Introduction to Family medicine

Family Practice Is the medical specialty that provides continuing comprehensive health care for the individual and the family. It is the specialty that integrates the biological, clinical and behavioral sciences. The scope of Family Practice encompasses all ages,both sexes, each organ system and every disease entity.

Family physician Is a physician who is educated and trained in the discipline of family practice and possesses unique attitudes, skills and knowledge that qualifies him (her) to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social. The World Organization of Family Doctors defines the family doctor as the physician who is primarily responsible for providing comprehensive health care to every individual seeking medical care, and arranging for other health personnel to provide services when necessary.

Characteristics and functions of family physician 1.A strong sense of responsibility for the total,ongoing care of the individual and the family during health, illness, and rehabilitation. 2.Compassion and empathy,with a sincere interest in the patient and family 3.A curious and constantly inquisitive attitude 4.An interest in the broad spectrum of clinical medicine

5.The ability to deal with multiple problems occurring simultaneously in one patient 6.The ability to support children during growth and development and during their adjustment to family and society 7.The ability to assist patients in coping with every day problems and in maintaining stability in their family and community 8.The capacity to act as coordinator of all health resources needed in the care of patient

9.A desire to identify problems at the earliest possible stage (or to prevent disease entity) 10.The skills necessary to manage chronic illness and to ensure maximal rehabilitation following acute illness 11.A feeling of personal satisfaction derived from intimate relationship with patients that naturally develop overlong periods of continuous care, as opposed to the short term pleasures gained from treating episodic illness 12.A skill for and commitment to educate patients and families about disease process, and the principles of good health

Continuing Responsibility One of the essential functions of the family physician is the willingness to accept ongoing responsibility for managing the medical care of patients. The commitment of the family physician to patients does not cease at the end of illness but is a continuing responsibility, regardless of the state of health or disease process. The greater degree of continuing involvement with a patient, the more capable the physician becomes in detecting early signs and symptoms of organic disease and differentiating it from a functional problem.

Patients with problems arising from emotional and social conflicts can be managed most effectively by a physician who has intimate knowledge of the individual and his or her family and community background. Chronic illness : the family physician must also be committed to managing the common chronic illnesses that have no known cure but for which continuing management by a personal physician is all the more necessary to maintain an optimal state of health for the patient.

The family physician as coordinator: The family physician, has unique insights into the skills possessed by physicians in the more limited specialties. The family physician is best prepared to select specialists whose skills can be applied most appropriately to a given case as well as to coordinate the activities of each. As medicine becomes more specialized and complex, the role of family physician as integrator of health services becomes increasingly important. The family physician not only facilitates the access of patients to the whole health care system but also interprets the activities of this system to the patient, explaining the nature of the illness, the implications of the treatment, and the effect of both upon the way of patient in life.

Quality of care: Primary care provided by physicians specifically trained to care for problems presenting to personal physicians and who know their patients over a spam of time is of higher quality than that provided by other physicians. Primary care, to be done well, requires extensive training specifically tailored to problems frequently seen by physicians in ambulatory care. These include the early detection, diagnosis of cancer (especially of the breast and colon ); the management of gynecologic problems; and the care of those with chronic and terminal illnesses.

1.Cost – effective care: The physician who is well acquainted with the patient not only provides personal and human medical care but also does so more economically than the physician involved only in episodic care. The physician who knows his or her patients well can assess the nature of their problems more rapidly and accurately.

Because of the intimate, ongoing relationship the family physician is under less pressure to exclude diagnostic possibilities by use of expensive laboratory and radiologic procedures and is more likely to use time as an ally in diagnosing a less urgent problem than is the physician who is unfamiliar with the patient. Medical care should be available to patients in the precise degree needed – neither too expensive nor too limited. Specialists generally treat their patients more recourse – intensively than do generalists, resulting in increased cost of care. Family physician order fewer tests than do specialists, perhaps because they know their patients well.

2.Comprehensive care :the term “comprehensive medical care” spans the entire spectrum of medicine. The effectiveness with which a physician delivers primary care depends upon the breadth of problems encountered during training and practice. The family physician must be comprehensively trained to acquire all the medical skills necessary to care for the majority of problems of patients. The greater the number of skills omitted from the family physicians training and practice, the more frequent is the need to refer minor problems to another physician. A truly comprehensive primary care physician adequately manages acute infections, biopsies skin and other lesions, repairs lacerations, treat musculoskeletal sprains and minor fractures, removes foreign bodies, treat vaginitis, provides obstetric care and care for the newborn infant, gives supportive psychotherapy, and supervises or performs diagnostic procedures.

Management of an illness involves much more than a diagnosis and an outline for treatment. It also requires an awareness of all the factors that may aid or hinder an individual recovery from illness. This requires consideration of religious beliefs; social, economic, or cultural problems; personal expectations; and heredity. Family practice is a comprehensive specialty involving varying depths of knowledge and skills of varying degrees in each specialty area, depending upon the prevalence of problems encountered in every day practice and the degree of skills needed to become an excellent diagnostician. A physician specializing in only one discipline, however, will have a much shallower base in comprehensive medicine and a much greater depth in the chosen discipline. The specialist is an excellent consultant but is not trained and cannot function effectively as a primary generalist.

3.Accessibility : it is an essential feature of primary care. Services must be available when needed and should be within geographic proximity. When primary care is not available, many individuals turn to hospital emergency departments. Emergency room care is, of course, fine for emergencies, but it is not a substitute for the personalized, long – term, comprehensive care that a family physician can provide.

Diagnostic skills- undifferentiated problems The family physician must be an outstanding diagnostician. Skills in this area must be honed to perfection, since problems are usually seen in their early, undifferentiated state and without the degree of resolution that usually is present by the time patients are referred to consulting specialists. This is a unique feature of family practice, because symptoms seen at this stage are often vague and nondescript, with signs being either minimal or absent. Unlike the consulting specialist, the family physician does not evaluate the case after it has been preselected by another physician, and the diagnostic procedures used by the family physician must be selected from the entire spectrum of medicine.