Family Medicine Lecture 1 PDF

 The medical specialty which provides continuing and comprehensive health care for the individual and the family.  In breadth it is the specialty which integrates the biological, clinical and behavioral sciences.  The scope of Family practice encompasses all ages, sexes, each organ system a...

 The medical specialty which provides continuing and comprehensive health care for the individual and the family.  In breadth it is the specialty which integrates the biological, clinical and behavioral sciences.  The scope of Family practice encompasses all ages, sexes, each organ system and every disease entity”. (American academy of Family Physicians)  It is a wider term including the family practice in addition to academic part of the discipline, this term is being used in universities and academic centers.  This term is used to indicate the service part which gives a low weight to the core knowledge but emphasizes its practical aspect.  It shared knowledge and skills with other specialties. However, the process in family practice is unique.  Family practice includes: ① Diagnosis of health problems. ② Management of acute and chronic health problems. ③ Health promotion. ④ Health education. ⑤ Health maintenance. ⑥ Disease prevention. ⑦ Counseling. ⑧ Home care  In many countries such as Saudi Arabia the “General Practitioner ” is the Physician who practices in the Primary Health Care Centers without having a postgraduate training in family medicine while it means the Family Physician in other countries such as the United Kingdom and Australia.  It is the level of care or setting (not a specialty) through which a person has the first contact with health care system.  This can be an emergency department, Primary health care centers or even the out- patient clinics of the hospitals.  The care at this level can be provided by the General Practitioner, Family Physician, Internist, and Pediatrician or even by the sub-specialized physician provided; it is the first contact or point of entry to the health care system.  This term is used frequently and wrongly as an equivalent term to family medicine.   Primary care physicians have to know a lot in order to  Any doctor can treat all of the unique cases that come through their perform primary office. ❶ care because it's  People go to them for any kind of sickness, injury and easy other health needs and doctors are expected to be able to know how to treat every unique case that comes to them.  A family physician that's well trained seldom gives out  Family doctors referrals for specialists. only hand out  Unless a sickness or injury is extremely severe and the referrals and don't ❷ doctor thinks it would be better for the patient to see a deal with any specialist, they will work with the patient to help them get medical back on their feet. conditions  They typically only refer out about 10% of the time.  Any kind of  Direct primary care allows you to avoid this by being a ❸ medical care is part of a medical team that you can visit whenever you expensive need to, without spending extra money each time.  It is a melting together of the major clinical specialties and ❹ nothing new in this specialty.Usually this myth created by colleagues from other specialties.  It is a new specialty which is specialized in family; this is created by Family Physician sometimes to resolve their ❺ identity under the pressure of misunderstanding by specialist colleagues  The term “ general practitioner ” was first mentioned by Lancet  The number of specialists and sub specialists increased dramatically, while number of general physicians declined  Dr. Francis Peabody (Professor of Medicine at Harvard) called for a rapid return of the general physician who would give comprehensive care.  American Academy of General Practice was founded  first residency training program was started  the specialty of family medicine was created based on three important committee reports recommendations in USA.  The American Board of Family Medicine was formed and family medicine was recognized as the 20th American medical specialty  In UK, the Royal college of General Practitioner was founded  the World Organization of Family Doctors (WONCA) which is made up of national colleges or organizations concerned with academic aspects of family medicine was founded.  It has over two million family physicians /general practitioners.  Family physicians constitute the fundamental core of the health system in Canada, Australia, New Zealand, Netherlands, UK, Cuba and Spain. Th e specialty is active in South Korea, Hong Kong, Singapore, Indonesia, Taiwan, Philippines, Bangladesh, and Pakistan   Academic and scientific discipline, with its own educational content, research, evidence base and clinical activity, and a clinical specialty orientated to primary care.  They look after their patients without considering their ages, sexes and body organs or systems involved. Skills are needed during ① Diagnosis ② Drug prescribing ③ Counseling ④ Office procedures ⑤ Palliative care  This includes giving the priority to the patient agenda to explore his/her experience of being patient by focusing on his/her ideas, concern and, expectations.  This also includes the concepts of patients, family and society.  Family physicians have good skills in using the family resources in order to care for any individual who suffers from any health problem.  Family practitioners see their patients during health and illness.  Family physicians are responsible for offering preventive care to all family members during their various stages of life. Immunization, periodic health examination and health education are examples of preventive measures in family practice. Patients can be seen by the family physician in the office, clinic, hospital or home  ① Basic knowledge of community medicine ② Practicing preventive medicine ③ Dealing with occupational and environmental diseases ④ Practicing screening in the office setting  Skills needed: ① Continuous Medical Education (CME) programs ② Clinical Auditing ③ Conducting epidemiological clinical studies ④ Practicing Evidence Based Medicine  Family physician acts as a coordinator who can refer the patients to the appropriate consultant, and coordinates the different health services in accordance with the needs of his/ her patients.  “Primary health care is the essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain health at every stage of their development in the spirit of self-reliance and self-determination.  It forms an integral part both of the country’s health system of which it is the central function and main focus, and of the overall social and economic development of the community.  It is the first contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process” ① Equity in distribution: essential services to all but more to the needy. ② Appropriate technology: Scientifically sound, culturally and economically acceptable by people and health providers. ③ Multi-sectorial approach: All related sectors e.g. Agriculture, industry, education, etc. should be involved in the development of PHC. ④ Community participation: community and individual participation in the planning, organization and operation of the PHC are essential.  Health education  Promotion of food supply and proper nutrition  Maternal and child health  Immunization  Prevention and control of endemic disease  Provision of safe water and basic sanitation  Treatment of common diseases and injuries  Essential drug provision  Good primary health care must include the following " As " It must be:  Available  Acceptable  Attainable  Accessible  Adaptable  Appropriate  Affordable  Applicable  Assessable  1st comes into  The patients having  Not enough facilities or contact with various specialized health care patient. abnormalities for management of particular patient.  Preventive health  Provides patients  Provides patients with care is the main with curative more advanced curative responsibility healthcare facilities. healthcare facilities.