Transcript Concept & Characteristic of FM

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CONCEPTS and CHARACTERISTICS
OF FAMILY MEDICINE
Prof. Sulaiman Al-Shammari
Professor of Family Medicine
Department Family and Community Medicine
College of Medicine
King Saud University, Riyadh
Introductory course fm ,SFH 5 Oct 2015
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Related terms to family medicine
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General practitioner (GP)
General practice (GP)
Family physician (FP)
Family medicine (FM)
Family doctor
Primary care
Primary care physician
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Case 1
• Sarah a 24year old teacher. She is married
and has two children. She complained of
abdominal pain for about three days.
• What are the differential diagnoses?
• Where should she seek help?
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Differential Dx of abdominal pain
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Food Poisonining
gastritis
menstral period
renal stone
appendicitis
cholicystis
gastric ulcer
IBS
chrone dis
Ischemia
trama
pancrititis
gall stone
Pregnancy
constipation
peptic ulcer
Somatization
Forigne body
Infectuous causes
Tumor
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autoimmune dis
sickle cll crisis
hepatitis
esophagitis
bowel obstruction
ulcerative colitis
hyperparathy roidism
endometrosis
urinary tract infection
cardic angina
abdominal aortic anurism
ectopic preqnancy
Pelvic inflammatory dis
hypocondriasis
panic disorder
intestirel valvulus
musculoskeletal pain
dermtitis
peritonitis
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Definition of Family medicine
Family medicine :Also called family practice .The
medical specialty which provides continuing and
comprehensive health care for the individual and
family .It is the specialty in breadth which
integrates the biological, clinical, and behavioral
sciences .The scope of family practice
encompasses all ages, both sexes, each organ
system, and every disease entity .
(American Academy of Family Physicians)
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Concepts of Family Medicine
DEFINITION:
Family Medicine is a medical specialty of first
contact with the patient, devoted to providing,
preventive, promotive , rehabilitative and curative
health care, with physical, psychological and social
aspects, for the patient, his family and the
community.
The scope is not limited by system, organ, disease
entity, age or sex.
Four Principles of Family Medicine
1. The family physician is a skilled clinician.
2. Family Medicine is a community-based
discipline.
3. The family physician is a resource to a
defined practice population.
4. The patient-physician relationship is central
to the role of the family physician.
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The College of Family Physicians of Canada
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Characteristics of general practice/family
medicine
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General
Continuous
Comprehensive
Coordinated
Collaborative
Family-oriented
Community-oriented
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DRAFT CHARTER FOR GENERAL PRACTICE/FAMILY MEDICINE IN EUROPE , WHO
1998
According to W. Fabb and J. Fry, good
primary health care must include
the following “As” It must be:
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Available
Accessible
Affordable
Acceptable
Adaptable
Applicable
Attainable
Appropriate
Assessable
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Influences lead to FM: Social changes.
 Specialization.
 New pattern of illness demanded a new
type of physician.
 Behavioral sciences gave new insights
into old problem.
 Existing disciplines neglect problems
encountered in fm.
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Many situations facing the
physician are complex
combinations of physical and
behavioral factors and today’s
practitioners are more likely to
help patients to achieve
equilibrium with their
environment.
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Changes in Mortality and Morbidity
 Successful control of infectious
diseases.
 Emergence of a new pattern of disease.
o Chronic diseases.
o Developmental disorders.
o Behavioral disorders.
o Accidents.
o Different infectious diseases.
o Increased proportion of elderly.
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Age of Specialization
 Technology and research lead to
specialties and sub-specialties.
 Specialist prestige and valuation of technical
and research skills over personal care made
PHC.
 This lead to deterioration of Dr/Pt relationship
and malpractice crisis.
 Therefore there is need for new kind of
generalist.
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New Development in the Behavioral Sciences.
Directed attention to:• Process of seeking medical care.
• Aware of physician behavior in decision
making and prescribing.
• Doctor-patient relationship.
• Behavioral aspect of illness.
• Concepts of health, disease and illness.
• Role of physician and ethics.
FP in key position to integrate these into
practice.
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The changing role of the hospital.
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Resurgence of care outside hospital
particularly at neighborhood.
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Balanced of personal continuing care
neighborhood with hospital providing
support.
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Family Medicine as a clinical and
Academic Discipline.
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The Principles of Family
Medicine
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FM body of knowledge (facts,
skills, techniques) about
problems encountered by FP.
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Principles of FM:1. FP committed to person rather than
knowledge, diseases or techniques.
2. Commitment open-ended in terms.
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Health problems.
No defined end point so Dr/Pt
relationship important.
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3. FP seeks to understand illness context
(personal, family, social).
4. Every contact is opportunity for prevention
or education.
5. Committed to single patients and
population whether or not attending HC.
6. Part of community network of supportive
and care agencies.
7. Share same habitat as their patients.
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8. See patients at HC, homes and in hospital.
9. Subjective aspects important. FP values,
attitudes, feelings determine practice.
10. Manager of resources: Admission,
Investigations, Prescription, Referral
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Implications
These principles have implications for
practice:1.
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Continuity of care.
Comprehensiveness of care.
Family care.
Bonding.
Cumulative knowledge of patient.
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The skills of family medicine
1. Solve undifferentiated problems in context
of continuing personal relationship with
individuals, families.
2. Preventive skills.
3. Therapeutic skills.
4. Resource management skills.
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The Role of Generalist
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Have a perspective of the whole
organization.
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They are communication centers.
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Help organization to adapt internal,
external changes.
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Misconceptions about the roles of generalist.
1. Cover whole medical knowledge.
Fact: specialists, generalists select
knowledge needed to fulfill role.
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2. Specialist knows more than generalist.
Fact: FP knowledgeable about commonly
encounter. Specialists knowledgeable about
rare selected by generalists.
3. Specializing eliminate uncertainty. Fact:
only way to eliminate uncertainty needs
generalist, since problems extend beyond
categorical perimeters.
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10 Cs of desirable qualities in a family
physician:
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= Caring/Compassionate
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= Clinically Competent
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= Cost-effective Care
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= Continuity of Care
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= Comprehensive Care
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= Common Problems Management
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= Co-ordination of Care
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= Community-based Care & Research
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= Continuing Professional Development
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= Communication & Counseling
Skills` with confidentiality
1. C = CARING
Caring/Compassionate care
An essential quality in a Family Physician
Personal patient centered Care-
2. C =
CLINICALLY
COMPETENT
Only caring is not enough
Need for four years training after
graduation and internship
3. C = COST- EFFECTIVE
In time and money
Gate keeper- Use of appropriate resources
Use of time as a diagnostic tool
4. C = CONTINUITY
OF CARE
For acute, chronic, from childhood to old
age, and terminal care patients and those
requiring rehabilitation.
Preventive care/ Promotion of health
Care from cradle to grave
5. C = COMPREHENSIVE
CARE
Responsibility for every problem a patient
presents with
Physical, Psychological & Social
Holistic approach with triple diagnosis
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C = COMMON PROBLEMS
MANAGEMENT
e.g. Hypertension, Diabetes, Asthma,
Depression, Anemia, Allergic Rhinitis,
Urinary Tract Infection
Common problems in children and
women
7. C = CONTINUING
PROFESSIONAL DEVELOPMENT
To keep up-to-date
Need for breath of knowledge
8. C = CO-ORDINATION
OF CARE
Patient’s advocate
Organizing multiple sources of help
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C = COMMUNITY BASED
CARE AND RESEARCH
Care nearer patients’ home
Preventive, promotive, rehabilitative and curative
care in patient’s own environment
Relevant research within the patient’s own
surroundings
10. C = COMMUNICATION &
COUNSELING SKILLS
Essential for compliance of advice and treatment/sharing
understanding
Confidentiality and safety netting
Needed for patient satisfaction
Involving patient in the management
Essentials of a Family Medicine
Consultation
• Meet & greet
• All the components of history, including medication,
personal and Psychosocial with patient centered approach
• Summarization
• ICE: Ideas, concerns &expectations and effects on
patient’s day to day life & work
• Examination/Diagnosis ? Differential diagnosis?/ Red flags
• Investigations & Management with patient’s involvement,
safety netting , appropriate F/U & Referral?
Major barriers to equitable health
care - WHO
Unequal access to disease prevention & care
Rising cost of health care
Inefficient health care system
Lack of emphasis on Generalists’ (Family
Medicine) training
How to overcome these barriers ?
The WHO also states, that the best option
to overcome these barriers is to utilize
services of trained Family Physicians
Health outcome indicators
 Barbra Starfield study confirmed that the central role of
Family Medicine in the health care system of a country
results in enhanced quality & cost-effective care .
 She proved in a large multicentre study that the health
outcome indicators are significantly better in those
countries in which Family Medicine plays a central role in
the health care system
Family medicine is well-suited to lead health care
reform in this era.
Superior patient outcomes, at a lower total
cost, with greater patient satisfaction,
over a wider variety of conditions than other
types of medical service.
These values will be appreciated when rationality
returns to health care. Until then, family
physicians must work to keep their professionalism
and pride intact.
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Overall, countries that achieve
better health levels
• Are primary care-oriented
• Have more equitable resource distributions
• Have government-provided health services or
health insurance
• Have little or no private health insurance
• Have no or low co-payments for health
services
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Why Is Primary Care
Important?
Better health outcomes
Lower costs
Greater equity in health
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CONCLUSION
Principles of FM have universal application.
Application however, will vary according to
circumstances?
The principles and competencies required for the
practice of Family Medicine are universal.
They are applicable to all cultures and all social
groups, from richest to the poorest in the community
The Need For Trained Family
Physicians
The central role of a well trained Family Physician in health care is well
recognized in:
Developed countries -- UK, USA and Canada
Gulf countries ??
Developing countries -- ? ? ? ? ?
The need is even greater in all less developed countries.
Questions?
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Thank you
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