1. Management in Family practice
Dr. JAWAHER AL-AHMADI
MB. ABFM. SBFM. MD

2. Programme Management option 40 MIN Problem solving 60 MIN
Compliance MIN

3. Some early truths to remember
The patient is as frightened as you are
The patient think is more serious than you
Illness is frightening but understanding what is going on helps

4. Diagnostic process Cues Clinical,behvioral Hypothesis Unexpected
revise
Hypothesis testing
Diagnosis
managment
Outcome evaluation

5. Management option (CRAPRIOP)
Clarifications
Reassurance
Advice
Prescribing
Referral
Investigation
Observations
Prevention

6. Involve pt. in management
Choosing options
Self–help & compliance

7. Clarifications (CRAPRIOP)
Good listing
Feedback
Flexible
Respect
Right way
Personal experience
Using patient cues

8. Reassurance (CRAPRIOP)
Active listening
Objective discussion
Physical examination
The diagnosis most probably is ----
It is common disease (prevalence is ----%
The treatment is ( ) safety & effectivnss
The prognosis is

9. Advice (CRAPRIOP)
Explanation about the disease and the important of the management
Short accurate information
Organization
Use the right way & practical method
Response to patient cues
Feed back & encouragement
How to help himself

10. Prescribing (CRAPRIOP)

11. prescription
A prescription is a physician's written instruction to a pharmacist to dispense medication for a patient.
It includes directions to the pharmacist regarding the preparation and to the patient regarding use of the medication.
However, a prescription represents much more than these directions. A prescription focuses on one slip of paper the diagnostic and therapeutic proficiency of the physician.

12. Drug information must be provided to the patient in an understandable manner
Communication can be both verbal and written.
Comprehensive written patient information should be a supplement to face-to-face discussion between the physician and the patient.
Pharmacist colleagues also contribute to patient education efforts

13. Adverse drug reactions
Adverse drug reactions have been said to be the inevitable price paid for the benefits of modern drug therapy.
The reported incidence of adverse drug reactions ranges from 1 to 28 percent.
Drug-induced hospitalizations account for approximately 5 percent of all admissions.
Between 5 and 30 percent of hospitalized patients experience adverse drug reactions

14. Referral (CRAPRIOP) To whom ? What for ? diagnosis treatment
shared care
When ?
How ?
patient opinion
explanation
referral letter

15. Investigation (CRAPRIOP)
Why ?
How ?
Misuse

16. Why
For Diagnosis
For follow up
For reassurance
For screeneening

17. How ?
Explanation
Be gradual
Non invasive

18. misuse
As routine
Unable to deal with it

19. Observation (CRAPRIOP)
Follow up appointment
To do what

20. Prevention (CRAPRIOP)
Anticipatory care
Opportunistic health promotion
Modification of help sickening behavior

22. Case 1
Salwa is 40 yrs house wife presented with headache. She had headache for years.
She was seen by several doctors ( ENT,allergist, neurologist)
CT scan normal
Her pain improved by paracetamol temporally.
By history she has (tension + migraine )
Family history of DM
O/E: normal

23. Case 2
Huda 32 yrs mother of two boys, complain from diarrhea 2 days mild pain and nausea. No fever or bloody stools. She has 6-8 stools motion per day.
O/E: normal

24. Case 3
Sara 33 yrs with 6 day nasal congestion and rhinorrhea. For 2 days her nasal discharge became greenish. She has headache and pain on bending.
No history of asthma on the family
O/E:
nose: swollen erythematous turbinates
sinuses: tender maxillary

25. Case 4 Sami 5 yrs boy is smaller than other boys
His past medical Hx is fine
O/E : Ht below 3rd centile
other is normal

26. Case 5
Sameera, a 40-year old house wife,is diabetic. She was diagnosed 5 year ago and always had blood sugars of mmole/liter. She tells you that she has stopped taking her 5 mg glibenclamide and start taking herbal medicine

27. poor compliance

28. Disease Psychiatric disorders
Chronic illness (especially if asymptomatic)
Minimal disability
Asymptomatic or decreased symptoms

29. Therapeutic regimen Multiple drug therapy
Higher frequency of administration
Longer duration of therapy
Adverse effects
Higher cost of medication
Administration of medication
Poor taste of medication
Slow onset of therapeutic effect

30. Physician-patient interaction
Poor physician-patient relationship
Inadequate follow-up or contact with physician
Poor understanding of instructions
Importance that physician places on adherence

31. thank you