Principles of Family Medicine

Dr Duaa Hiasat MD. Consultant Family Medicine

Family Medicine

Objectives The goal of this activity is : To reinforce and highlight common concepts about Family Medicine By the end of this lecture Family Medicine residents should have a good knowledge of FM principles and FM Practice

Short History of the specialty Family medicine is the natural evolution of historical medical practice. The first physicians were generalists. For thousands of years, generalists provided all of the medical care available, they diagnosed and treated illnesses, performed surgery, and delivered babies.

With World War II, the age of specialization began to flourish With World War II, the age of specialization began to flourish. In the two decades following the war, the number of specialists and subspecialists increased at a phenomenal rate, while the number of generalists declined dramatically. As medical knowledge expanded and technology advanced, many physicians chose to limit their practices to specific, defined areas of medicine.

The public became increasingly vocal about the fragmentation of their care and the shortage of personal physicians who could provide initial, continuing and comprehensive care At the same time far sighted health care planners decried the fragmentation of the American medicine and called for the creation of a physician who is specialized in personal health care – the family physician.

Establishment of family medicine medicine's twentieth specialty. Thus began the reorientation of medicine back to personal, primary care. The concept of the generalist was reborn with the establishment in 1969 of family medicine as the twentieth American medical specialty.

FAMILY MEDICINE It is 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. (From the American Academy of Family Physicians)

Wonca definition (Word organization of FM) General practice/family medicine is an academic and scientific discipline, with its own educational content, research, evidence base and clinical activity, and a clinical specialty orientated to primary care. (European definition of FM, WONCA 2002 )

Comprehensive care Full-service care of both sexes and all ages “from cradle to death” “from conception to resurrection” “the person not the disease”

Continuing care 1. -interpersonal 2.-chronological 3.-geographic 4.-interdisciplinary 5.-informational The key word here is “responsibility”

The characteristics family medicine There are eleven characteristics of the discipline The eleven characteristics of the discipline relate to eleven abilities - cores that every specialist family doctor should master.

1. Is normally the point of first medical contact within the health care system, providing open and unlimited access to its users, dealing with all health problems regardless of the age, sex, or any other characteristic of the person concerned.

2. 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 .Develops a person-centred approach, orientated to the individual, his/her family, and their community. 4.Has a unique consultation process, which establishes a relationship over time, through effective communication between doctor and patient

5. Is responsible for the provision of longitudinal continuity of care as determined by the needs of the patient. 6. Has a specific decision making process determined by the prevalence and incidence of illness in the community.

7.Manages simultaneously both acute and chronic health problems of individual patients. 8.Manages illness which presents in an undifferentiated way at an early stage in its development, which may require urgent intervention

9.Promotes health and well being both by appropriate and effective intervention. 10.Has a specific responsibility for the health of the community. 11.Deals with health problems in their physical, psychological, social, cultural and existential dimensions.

CORE COMPETENCIES Core means essential to the discipline, irrespective of the health care system in which they are applied The eleven abilities that every specialist family doctor should master are clustered into six independent categories of core competencies.

1. Primary Care Management (1,2) Includes the ability: - to manage primary contact with patients, dealing with unselected problems; - to cover the full range of health conditions; - to co-ordinate care with other professionals in primary care and with other specialists;

- to act as advocate for the patient -to master effective and appropriate care provision and health service utilization; - to make available to the patient the appropriate services within the health care system; - to act as advocate for the patient

2.Person-centred Care (3,4,5) Includes the ability: to adopt a person-centred approach in dealing with patients and problems in the context of patient’s circumstances; - to develop and apply the general practice consultation to bring about an effective doctor-patient relationship, with respect for the patient’s autonomy; -

to communicate, set priorities and act in partnership; - to provide longitudinal continuity of care as determined by the needs of the patient, referring to continuing and co-ordinated care management.

3.Specific Problem Solving Skills (6,7) Includes the ability: to relate specific decision making processes to the prevalence and incidence of illness in the community; - to selectively gather and interpret information from history-taking, physical examination, and investigations and apply it to an appropriate management plan in collaboration with the patient; -

to adopt appropriate working principles. e. g to adopt appropriate working principles. e.g. incremental investigation, using time as a tool and to tolerate uncertainty; -to adopt appropriate working principles. e.g. incremental investigation, using time as a tool and to tolerate uncertainty -

-to intervene urgently when necessary; to manage conditions which may present early and in an undifferentiated way; - to make effective and efficient use of diagnostic and therapeutic interventions

4. Comprehensive Approach(8,9) Includes the ability: - to manage simultaneously multiple complaints and pathologies, both acute and chronic health problems in the individual; - to promote health and well being by applying health promotion and disease prevention strategies appropriately; - to manage and co-ordinate health promotion, prevention, cure, care and palliation and rehabilitation

5. Community Orientation(10) Includes the ability:   5. Community Orientation(10) Includes the ability: - to reconcile the health needs of individual patients and the health needs of the community in which they live in balance with available resources.

6. Holistic Approach(11) Includes the ability: - to use a bio-psycho-social model taking into account cultural and existential dimensions.

THE FIVE AREAS OF FAMILY MEDICINE PRACTICE A family doctor has a great breadth of knowledge, skills and attitudes within the Five Areas of Family Medicine Practice

Clinical practice – health and disease This area includes: The range of natural normal The patterns of illness The of natural history of diseases Prevention Early diagnosis Diagnostic methods and techniques Management and treatment

2.Clinical practice – human development This area includes: Genetics Fetal development Intelectualdevelopment in childhood , maturity and ageing Physical development in childhood , maturity and ageing Emotionaldevelopment in childhood , maturity and ageing The range of normal

3.Clinical practice – human behavior This area includes: Behavior presenting to the family doctor Behavior in interpersonal relationships Behaviorof the family Behavior in the doctor – patient relationship

4.Medicine and society Sociological aspects health and illness The uses of epidemiology The organisation of medical care in the country he works and comparisons with other countries The relationship of medical services to other institutions of society

5.The practice Practice management The team Financial Premises Medical records Medico-legal matters Research

THE JOY OF FAMILY MEDICINE If you cannot work with love but only with distaste it is better that you should leave your work and sit at the gate of the temple and take alms from those who work with joy Khalil Gibran (1883-1938)

First do no harm

HOW DO I KNOW WHEN I HAVE A GOOD DAY IN MY PRACTICE I’ve asked the right questions and at least one person has cried and at least one person has laughed in my consulting room I’ve had at least one person tell me the real reason why they have come to see me. I’ve learned something new about human existence. I’ve increased my medical knowledge. I’ve cared about what happened to each patient and each colleague I have seen today . Michael Kidd President elect WONCA

3.Clinical practice – human behavior