1. EVOLUTION &CONCEPTS OF FAMILY MEDICINE
Dr. Riaz Qureshi
Distinguished Professor
Department of Family & Community Medicine
King Saud University, Riyadh

2. Objectives
Become familiar with the history and evolution of Family Medicine
- Understand the concepts of Family Medicine and its central & universal role in the health care system
- Become aware of the desirable qualities of a Family Physician and essentials of a Family Medicine consultation

3. History of Family Medicine
EVOLUTION: The age of the General Practitioner / The age of Specialization/Family Medicine as a Clinical and Academic Discipline

4. Major barriers to equitable 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

5. How to overcome these barriers ?
The WHO also states, that the best option to overcome these barriers is to utilize the services of trained Family Physicians

6. Health outcome indicators
Barbra Starfield study confirmed that the central role of Family Medicine in the health care system of a country results in enhanced quality & cost-effective care .
She proved in a large multicentre study that the health outcome indicators are significantly better in those countries in which Family Medicine plays a central role in the health care system

7. Problems in the community
75% Self care
25% Consult FP
Hosp
2.5%

8. Concepts of Family Medicine
DEFINITION: Family Medicine is a medical specialty of first contact with the patients and is devoted to providing preventive, promotive, rehabilitative and curative care, with emphasis on the physical, psychological and social aspects, for the patient, his family and community.
The scope is not limited by system, organ, disease entity, age or sex.

9. The Need For Trained Family Physicians
The central role of a well trained Family Physician in health care is well recognized in:
Developed countries -- UK, USA and Canada
Oil rich countries -- Saudi Arabia and Kuwait?
Developing countries -- ? ? ? ? ?
The need is even greater in all less developed countries.

10. 10 Cs OF FAMILY PRACTICE 1. C = Caring/Compassionate
2. C = Clinically Competent
3. C = Cost-effective Care
4. C = Continuity of Care
5. C = Comprehensive Care
6. C = Common Problems Management
7. C = Co-ordination of Care
8. C = Community-based Care & Research
9. C = Continuing Medical Education
10. C = Communication & Counseling Skills` with confidentiality

11. 1. C = CARING Caring/Compassionate care
An essential quality in a Family Physician
Personal Care

12. 2. C = CLINICALLY COMPETENT
Only caring is not enough
Need for 4 years training after graduation and internship

13. 3. C = COST- EFFECTIVE In time and money
Gate keeper- Appropriate resources use
Use of time as a diagnostic tool

14. 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

15. 5. C = COMPREHENSIVE
CARE
Responsibility for every problem a patient presents with
Physical, Psychological & Social
Holistic approach with triple diagnosis

16. 6. C = COMMON PROBLEMS MANAGEMENT EXPERTISE
e.g. Hypertension, Diabetes, Asthma, Depression, Anemia, Allergic Rhinitis, Urinary Tract Infection
Common problems in children and women

17. 7. C = CONTINUING MEDICAL EDUCATION (CME)
To keep up-to-date
Need for breath of knowledge

18. 8. C = CO-ORDINATION OF CARE
Patient’s advocate
Organizing multiple sources of help

19. 9. C = COMMUNITY BASED CARE AND RESEARCH
Care nearer patients’ home
Preventive, promotive, rehabilitative and curative care in patients own environment.
Relevant research within the patient’s own surroundings

20. 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

21. 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 patients involvement, safety netting , appropriate F/U & Referral?

22. 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.

23. Thank you
Have a nice day