بسم الله الرحمن بسم الله الرحمن الرحيمالرحيم

ByBy

Prof. Adnan Ahmad AlbarProf. Adnan Ahmad Albar

The Learning ObjectivesThe Learning ObjectivesBy the end of these session participants will be By the end of these session participants will be

able to :able to : List and explain the different levels of health List and explain the different levels of health

care .care . Define family medicine and family practice .Define family medicine and family practice . Identify the place and role of family medicine Identify the place and role of family medicine

in the health care system .in the health care system . List and explain the main characteristics and List and explain the main characteristics and

functions of a family physician .functions of a family physician . List and explain the mainList and explain the main principles of family principles of family

medicine and primary care .medicine and primary care . List the main misconceptions about family List the main misconceptions about family

medicine .medicine .

Definition of healthDefinition of health

WHO defines health asWHO defines health as : :a state of well being physically, a state of well being physically, mentally , Socially and mentally , Socially and spiritually spiritually and not the mere and not the mere absence ofabsence of disease disease

Constituents of The Health Constituents of The Health Care systemCare system

Public health strategies .Public health strategies . 3 levels of health care3 levels of health care : :

Primary , Secondary and Tertiary .Primary , Secondary and Tertiary . Family medicine & community medicine .Family medicine & community medicine . Community medicine specialists Community medicine specialists Epidemiologists , Environmentalists , Occupational health Epidemiologists , Environmentalists , Occupational health

specialists , Health educationists , etc.specialists , Health educationists , etc. Family physicians , generalist ,and team members.Family physicians , generalist ,and team members. Other specialists , sub specialties ,and team members .Other specialists , sub specialties ,and team members .

Levels of health careLevels of health care

Primary heath care .Primary heath care .“ “ primary heath care centers “primary heath care centers “

Secondary health careSecondary health care“ “ general hospital “general hospital “

Tertiary health careTertiary health care“ “ University & highly specialized University & highly specialized

hospitalhospital ” ”

Terms of ReferenceTerms of Reference

Sciences Sciences • General medicine General medicine • Primary carePrimary care• Primary care medicinePrimary care medicine• Family medicine Family medicine

Practitioners Practitioners • General practitioners / physicians General practitioners / physicians • Primary care practitioners / physicians Primary care practitioners / physicians • Family practitioners / physicians Family practitioners / physicians

Terms of Reference (cont’d)Terms of Reference (cont’d)

Sites of practice Sites of practice • General practiceGeneral practice• Primary health care centersPrimary health care centers• Family practiceFamily practice• General and polyclinicsGeneral and polyclinics

The Age Of SpecializationThe Age Of Specialization

Emergence of major specialties.Emergence of major specialties. Fragmentation of the profession.Fragmentation of the profession. Technology rather than human oriented Technology rather than human oriented

approach.approach.

The growth of specialization.The growth of specialization.

The age of the general practitionerThe age of the general practitioner

The Origins Of Family MedicineThe Origins Of Family Medicine Changes in mortality & morbidity.Changes in mortality & morbidity. Successful control of infectious diseases.Successful control of infectious diseases. Increasing incidence & prevalence of chronic Increasing incidence & prevalence of chronic

disease.disease. Accidents.Accidents.

The Origins Of Family Medicine The Origins Of Family Medicine (cont’d)(cont’d)

Behavioral disorders.Behavioral disorders. Newly emerging and re-emerging diseases.Newly emerging and re-emerging diseases. Population growth.Population growth. Increased life span.Increased life span.

New Developments In The Behavioral New Developments In The Behavioral SciencesSciences

New insights.New insights. Better understanding of human behaviors Better understanding of human behaviors

and needs.and needs. Better understanding of the roles of family Better understanding of the roles of family

& society in the health care system.& society in the health care system.

The changing role of the hospital.The changing role of the hospital.

Managed care and the age of integration.Managed care and the age of integration.

Patients consider a good physician one who :Patients consider a good physician one who :

Shows genuine interest in them; Shows genuine interest in them; Thoroughly evaluates their problem; Thoroughly evaluates their problem; Demonstrates compassion , understanding, and Demonstrates compassion , understanding, and

warmth; and warmth; and Provides clear insight into what a wrong and what Provides clear insight into what a wrong and what

must be done to correct it.must be done to correct it.

Who Is A FAMILY Who Is A FAMILY PHYSICIAN ?PHYSICIAN ?

The family physician is a physician who is educated The family physician is a physician who is educated and trained in the discipline of family practice-a and trained in the discipline of family practice-a broadly encompassing medical specialty. Family broadly encompassing medical specialty. Family physicians possess unique attitudes, skills, and physicians possess unique attitudes, skills, and knowledge that qualify them to provide continuing knowledge that qualify them to provide continuing and comprehensive medical care, health maintenance, and comprehensive medical care, health maintenance, and preventive services to each member of the family and preventive services to each member of the family regardless of sex, age, or type of problem, be it regardless of sex, age, or type of problem, be it biological, behavioral, or social. biological, behavioral, or social.

THE FAMILY THE FAMILY PHYSICIAN (cont’d)PHYSICIAN (cont’d)

These specialists, because of their background and These specialists, because of their background and interactions with the family, are best qualified to interactions with the family, are best qualified to serve as each patient’s advocate in all health-serve as each patient’s advocate in all health-related matters, including the appropriate use of related matters, including the appropriate use of consultants, health services, and community consultants, health services, and community resources (AAFP Congress, 1993).resources (AAFP Congress, 1993).

““The physician who is primarily responsible for The physician who is primarily responsible for providing comprehensive health care to every providing comprehensive health care to every individual seeking medical care, and arranging for individual seeking medical care, and arranging for other health personnel to provide services when other health personnel to provide services when necessary. The family physician functions as a necessary. The family physician functions as a generalist who accepts everyone seeking care, generalist who accepts everyone seeking care, whereas other health providers limit access to whereas other health providers limit access to their services on the basis of age, sex, and/or their services on the basis of age, sex, and/or diagnosis” (WONCA, 1991)diagnosis” (WONCA, 1991)

The FAMILY PHYSICIANThe FAMILY PHYSICIAN

WHAT IS FAMILY PRACTICE ?WHAT IS FAMILY PRACTICE ?

Family practice is the medical specialty thatFamily practice is the medical specialty thatprovides provides continuing continuing and and comprehensivecomprehensive health healthcare for the care for the individual and the familyindividual and the family. It is the. It is thespecialty in breadth that specialty in breadth that integrates the biological,integrates the biological,clinical, and behavioral sciencesclinical, and behavioral sciences. The scope of. The scope offamily practice family practice encompasses all ages, both sexes,encompasses all ages, both sexes,each organ system, and every disease entity.each organ system, and every disease entity.

Family practice is Family practice is a comprehensive a comprehensive specialty specialty involving involving varying depths of varying depths of knowledgeknowledge in many disciplines. in many disciplines.

Primary Care / Family PracticePrimary Care / Family Practice

Primary care is that care provided by physiciansPrimary care is that care provided by physiciansspecifically trained for and skilled inspecifically trained for and skilled incomprehensive first contact and continuing carecomprehensive first contact and continuing carefor ill persons or those with an undiagnosed sign,for ill persons or those with an undiagnosed sign,symptom, or health concern (thesymptom, or health concern (the““undifferentiated” patient) not limited byundifferentiated” patient) not limited byproblem origin (biological, behavioral, or social),problem origin (biological, behavioral, or social),organ system, or gender.organ system, or gender.

Family practiceFamily practice emphasizes the integration emphasizes the integration of of compassion, empathy, and personalized compassion, empathy, and personalized concernconcern to a greater degree than does a more to a greater degree than does a more technical or task-oriented specialty.technical or task-oriented specialty.

Primary care is a form of delivery of medical care that Primary care is a form of delivery of medical care that encompasses the following functions:encompasses the following functions:

It is highly personalized “first-contact” care, serving as a It is highly personalized “first-contact” care, serving as a point-of-entry for the patient into the health care system;point-of-entry for the patient into the health care system;

It includes continuity by virtue of caring for patients over It includes continuity by virtue of caring for patients over a period of time, both in sickness and in health;a period of time, both in sickness and in health;

It is comprehensive care, drawing from all the traditional It is comprehensive care, drawing from all the traditional major disciplines for its functional content;major disciplines for its functional content;

It serves a coordinative function for all the It serves a coordinative function for all the health-care needs of the patient;health-care needs of the patient;

It assumes continuing responsibility for It assumes continuing responsibility for individual patient follow-up and community individual patient follow-up and community health problems; andhealth problems; and

It is a highly personalized of care.It is a highly personalized of care.

WHO IS A PRIMARY CARE WHO IS A PRIMARY CARE PHYSICIAN ?PHYSICIAN ?

A primary care physician is a generalistA primary care physician is a generalist

physician who provides definitive care to thephysician who provides definitive care to the

undifferentiated patient at the point of firstundifferentiated patient at the point of first

contact and takes continuing responsibility forcontact and takes continuing responsibility for

providing the patient’s care.providing the patient’s care.

Primary care physicians devote the majority Primary care physicians devote the majority of their practice to providing primary care of their practice to providing primary care

services to services to a defined population of a defined population of patientspatients..

Principles of Family MedicinePrinciples of Family Medicine

Comprehensiveness:Comprehensiveness:

The family physician must be comprehensive The family physician must be comprehensive trained to acquire all the medical skills necessary trained to acquire all the medical skills necessary to care for the majority of patient problems to care for the majority of patient problems including, each specialty according to its including, each specialty according to its prevalence.prevalence.

PrinciplesPrinciples

Comprehensive Care:Comprehensive Care:

-- PromotivePromotive

-- PreventivePreventive

-- CurativeCurative

-- RehabilitiveRehabilitive

PrinciplesPrinciples

Holistic Approch:Holistic Approch:

-- Bio-sycho-social and physical approach.Bio-sycho-social and physical approach.

-- Individual, family and community Individual, family and community oriented and centered rather than disease oriented and centered rather than disease orientedcare.orientedcare.

-- Team work.Team work.

PrinciplesPrinciples

Screening:Screening:-- Premarital.Premarital.-- Antenatal.Antenatal.-- Well Baby Clinic.Well Baby Clinic.-- Pre-school.Pre-school.-- Adolescent.Adolescent.-- Adults.Adults.-- Elderly.Elderly.

PrinciplesPrinciples

Prevention:Prevention:

-- Clinical prevention.Clinical prevention.

-- Clinical health educationClinical health education..

AccessibilityAccessibility

ServicesServices must be available when must be available when needed needed and should be within and should be within geographic geographic proximity.proximity.

PrinciplesPrinciples

Continuity Of CareContinuity Of Care

The family physician’s commitment to patients The family physician’s commitment to patients does not cease at the end of illness but is a does not cease at the end of illness but is a continuing responsibility, regardless of the continuing responsibility, regardless of the patient’s state of health or the disease patient’s state of health or the disease process.process.

The greater the degree of continuingThe greater the degree of continuing

involvement with a patient, the more involvement with a patient, the more capable the physician becomes in detecting capable the physician becomes in detecting early signs and symptoms of organic disease early signs and symptoms of organic disease and differentiating it from a functional and differentiating it from a functional problem.problem.

As the family physician maintains thisAs the family physician maintains this

continuing involvement with successivecontinuing involvement with successive

generations within a family, the ability to generations within a family, the ability to manage intercurrent problems increases with manage intercurrent problems increases with knowledge of the total family background.knowledge of the total family background.

PrinciplesPrinciples

FAMILY PHYSICIAN AS COORDINATORFAMILY PHYSICIAN AS COORDINATOR..

THE CONCEPT OF A GATE KEEPER.THE CONCEPT OF A GATE KEEPER.

The family physician The family physician facilitates the patient’s facilitates the patient’s accessaccess to the health care system , to the health care system , interprets interprets the activitiesthe activities of this system to him , of this system to him , explaining the explaining the nature of the illnessnature of the illness, , implications of treatment, and the implications of treatment, and the effect of effect of both upon the patient’s way of lifeboth upon the patient’s way of life..

Millis Commission Report.Millis Commission Report.

PrinciplesPrinciplesCost Effective CareCost Effective CareKnowing their patients well family physician areKnowing their patients well family physician arecapable of:capable of: Assessing the nature of their patient’s health problem more Assessing the nature of their patient’s health problem more

rapidly and accurately.rapidly and accurately. Using time as an ally in diagnosing less urgent problems.Using time as an ally in diagnosing less urgent problems. Ensuring the most logical and economical management.Ensuring the most logical and economical management. Controlling magnification of simple problem.Controlling magnification of simple problem. Ordering fewer test.Ordering fewer test.

PERSONALIZED CAREPERSONALIZED CARE

It is much more important to know what sort of It is much more important to know what sort of patient has a disease than what sort of disease patient has a disease than what sort of disease a patient has.a patient has.

PrinciplesPrinciples

Family practice emphasizes consideration Family practice emphasizes consideration of the individual patient in the full of the individual patient in the full context of his or her life, rather than the context of his or her life, rather than the episodic care of a presenting complaint.episodic care of a presenting complaint.

The physician should guard against The physician should guard against thinking in terms of diseases and instead thinking in terms of diseases and instead think in terms of patients who have think in terms of patients who have problems needing attention.problems needing attention.

The whole-person approach to patient The whole-person approach to patient care is hampered by focusing primarily care is hampered by focusing primarily on the disease.on the disease.

The family physician serves as the patients’ The family physician serves as the patients’ advocate, explaining the causes and advocate, explaining the causes and implications of illness to the patients and their implications of illness to the patients and their families, and serves as an advisor and families, and serves as an advisor and confidant to the family- both individually and confidant to the family- both individually and collectively.collectively.

Home CareHome Care

Home visitsHome visits

Outreach activitiesOutreach activities

PrinciplesPrinciples

PrinciplesPrinciples

Quality driven:Quality driven:-- Scientific soundness.Scientific soundness.-- Essential skills.Essential skills.-- Appropriate technology.Appropriate technology.-- Clinical guidelines.Clinical guidelines.-- Certification and re-certification.Certification and re-certification.-- CME & CPD.CME & CPD.-- Audit and peer review.Audit and peer review.-- Accreditation and re-accreditation.Accreditation and re-accreditation.

A strong sense of responsibility for the total, A strong sense of responsibility for the total, ongoing care of the individual and the family ongoing care of the individual and the family during health, illness, and rehabilitation.during health, illness, and rehabilitation.

Compassion and empathy, with a sincere Compassion and empathy, with a sincere interest in the patient and the family.interest in the patient and the family.

A curious and constantly inquisitive attitude.A curious and constantly inquisitive attitude.

Enthusiasm for the undifferentiated medical Enthusiasm for the undifferentiated medical problem and its resolution.problem and its resolution.

An interest in the broad spectrum of clinical An interest in the broad spectrum of clinical medicine.medicine.

The ability of deal comfortably with multiple The ability of deal comfortably with multiple problems occurring simultaneously in one problems occurring simultaneously in one patient.patient.

A desire for frequent and varied intellectual A desire for frequent and varied intellectual and technical challenges.and technical challenges.

The ability to support children during growth The ability to support children during growth and development and during their adjustment and development and during their adjustment to family and society.to family and society.

The ability to assist patients in coping with The ability to assist patients in coping with everyday problems and in maintaining everyday problems and in maintaining stability in the family and community.stability in the family and community.

The capacity to act as coordinator of all health The capacity to act as coordinator of all health resources needed in the care of a patient.resources needed in the care of a patient.

A continuing enthusiasm for learning and for the A continuing enthusiasm for learning and for the satisfaction that comes from remaining current satisfaction that comes from remaining current through continuing medical education.through continuing medical education.

The ability to maintain composure in times of stress The ability to maintain composure in times of stress and to respond quickly with logic, effectiveness, and to respond quickly with logic, effectiveness, and compassion.and compassion.

A desire to identify problems at the earliest A desire to identify problems at the earliest possible stage (or to prevent disease possible stage (or to prevent disease entirely).entirely).

A strong wish to maintain maximum patient A strong wish to maintain maximum patient satisfaction, recognizing the need for satisfaction, recognizing the need for continuing patient rapport.continuing patient rapport.

The skills necessary to manage chronic The skills necessary to manage chronic illness and to ensure maximal rehabilitation illness and to ensure maximal rehabilitation following acute illness.following acute illness.

An appreciation for the complex mix of An appreciation for the complex mix of physical, emotional, and social elements in physical, emotional, and social elements in holistic and personalized patient care.holistic and personalized patient care.

A feeling of personal satisfaction derived from A feeling of personal satisfaction derived from intimate relationships with patients that naturally intimate relationships with patients that naturally develop over long periods of continuous care, as develop over long periods of continuous care, as opposed to the short-term pleasures gained from opposed to the short-term pleasures gained from treating episodic illnesses.treating episodic illnesses.

A skill for and commitment to educating patients A skill for and commitment to educating patients and families about disease processes and the and families about disease processes and the principles of good health.principles of good health.

A truly comprehensive primary care (family) A truly comprehensive primary care (family) physician adequatelyphysician adequately

Manages acute infections. Manages acute infections. Biopsies skin and other lesions. Biopsies skin and other lesions. Repairs lacerations.Repairs lacerations. Treats musculoskeletal sprains and minor fractures.Treats musculoskeletal sprains and minor fractures. Removes foreign bodies.Removes foreign bodies. Treats vaginitis and provides obstetric care.Treats vaginitis and provides obstetric care. Care for the newborn infant. Care for the newborn infant. Gives supportive psychotherapy. Gives supportive psychotherapy. Supervises or performs diagnostic procedures.Supervises or performs diagnostic procedures.

The family physicianThe family physician must be aware of the must be aware of the variety and complexity of skills and facilities variety and complexity of skills and facilities available to help manage patients and must available to help manage patients and must match these to the individual’s specific match these to the individual’s specific needs, giving full consideration to the needs, giving full consideration to the patient’s personality and expectations.patient’s personality and expectations.

Management of an illness involves much more Management of an illness involves much more than a diagnosis and an outline for treatment . It than a diagnosis and an outline for treatment . It requires :requires :

Awareness of the factors aiding or hindering Awareness of the factors aiding or hindering recovery from illness.recovery from illness.

Consideration of religious beliefs; social, economic, Consideration of religious beliefs; social, economic, or cultural problems; personal expectations; and or cultural problems; personal expectations; and heredity.heredity.

The outstanding clinician recognizes the effects that The outstanding clinician recognizes the effects that spiritual, intellectual, emotional, social, and spiritual, intellectual, emotional, social, and economic factors have on a patient’s illness.economic factors have on a patient’s illness.

The family physician’s ability to confront The family physician’s ability to confront relatively large numbers of unselected relatively large numbers of unselected patients with undifferentiated conditions and patients with undifferentiated conditions and carry on a therapeutic relationship over time carry on a therapeutic relationship over time is a unique primary care skill.is a unique primary care skill.

The early identification of disease while it is The early identification of disease while it is in its undifferentiated stage requires specific in its undifferentiated stage requires specific training and is not a skill that can training and is not a skill that can automatically be assumed by someone whose automatically be assumed by someone whose training has been mostly in hospital intensive training has been mostly in hospital intensive care units.care units.

Interpersonal SkillsInterpersonal Skills

One of the foremost skills of the family One of the foremost skills of the family physician is the ability to effectively utilize the physician is the ability to effectively utilize the knowledge of interpersonal relations in the knowledge of interpersonal relations in the management of patients. management of patients. This powerful This powerful element of clinical medicine is perhaps the element of clinical medicine is perhaps the specialty’s most useful tool.specialty’s most useful tool.

Develop compassion and courtesy. Develop compassion and courtesy. Establish rapport. Establish rapport. Communicate effectively. Communicate effectively. Gather information rapidly and to organize it Gather information rapidly and to organize it

logically. logically. Identify all significant patient problems and manage Identify all significant patient problems and manage

them appropriately. them appropriately. Listen , observe patients and detect nonverbal clues.Listen , observe patients and detect nonverbal clues. Motivate people.Motivate people.

To relate well to patients, a physician must

Misconceptions About The Roles Of Misconceptions About The Roles Of Generalists & SpecialistsGeneralists & Specialists

The generalist has to cover the whole field of The generalist has to cover the whole field of medical knowledge.medical knowledge.

In any field of medicine the specialist always In any field of medicine the specialist always knows more than the generalist.knows more than the generalist.

By specializing one can eliminate uncertainty.By specializing one can eliminate uncertainty.

Misconceptions About The Roles Of Misconceptions About The Roles Of Generalists & Specialists (cont’d)Generalists & Specialists (cont’d)

Only by specialization one can attain depth Only by specialization one can attain depth of knowledge.of knowledge.

Error in medicine is usually caused by lack Error in medicine is usually caused by lack of information.of information.

The Family PhysicianThe Family Physician

In PracticeIn Practice

Thank YouThank You