < 1  > 3 acceptable 6000 available
Option3 least survival rate acceptable 3000 available

Which should be chosen? OPTION 1

 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
So, the advice given by the
physician at this point consist of
explaining the processes of
selection (BRCA) to choose the
most cost-effective treatment
procedure and to the desire of the
patient.
He can recommend. He waits and
answers queries from the patient;
allows the patient to decide; and
forges a shared agreement.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
Once a shared agreement is
arrived at, the treatment is
executed.
Just before, during and right after
treatment, the physician advises
patient on preparation, outcome,
things to monitor, etc.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
After treatment, the physician
advises patient on health
restoration and maintenance.
With this step, one whole cycle of
patient management inclusive of
involved processes is completed
by the physician with full
participation from the patient.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines
That in brief,
is an
overview of
the ROJoson
Patient
Management
Process
framework or
algorithm.
 Reynaldo O. Joson, MD
Education for Health Development in
the Philippines

ROJoson
Patient Management Process –
An Overview