PRINCIPLES OF FAMILY MEDICINE What is Family medicine:  Family Practice  General Practice  Primary Care Misconceptions about FM Brief History of FM The Principles

Family medicine Medical specialty: continuing and comprehensive care to indiv & family Integrates biological, clinical & behavioral science Scope encompasses all ages, sexes, each organ system and every dx entity

“Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity”. (1984) (2010 COD)

FM is concerned with the holistic approach to patient care in which the individual is seen in his totality, and in the context of his family, community and culture.

“ The Family Physician is the specialist trained to work in the front line of health care system and to take the initial steps to provide care for ANY health problem(s) that the patient have” (Olesen Def. 2006) A lot of confusion existed within and outside the field:- Family pract, GP, Prim Care & FM

Family Medicine:- Wider term of Family practice including academic part of the discipline*** use in Univer & Acada. Family Practice:- Emphasizes service & practical aspect; shared knowledge & skill with other specialties:- unique practice!! General Practice:- “GP” practice in PHC without post grad FM training BUT same as FP in some areas!

MISCONCEPTIONS Myth 1: Melting major clinical specialties and nothing new in FM:- by Colleagues in other specialties. Myth 11: New specialty which specialized in family:- by FM to resolve their identity under the pressure of misunderstanding by specialist colleagues.

HISTORY Family medicine is the natural evolution of historical medical practice For thousands of years, generalists provided all of the medical care Limit practice with expanded knowledge & technology With World War II, the age of specialization began to flourish.

History Two decade after WW II = ↑ in Specialization/specialist with↓ in Generalist Intense public outcry about fragmentation of their care and lack of personal physicians Thus began the reorientation of medicine back to personal, primary care. The concept of the generalist was reborn with the establishment of family medicine as medicine's twentieth specialty

History In 1923, Dr Francis Peabody (Prof. of Med at Harvard) called for rapid return to GP=Comprehensive care American Academy of GP was founded in 1947 & residency started in 1950 In 1960 FM was created in USA base on 3 Committee report In 1969 Am Board of FM was formed & FM recognized 20 th Am Medical specialty

In the UK Royal College of GP was founded in 1952 In 1972 the World Organization of Family Doctors(WONCA) made up of National Colleges or org. concern with academic aspects of FM was founded Nigerian hx…. Role of missionary/NPMCN in the late 1970s with training started in 1980s Most FM concentrations are in the Southern part

THE PRINCIPLE Family medicine is a three-dimensional specialty, incorporating: KNOWLEDGE, SKILL & PROCESS At the center of this PROCESS is 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.

Principle The process = fnx as a means of entry of the pt to health system & as physician of first contact in MOST situation. Have unique position to form a bond with the patient. FM’s care is both personal and comprehensive and not limited by……be it biological, behavioral or social.

DOMAINS OF FAMILY MEDICINE 14

TENETS OF FAMILY MEDICINE 1.Primary care management. 2.Person-centred care. 3.Comprehensive approach. 4.Holistic approach. 5.Specific problem solving skills. 6.Community orientation. 15

Comprehensive approach Every contact with the patient is an opportunity for health promotion, prevention, and health education. Manages simultaneously both acute and chronic health problems of individual patients. 16

Holistic Deals with health problems in their physical, psychological, social, and cultural dimensions. When referral is indicated, the FP refers the patient to other specialists or caregivers but remains the coordinator of the patient’s health care 17

Specific problem-solving skills Manages illness which presents in an undifferentiated way at an early stage in its development, which may require urgent intervention. Unique consultation process, which establishes a relationship over time, through effective communication between doctor and patient. 18

FAMILY FOCUS Can recognize the impact of family factors on the patient’s health when considering preventive and curative measures. Can recognize the impact of the patient’s problem on the family. Involves multiple family members Involves Home care Involves Family Dynamics Family Health Beliefs and practices Social, work and religious factors

Community orientation Responsible for the health of the community. Each patient is seen as representing a “population at risk.” The FP sees himself as part of a community-wide network of supportive and health care agencies. He tries to deploy the resources of the community for the benefit of his patients. He tries to see his patients in their home environment. This helps to understand the context or ecology of the illness. 20

Although all FPs share a core of information, the dimensions of knowledge and skill vary with the individual family physician. Pts needs differ in various geographic areas, and the content of the family physician's practice varies accordingly. The scope of an FP's practice changes over time, evolving in current skills and new knowledge and skill are obtained through CME

CONCLUSION FM is rooted in the historical generalist tradition Three dimensional, combining knowledge and skill with a unique process The patient-physician relationship in the context of the family is central to this process The scope of family medicine is dynamic, expanding, and evolutionary.

62 nd W.H.A. Resolution May Improving PHC through Family Medicine: UN member-nations to “… intensify the training of family physicians as the means to improving PHC and helping to achieve the MDGs.” 23

“a clinical leader and consultant in the primary health care team, ensuring primary, continuing, comprehensive, holistic, and & personalized care of high quality to individuals, families & communities”