DEVELOPMENT OF FAMILY MEDICINE
 General Practitioner (GP)
Learning Objectives
At the end of the session, the student will:
1. Define key terms.
2. Discuss the development of FM
3. Describe the characteristics of family practice.
4. Differentiate the scope and categories of family medicine,
community medicine and public health activities.
JOURNEY TO THE FIELD OF MEDICINE
 Being a doctor entails a lot of sacrifice. We invest not only
money but time and effort.
 Medical education is a lifelong process.
 Everyone who goes into medicine should be ready for that
lifelong commitment
 This kind of education should be outcome based, taking
into consideration the competencies expected of the
students.
 It should also be transformative where relevance to the
needs of the community is at the forefront, and realistic,
where compliance with the requirements of medical
practice matters.
 Three cornerstones of a successful career in medicine:
o A love for learning in general
o A true intellectual curiosity about medicine.
o A strong desire to help others.
 Earn prestige and distinction
 Good predictors of success:
o Conscientiousness
o Self-discipline
o Competence
 Important interpersonal traits:
o Honesty
o Dependability
o Empathy
o Love
 Needs emotional resources to cope with the general
pressures of the study of Medicine.
o Family
o Partner
o Friends
o Counselor
 Spending more time on social relationships during the first
years of medical school could hinder good academic
performance and results to lower grades.
CAREER IN MEDICINE
 It is an investment.
 Continuing professional development – lifetime
 General Practitioner (GP)
o Specialty training – 3 to 5 years
o Medical board exam – 1 year
o Postgraduate internship – 1 year
o Doctor of Medicine – 4 years
o Bachelor's degree – 4years
o Passed the physician licensure examination
o Treats individuals and family members of all age
groups.
o Deals with different members of the household.
o Has skills attributed to surgeons, OBs, pedias,
and internists.
o Provides care that is personal, continuous, and
comprehensive.
 Anesthesiology  Ophthalmology
 Child Health  Pathology
 Community and Family Medicine  Radiology
 Head and Neck Surgery  Rehabilitation Medicine
 Internal Medicine  Surgery
 Obstetrics and Gynecology
 Clinical Specialists
o physicians who chose to limit their practices to
specific, defined areas of medicine 
o Focused on different organ system or diseases 
o Fragmented or depersonalized care
o Specialist's Focus of Care
 Curative medicine was given more
emphasis over preventive medicine.
 The fragmentation of their care and the shortage of
personal physicians who could provide initial, continuing
and comprehensive care.
 FMs are not GPs.
o Coincidental concern with family.
o Not versed in family systems.
o Has little recognition of the family as a
medicosocial unit in which health and disease
concepts could be better understood and
executed.
FAMILY MEDICINE
 The patient-physician relationship with the patient viewed
in the context of the family.
 It is the extent to which this relationship is valued,
developed, nurtured and maintained that distinguishes
family medicine from all other specialties.
 Definition: A discipline of medicine with distinct core
knowledge and characteristics of care, which refers to
individuals, family and community, and functions within
economic, cultural and social environments and resources.
(Wonca, 1979)
 Academic discipline
 Encompasses a distinct body of knowledge appropriate to
the needs of changing society.
 Roots from general practice
 Centered on the family as the basic social unit.
 Health and disease oriented
 Emphasizes the importance of:
1. disease prevention
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 2. health maintenance communicator teacher educator/ teacher
3. curative medicine community
social mobilizer social mobilizer
leader

CHARACTERISTICS OF FAMILY MEDICINE

1. Primary
o First contact care, at the forefront
o OPD, ER, Health Center, Multi-specialty clinic,
Home care
o Has a unique consultation process, which
establishes a relationship over time, through
effective communication between doctor and
patient.
o The value of this personal relationship is
determined by the communication skills of the
family doctor and is in itself therapeutic.
2. Continuing
o is responsible for the provision of longitudinal
continuity of care as determined by the needs
of the patient.
o makes efficient use of health care resources
through coordinating care, working with other
professionals in the primary care setting, and by
managing the interface with other specialties
taking an advocacy role for the patient when
needed.
3. Comprehensive
o develops a person-centered approach, orientated
to the individual, his/her family, and their
community.
o understand how the patient copes with and views
their illness as dealing with the disease process
itself.
o The common denominator is the person with
their beliefs, fears, expectations and needs.
o Illness behavior and patterns of disease are
varied by many of these issues and much
unhappiness is caused by interventions which do
not address the root cause of the problem for the
patient.
4. Preventive
o promotes health and well-being both by
appropriate and effective intervention.
o Interventions must be appropriate, effective and
based on sound evidence whenever possible.
o Intervention when none is required may cause
harm and wastes valuable health care resources.
5. Curative
o manages illness at an early stage in its
development, which may require urgent
intervention.
o manages simultaneously both acute and chronic
health problems of individual patients.
6. Rehabilitative
o assist patient to go back to society.  the physical and social environment and by appreciating
THE FIVE STAR PHYSICIAN
WHO, 1994 DOH-APMC, 2000 CHED, 2006
care provider care provider care provider
decision researcher/
researcher
maker information manager
manager manager manager/ leader
CARE PROVIDER
 Curative Role
 apply evidence based, patient centered, family focused,
community-oriented care
 Apply validated complementary alternative healthcare
practice
 Apply the biopsychosocial approach: Besides giving
individual treatment must take into account the total
(physical, mental and social) needs of the patient.
 They must ensure that a full range of treatment - curative,
preventive, early diagnosis and treatment, disability
limitation, rehabilitative and palliative - will be dispensed
in ways that are complementary, integrated and
continuous.
 And they must ensure that the treatment is of the highest
quality.
 Practice self-directed learning
DECISION-MAKER
 In a climate of transparency “five-star doctors” will have
to take decisions that can be justified in terms of efficacy
and cost.
 From all the possible ways of treating a given health
condition, the one that seems most appropriate in the
given situation must be chosen.
 As regards expenditure, the limited resources available for
health must be shared out fairly to the benefit of every
individual in the community.
COMMUNICATOR
 Health Educator
 Lifestyle aspects such as a balanced diet, safety measures
at work, type of leisure pursuits, respect for the
environment and so on all have a determining influence on
health.
 The involvement of the individual in protecting and
restoring his or her own health is therefore vital, since
exposure to a health risk is largely determined by one’s
behavior.
 The doctors of tomorrow must be excellent
communicators in order to persuade individuals, families
and the communities in their charge to adopt healthy
lifestyles and become partners in the health effort.
COMMUNITY LEADER
 Social Mobilizer
 The needs and problems of the whole community in a
suburb or a district - must not be forgotten.
 By understanding the determinants of health inherent in
the breadth of each problem or health risk “five-star
doctors” will not simply be treating individuals who seek
help but will also take a positive interest in community
health activities which will benefit large numbers of
people.
MANAGER

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1. To carry out all these functions, it will be essential for
“five-star doctors” to acquire managerial skills. THE PROGRAM OUTCOMES
2. This will enable them to initiate exchanges of information 1. Demonstrate clinical competence
in order to make better decisions, and to work within a 2. Communicate effectively
multidisciplinary team in close association with other 3. Lead and manage healthcare teams
partners for health and social development. 4. Produce relevant research in family medicine
3. Both old and new methods of dispensing care will have to 5. Collaborate with interprofessional team
be integrated with the totality of health and social 6. Engage in continuing personal and professional
services, whether destined for the individual or for the development
community 7. Adhere to ethical, professional and legal standards
8. Practice nationalism and global cooperation
THE RESIDENCY TRAINING PROGRAM IN FAMILY AND 9. Practice the principles of social accountability
COMMUNITY MEDICINE
THE CORE COMPETENCIES PHILIPPINE ACADEMY OF FAMILY PHYSICIANS
1. Clinical  Dedicated to providing holistic, accessible, continuous,
2. Family Concepts and Principles, Communication and comprehensive, coordinated, compassionate and culturally
Relational Skills effective health care.
3. Community Health Care  Patient centered, family focused, community-oriented
4. Evidence-Based Medicine approach to health care.
5. Ethics and Professionalism
CAREERS IN CFM
THE FOUNDATION COURSES  Family Practice
1. Family medicine principles and family practice  Community Medicine
2. Primary and secondary care  Public Health
3. Acute care  Academe
4. Preventive care and wellness
5. Communication and relational skills FAMILY PRACTICE
6. Community oriented primary care  The family physician functions as the patient's means of
7. Evidence based medicine entry into the health care system and as the physician of
8. Quality assurance first contact in most situations is in a unique position to
9. Research form a bond with the patient.
10. Information Technology  An FM knows the limits.
11. Medical ethics and professionalism  When referral is indicated, an FM refers the patient to
12. Health legislations, issues and advocacies other specialists or caregivers but remains the coordinator
13. Practice management and health administration of the patient’s health care.
14. Occupational safety and health  This prevents fragmentation of care.
15. Hospice and palliative medicine  Although all family physicians share a core of information,
the dimensions of knowledge and skill vary with the
THE APPROACH OF HEALTH CARE DELIVERY individual family physician.
 The scope of an individual family physician's practice
changes over time, evolving as competency in current
skills is maintained and new knowledge and skills are
obtained through continuing medical education.
 This growth in medical information also confers on the
family physician a responsibility for the assessment of new
medical technologies and for participation in resolving
ethical dilemmas brought about by these technological
advances.

THE LADDERIZED EDUCATION PROGRAM

THE CONTENTS OF THE PROGRAM
COMMUNITY MEDICINE
 A discipline concerned with the identification and solution
of health care problems of communities or other defined
populations.
 Aims to ensure personal health services that each
individual in the population will have comprehensive care
encompassing the 3 levels of prevention.
 Two basic advantages for family practice:
o It fosters a contextual approach in the care of
individual patients.
o It builds knowledge and skills for those who will
work with communities in future practices.

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 PUBLIC HEALTH
 The science and the art of preventing disease, prolonging
life and promoting health through the organized efforts
and informed choices of society, organizations, public and
private, communities and individuals.
 It is concerned with threats to the overall health of a
community based on population health analysis.
 Public health is typically divided into epidemiology,
biostatistics and health services.
 Environmental, social, behavioral, and occupational health
are other important subfields.

Characteristics of Public Health

 It deals with preventive rather than curative aspects of
health.
 It deals with population-level, rather than individual-level
health issues.
 Focus is on prevention of a disease through surveillance of
cases and the promotion of healthy behaviors.
 In many cases treating a disease may be vital to
preventing it in others, such as during an outbreak of an
infectious disease.
 The goal of public health is to improve lives through the
prevention and prompt treatment of disease.

Scope of Public Health

 Health service system
 Health behavior and motivation
 Environmental Hazards

Activities of Public Health

 Community-based
 Designed to prevent illness, disability or premature death.
 Related to comprehensive health care.
 Concerned with collection and use of vital records.
 Conducts public education and motivation in personal and
community health.
 Involved comprehensive health planning and evaluation.
 Incorporates research-scientific, technical and
administrative.

Reference:
Dr. Oczon’s ppt

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