بسم الله الرحمن الرحيم

By Prof. Adnan Ahmad Albar

The Learning Objectives By the end of these session participants will be able to :  List and explain the different levels of health care.  Define family medicine and family practice.  Identify the place and role of family medicine in the health care system.  List and explain the main characteristics and functions of a family physician.  List and explain the main principles of family medicine and primary care.  List the main misconceptions about family medicine.

Definition of health WHO defines health as : a state of well being physically, mentally, Socially and spiritually and not the mere absence of disease

Constituents of The Health Care system Constituents of The Health Care system  Public health strategies.  3 levels of health care : Primary, Secondary and Tertiary.  Family medicine & community medicine.  Community medicine specialists Epidemiologists, Environmentalists, Occupational health specialists, Health educationists, etc.  Family physicians, generalist,and team members.  Other specialists, sub specialties,and team members.

Levels of health care  Primary heath care. “ primary heath care centers “  Secondary health care “ general hospital “  Tertiary health care “ University & highly specialized hospital ”

Terms of Reference  Sciences General medicine General medicine Primary carePrimary care Primary care medicine Primary care medicine Family medicine Family medicine  Practitioners General practitioners / physicians General practitioners / physicians Primary care practitioners / physicians Primary care practitioners / physicians Family practitioners / physicians Family practitioners / physicians

Terms of Reference (cont’d)  Sites of practice General practice General practice Primary health care centers Primary health care centers Family practice Family practice General and polyclinics General and polyclinics

The Age Of Specialization  Emergence of major specialties.  Fragmentation of the profession.  Technology rather than human oriented approach.

 The growth of specialization.  The age of the general practitioner

The Origins Of Family Medicine  Changes in mortality & morbidity.  Successful control of infectious diseases.  Increasing incidence & prevalence of chronic disease.  Accidents.

The Origins Of Family Medicine (cont’d)  Behavioral disorders.  Newly emerging and re-emerging diseases.  Population growth.  Increased life span.

New Developments In The Behavioral Sciences  New insights.  Better understanding of human behaviors and needs.  Better understanding of the roles of family & society in the health care system.

 The changing role of the hospital.  Managed care and the age of integration.

Patients consider a good physician one who :  Shows genuine interest in them;  Thoroughly evaluates their problem;  Demonstrates compassion, understanding, and warmth; and  Provides clear insight into what a wrong and what must be done to correct it.

Who Is A FAMILY PHYSICIAN ? The family physician is a physician who is educated and trained in the discipline of family practice-a broadly encompassing medical specialty. Family physicians possess unique attitudes, skills, and knowledge that qualify them 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 FAMILY PHYSICIAN (cont’d) These specialists, because of their background and interactions with the family, are best qualified to serve as each patient’s advocate in all health- related matters, including the appropriate use of consultants, health services, and community resources (AAFP Congress, 1993).

“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. The family physician functions as a generalist who accepts everyone seeking care, whereas other health providers limit access to their services on the basis of age, sex, and/or diagnosis” (WONCA, 1991) The FAMILY PHYSICIAN

WHAT IS FAMILY PRACTICE ? WHAT IS FAMILY PRACTICE ? Family practice is the medical specialty that provides continuing and comprehensive health care for the individual and the family. It is the specialty in breadth 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 practice is a comprehensive specialty involving varying depths of knowledge in many disciplines.

Primary Care / Family Practice Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for ill persons or those with an undiagnosed sign, symptom, or health concern (the “undifferentiated” patient) not limited by problem origin (biological, behavioral, or social), organ system, or gender.

Family practice emphasizes the integration of compassion, empathy, and personalized concern to a greater degree than does a more technical or task-oriented specialty.

Primary care is a form of delivery of medical care that encompasses the following functions:  It is highly personalized “first-contact” care, serving as a point-of-entry for the patient into the health care system;  It includes continuity by virtue of caring for patients over a period of time, both in sickness and in health;  It is comprehensive care, drawing from all the traditional major disciplines for its functional content;

 It serves a coordinative function for all the health-care needs of the patient;  It assumes continuing responsibility for individual patient follow-up and community health problems; and  It is a highly personalized of care.

WHO IS A PRIMARY CARE PHYSICIAN ? A primary care physician is a generalist physician who provides definitive care to the undifferentiated patient at the point of first contact and takes continuing responsibility for providing the patient’s care.

Primary care physicians devote the majority of their practice to providing primary care services to a defined population of patients.

Principles of Family Medicine Comprehensiveness: The family physician must be comprehensive trained to acquire all the medical skills necessary to care for the majority of patient problems including, each specialty according to its prevalence.

Principles Comprehensive Care: -Promotive -Preventive -Curative -Rehabilitive

Principles Holistic Approch: -Bio-sycho-social and physical approach. -Individual, family and community oriented and centered rather than disease orientedcare. -Team work.

Principles Screening: -Premarital. -Antenatal. -Well Baby Clinic. -Pre-school. -Adolescent. -Adults. -Elderly.

Principles Prevention: -Clinical prevention. -Clinical health education.

Accessibility Services must be available when needed and should be within geographic proximity.

Principles Continuity Of Care

The family physician’s commitment to patients does not cease at the end of illness but is a continuing responsibility, regardless of the patient’s state of health or the disease process.

The greater the 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.

As the family physician maintains this continuing involvement with successive generations within a family, the ability to manage intercurrent problems increases with knowledge of the total family background.

Principles FAMILY PHYSICIAN AS COORDINATOR. THE CONCEPT OF A GATE KEEPER.

The family physician facilitates the patient’s access to the health care system, interprets the activities of this system to him, explaining the nature of the illness, implications of treatment, and the effect of both upon the patient’s way of life. Millis Commission Report.

Principles Cost Effective Care Knowing their patients well family physician are capable of:  Assessing the nature of their patient’s health problem more rapidly and accurately.  Using time as an ally in diagnosing less urgent problems.  Ensuring the most logical and economical management.  Controlling magnification of simple problem.  Ordering fewer test.

PERSONALIZED CARE It is much more important to know what sort of patient has a disease than what sort of disease a patient has. Principles

Family practice emphasizes consideration of the individual patient in the full context of his or her life, rather than the episodic care of a presenting complaint.

The physician should guard against thinking in terms of diseases and instead think in terms of patients who have problems needing attention. The whole-person approach to patient care is hampered by focusing primarily on the disease.

The family physician serves as the patients’ advocate, explaining the causes and implications of illness to the patients and their families, and serves as an advisor and confidant to the family- both individually and collectively.

Home Care Home visits Outreach activities Principles

Principles Quality driven: -Scientific soundness. -Essential skills. -Appropriate technology. -Clinical guidelines. -Certification and re-certification. -CME & CPD. -Audit and peer review. -Accreditation and re-accreditation.

 A strong sense of responsibility for the total, ongoing care of the individual and the family during health, illness, and rehabilitation.  Compassion and empathy, with a sincere interest in the patient and the family.  A curious and constantly inquisitive attitude.

 Enthusiasm for the undifferentiated medical problem and its resolution.  An interest in the broad spectrum of clinical medicine.  The ability of deal comfortably with multiple problems occurring simultaneously in one patient.

 A desire for frequent and varied intellectual and technical challenges.  The ability to support children during growth and development and during their adjustment to family and society.  The ability to assist patients in coping with everyday problems and in maintaining stability in the family and community.

 The capacity to act as coordinator of all health resources needed in the care of a patient.  A continuing enthusiasm for learning and for the satisfaction that comes from remaining current through continuing medical education.  The ability to maintain composure in times of stress and to respond quickly with logic, effectiveness, and compassion.

 A desire to identify problems at the earliest possible stage (or to prevent disease entirely).  A strong wish to maintain maximum patient satisfaction, recognizing the need for continuing patient rapport.

 The skills necessary to manage chronic illness and to ensure maximal rehabilitation following acute illness.  An appreciation for the complex mix of physical, emotional, and social elements in holistic and personalized patient care.

 A feeling of personal satisfaction derived from intimate relationships with patients that naturally develop over long periods of continuous care, as opposed to the short-term pleasures gained from treating episodic illnesses.  A skill for and commitment to educating patients and families about disease processes and the principles of good health.

A truly comprehensive primary care (family) physician adequately  Manages acute infections.  Biopsies skin and other lesions.  Repairs lacerations.  Treats musculoskeletal sprains and minor fractures.  Removes foreign bodies.  Treats vaginitis and provides obstetric care.  Care for the newborn infant.  Gives supportive psychotherapy.  Supervises or performs diagnostic procedures.

The family physician must be aware of the variety and complexity of skills and facilities available to help manage patients and must match these to the individual’s specific needs, giving full consideration to the patient’s personality and expectations.

Management of an illness involves much more than a diagnosis and an outline for treatment. It requires :  Awareness of the factors aiding or hindering recovery from illness.  Consideration of religious beliefs; social, economic, or cultural problems; personal expectations; and heredity.  The outstanding clinician recognizes the effects that spiritual, intellectual, emotional, social, and economic factors have on a patient’s illness.

The family physician’s ability to confront relatively large numbers of unselected patients with undifferentiated conditions and carry on a therapeutic relationship over time is a unique primary care skill.

The early identification of disease while it is in its undifferentiated stage requires specific training and is not a skill that can automatically be assumed by someone whose training has been mostly in hospital intensive care units.

Interpersonal Skills One of the foremost skills of the family physician is the ability to effectively utilize the knowledge of interpersonal relations in the management of patients. This powerful element of clinical medicine is perhaps the specialty’s most useful tool.

 Develop compassion and courtesy.  Establish rapport.  Communicate effectively.  Gather information rapidly and to organize it logically.  Identify all significant patient problems and manage them appropriately.  Listen, observe patients and detect nonverbal clues.  Motivate people. To relate well to patients, a physician must

Misconceptions About The Roles Of Generalists & Specialists  The generalist has to cover the whole field of medical knowledge.  In any field of medicine the specialist always knows more than the generalist.  By specializing one can eliminate uncertainty.

Misconceptions About The Roles Of Generalists & Specialists (cont’d)  Only by specialization one can attain depth of knowledge.  Error in medicine is usually caused by lack of information.

The Family Physician In Practice

Thank You