全科医学：主观题.docxVIP

全科主观题 1. What are the patient’s experience of illness? Patients become very much aware of the body and the limitations it imposes. They have to think of activities that were before carried out below the level of awareness. Chronic disease especially if it rings successive losses of independence and control, often engenders profound sensations of grief. With grief are associated the feelings of sadness and anger, guilt and remorse. If the illness carries stigma like epilepsy, cancer or AIDS, then the feelings of rejection may be added to grief. When the patient feels responsible for his own disease, the anger turned inwards. Fear and anger are ever present in illness, even in minor illness. Fears are many and varied, rational and irrational. Illness may impair the faculty of reason. Patient may become irrational and even superstitious. The threats to self that brings disruption, loss of autonomy, loss of control and loss of confidence , makes the sick person vulnerable. The natural rhythms of the body like eating. sleeping, working, resting are disturbed. Several disabilities lead to decrease in space and increase in time. In mental illness, the threat to self is terrifying. The experience of dementia, depression, schizophrenia, or anxiety may produce the most intense suffering. However, people do triumph over their disabilities. The body has remarkable powers of compensation and adaptation. The situation is different for those who are born with a disability. In these, the disabled body is the lived body, from the very beginning. So the body with disease , rather than being alien , becomes self. The experience of illness also varies with the course the illness takes, a sudden or gradual onset, a one-time disability like stroke or injury, which then remains static, a progressively downhill course, or a process of remission and relapse. 2. Pew Health Professions Commission (PHFC) Created by The Pew Charitable Trusts in 1989, the Pew Health Professions Commission has