McWhinney Principles of Family Medicine in Primary Health Care

Public Health Systems

• Multiple levels of care within a public health system:
  • Primary care: first level of contact with the health system, provides basic promotion/prevention/curative care
  • Secondary care: general hospitals, curative approach, some general specialist care
  • Tertiary care: advanced specialist care, often associated with academic institutions
  • Quarternary care: most advanced specialist care (e.g., organ transplants)

Primary Health Care

• Involves the first level of care in the public health system
• Guided by a philosophy of social development that emphasizes equity and community empowerment
• Seeks to include all elements that play a role in health
• Goes beyond the usual healthcare system

Family Medicine and Public Health

• 5 functions of family physicians within a public health system:

  • Implementing recommended preventive service guidelines
  • Serving as the front line of the surveillance system
  • Appropriately referring to the Public Health Department
  • Accepting referrals from the Public Health Department
  • Interacting constructively with the local health department

• Family Medicine recognizes the difference between primary care and Primary Health Care

• Aims to integrate the systems contributing to the health of the community and individual care

McWhinney Principles of Family Medicine

• 10 principles:
  • Committed to the person rather than to a particular body of knowledge
  • Seeks to understand the context of the illness
  • Attaches importance to the subjective aspects of medicine
  • Sees every contact with patients as an opportunity for prevention or health education
  • Views practice as a population at risk
  • Sees herself as part of a community-wide network of supportive and healthcare agencies
  • Able to perform most common procedures and operations appropriate to the district health system
  • Sees patients at the office, at their homes, and in hospital
  • Manages resources
  • Is a lifelong learner

Health for All – Principles of Primary Health Care

• 14 principles:
  • Holistic (Biopsychosocial approach)
  • Equity and equality
  • Accessibility
  • Listening to, and learning from, communities
  • Teamwork (Multi-disciplinary)
  • Health promotion
  • Funding and resources (Affordability)
  • Other sectors (Intersectoral collaboration)
  • Rights (Human Rights) and responsibilities
  • Acceptability and appropriateness
  • Literature (Evidence-based practice)
  • Levels of care and referral

Primary Health Care vs. Practice Population

• Primary Health Care is not defined by:
  • Site or level of care delivered
  • Qualifications of the healthcare worker
  • Primary medical care
  • A "package" of cheap interventions for the poor
  • Health education
  • Disease prevention
  • "Touchy-feely" medicine

Practice Population and Population at Risk

• Practice population: patients who present themselves for care
• Population at risk: people who are not yet ill but are likely to become so, or those who do not present themselves for care

Community-Oriented Primary Care (COPC)

• A continuous process by which primary health care is provided to a defined community on the basis of its assessed health needs
• Planned integration of primary care practice and public health