Introduction to Family medicine

Lecture Objectives

 To understand the concepts of Family

Medicine, including its definition

 To become familiar with the desirable

qualities of a Family Physician
 Definition and Concepts of Family
Medicine

Family Medicine is a medical specialty of :

•First contact with the patient,
•Devoted to providing preventive, promotive,
rehabilitative and curative health care, from physical,
psychological and social aspects
•The scope is not limited by system, organ, disease
entity, age or sex.
Why Is Family Medicine Needed?
• Social Change
• Specialization
• New pattern of illness demanded a new type of
Physician
• Behavioral Sciences gave new insight into older
problems
• Existing discipline neglect problems encountered
in health centers
 Equity In Health Care
 Equity in health is the absence of systematic disparities
in health between groups with different levels of
underlying social advantage/disadvantage that is, wealth,
power, or prestige.
 Inequities in health systematically put groups of people
who are already socially disadvantaged (for example, by
virtue of being poor, female, and/or members of a
disenfranchised racial, ethnic, or religious group)
 Major barriers to equity of 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
WHO: The Five-Stars Doctor
• Care-provider
Takes into account the total (physical, mental and social) needs of
the patient; ensure that a ‘full range of treatment - curative,
preventive or rehabilitative - will be dispensed…’
WHO: The Five-Stars Doctor
 Decision-maker:
Decisions justified in terms of efficacy and cost. Fair
allocation of limited healthcare resource to all
individuals in the community
 Communicator:

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.’
WHO: The Five-Stars Doctor
• Community leader
 Aware of needs and problems of the whole community - in a
suburb or a district
 Understands the determinants of health in the physical, social
environments
 Takes a ‘positive interest in community health activities which
will benefit large numbers of people’
 Manager
 Able to ‘initiate exchanges of information in order to make better
decisions’
 Works ‘within a multidisciplinary team in close association with
other partners for health and social development’
The Principles of FM
• The FP is committed to person rather than to knowledge,
disease and techniques
• The commitment is to single patients and to population
whether or not attending the Health centre
• The FP seeks to understand the illness context (personal,
family and social)
• The commitment is continuous and open-ended i.e. indefinite
follow up
• The FP sees the patient at the clinic, home or in the hospital.
• The FP is a resource manager (admissions, investigations,
prescriptions, referrals)
• The FP ideally shares the same habitat with served
community
A Case of Headache
10 Cs of desirable qualities in a family
physician:
1 = Caring/Compassionate
2 = Clinically Competent
3 = Cost-effective Care
4 = Continuity of Care
5 = Comprehensive Care
6 = Common Problems Management
7 = Co-ordination of Care
8 = Community-based Care & Research
9 = Continuing Professional Development
10 = Communication & Counseling
Skills` with confidentiality
1. C = Caring & Compassionate

Caring/Compassionate care
• An essential quality in a Family Physician
• Personal patient centered Care
2. C = Clinically competent

• Caring Only is not enough

• Need for four years training after

graduation and internship
3. C = Cost – effective care

• 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
o Routine checkups
o Health-risk assessments
o Immunization
o Screening tests, and personalized counseling
6. C = Common problems management

• e.g. Hypertension, Diabetes, Asthma,

Depression, Anemia, Allergic Rhinitis,
Urinary Tract Infection

• Common problems in children and

women
7. C = CME / CPD
(Continuous medical Education/ Continuous 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

9. C = Community based care & 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?
• Investigations & Management with patient’s involvement, safety
netting, appropriate F/U & Referral
 Family Physician Education Needs

• Knowledge

• Attitude

• Skills
 Family Physician Education Needs
1. Knowledge

• That he has sufficient knowledge of disease processes

particularly of common diseases, chronic diseases,
and those which endanger life or have serious
complications or consequences.
• That he understands the opportunities, methods, and
limitations of prevention, early diagnosis, and
management in the setting of general practice.
• His understanding of the way in which interpersonal
relationships within the family can cause health
problems or alter their presentation, course and
management, just as illness can influence family
relationships.
 Family Physician Education Needs
1. Knowledge
• An understanding of the social and environmental
circumstances of his patients and how they may effect a
relationship between health and illness

• His knowledge and appropriate use of the wide range of

interventions available to him

• That he understands the ethics of his profession and their

importance for the patient

• That he understands the basic method of research as applied to

general practice.
 Family Physician Education Needs
2. Skills

• How to form diagnosis which takes account of

physical, psychological, and social factors

• That he understands the use of epidemiology and

probability in his everyday work

• Understanding and use of the factor ‘time’ as a

diagnostic, therapeutic, and organizational tool
 Family Physician Education Needs
2. Skills
• That he can identify persons at risk and take
appropriate action;
• That he can make relevant initial decisions about
every problem presented to him as a doctor;
• The capacity to co-operate with medical and non-
medical professionals;
• Knowledge and appropriate use of the skills of
practice management.
 Family Physician Education Needs
3. Attitudes

• A capacity for empathy and for forming a specific

and effective relationship with patients and for
developing a degree of self-understanding

• How is recognition of the patient as a unique

individual modifies the ways in which he elicits
information and makes hypotheses about the nature
of his problems and their management

• That he understands that helping patients to solve

their own problems is a fundamental therapeutic
activity
 Family Physician Education Needs
3. Attitudes
• That he recognizes that he can make a professional
contribution to the wider community;

• That he is willing and able critically to evaluate his own work;

• That he recognizes his own need for continuing education and

critical reading of medical information.
 CONCLUSION

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
THANK YOU