CONCEPTS OF FAMILY CONCEPTS OF FAMILY MEDICINEMEDICINE

Dr. Riaz QureshiDr. Riaz Qureshi

Distinguished Professor Distinguished Professor

Family & Community MedicineFamily & Community Medicine

King Saud University, RiyadhKing Saud University, Riyadh

Objectives :

To become aware of the history of Family MedicineTo become aware of the history of Family Medicine To understand the concepts of Family Medicine, including To understand the concepts of Family Medicine, including

its definitionits definition To become aware of the major barriers to equitable health To become aware of the major barriers to equitable health

carecare To become familiar with the desirable qualities of a To become familiar with the desirable qualities of a

Family PhysicianFamily Physician

History of Family Medicine

EVOLUTION:EVOLUTION: The age of the General PractitionerThe age of the General Practitioner

The age of SpecializationThe age of Specialization

Family Medicine as a Clinical and Academic Discipline Family Medicine as a Clinical and Academic Discipline

Major barriers to equitable health Major barriers to equitable health care - WHOcare - WHO

Unequal access to disease prevention & careUnequal access to disease prevention & care

Rising cost of health care Rising cost of health care

Inefficient health care systemInefficient health care system

Lack of emphasis on Generalists’ (Family Lack of emphasis on Generalists’ (Family Medicine) trainingMedicine) training

How to overcome these barriers ?

The WHO also states, that the best optionThe WHO also states, that the best option

to overcome these barriers is to utilize to overcome these barriers is to utilize services of trained Family Physiciansservices of trained Family Physicians

Health outcome indicators

Barbra Starfield study confirmed that the central role of Barbra Starfield study confirmed that the central role of Family Medicine in the health care system of a country Family Medicine in the health care system of a country results in enhanced quality & cost-effective care .results in enhanced quality & cost-effective care .

She proved in a large multicentre study that the health She proved in a large multicentre study that the health outcome indicators are significantly better in those outcome indicators are significantly better in those countries in which Family Medicine plays a central role in countries in which Family Medicine plays a central role in the health care system the health care system

Problems in the communityProblems in the community

75% Self care75% Self care

25% Consult FP25% Consult FP

2.5%2.5% Hosp

Concepts of Family MedicineConcepts of Family Medicine

DEFINITION:DEFINITION:

Family Medicine is a medical specialty of first Family Medicine is a medical specialty of first contact with the patient, devoted to providing, contact with the patient, devoted to providing, preventive, promotive , rehabilitative and curative preventive, promotive , rehabilitative and curative health care, with physical, psychological and social health care, with physical, psychological and social aspects, for the patient, his family and the aspects, for the patient, his family and the community.community.

The scope is not limited by system, organ, disease The scope is not limited by system, organ, disease entity, age or sex.entity, age or sex.

The Need For Trained Family The Need For Trained Family Physicians Physicians

The central role of a well trained Family Physician in health The central role of a well trained Family Physician in health care is well recognized in:care is well recognized in:

Developed countries -- UK, USA and CanadaDeveloped countries -- UK, USA and Canada

Oil rich countries – Gulf countries ??Oil rich countries – Gulf countries ??

Developing countries -- ? ? ? ? ?Developing countries -- ? ? ? ? ?

The need is even greater in all less developed countries. The need is even greater in all less developed countries.

10 Cs of desirable qualities in a family 10 Cs of desirable qualities in a family physicianphysician::

11 = Caring/Compassionate= Caring/Compassionate22 = Clinically Competent= Clinically Competent33 = Cost-effective Care= Cost-effective Care

44 = Continuity of Care= Continuity of Care 55 = Comprehensive Care= Comprehensive Care

66 = Common Problems Management= Common Problems Management77 = Co-ordination of Care= Co-ordination of Care88 = Community-based Care & Research= Community-based Care & Research

99 = Continuing Professional Development= Continuing Professional Development 1010 = Communication & Counseling = Communication & Counseling

Skills` with confidentiality Skills` with confidentiality

1.1. C C = CARING= CARING

Caring/Compassionate careCaring/Compassionate care

An essential quality in a Family PhysicianAn essential quality in a Family Physician

Personal patient centered CarePersonal patient centered Care

2.2. C = C = CLINICALLYCLINICALLY COMPETENT COMPETENT

Only caring is not enoughOnly caring is not enough

Need for four years training after Need for four years training after graduation and internshipgraduation and internship

3.3. C C = COST- EFFECTIVE= COST- EFFECTIVE

In time and moneyIn time and money

Gate keeper- Use of appropriate resources Gate keeper- Use of appropriate resources

Use of time as a diagnostic toolUse of time as a diagnostic tool

4.4. C C = CONTINUITY = CONTINUITY OF CARE OF CARE

For acute, chronic, from childhood to old For acute, chronic, from childhood to old age, and terminal care patients and those age, and terminal care patients and those requiring rehabilitation.requiring rehabilitation.

Preventive care/ Promotion of healthPreventive care/ Promotion of health

Care from cradle to graveCare from cradle to grave

5.5. C C = COMPREHENSIVE = COMPREHENSIVE CARECARE

Responsibility for every problem a Responsibility for every problem a patient presents withpatient presents with

Physical, Psychological & SocialPhysical, Psychological & Social

Holistic approach with triple diagnosisHolistic approach with triple diagnosis

6. 6. C = C = COMMON PROBLEMS COMMON PROBLEMS MANAGEMENT MANAGEMENT

e.g. Hypertension, Diabetes, Asthma, e.g. Hypertension, Diabetes, Asthma, Depression, Anemia, Allergic Rhinitis, Depression, Anemia, Allergic Rhinitis, Urinary Tract InfectionUrinary Tract Infection

Common problems in children and Common problems in children and womenwomen

7.7. C C = CONTINUING = CONTINUING PROFESSIONAL DEVELOPMENT PROFESSIONAL DEVELOPMENT

To keep up-to-dateTo keep up-to-date

Need for breath of knowledgeNeed for breath of knowledge

8.8. C C = CO-ORDINATION= CO-ORDINATION OF CARE OF CARE

Patient’s advocate

Organizing multiple sources of help

9. C = COMMUNITY BASED CARE AND RESEARCH

Care nearer patients’ homeCare nearer patients’ home

Preventive, promotive, rehabilitative and curative Preventive, promotive, rehabilitative and curative care in patient’s own environmentcare in patient’s own environment

Relevant research within the patient’s own Relevant research within the patient’s own surroundingssurroundings

10.10. C = C = COMMUNICATION &COMMUNICATION & COUNSELING SKILLS COUNSELING SKILLS

Essential for compliance of advice and Essential for compliance of advice and treatment/sharing understandingtreatment/sharing understanding

Confidentiality and safety nettingConfidentiality and safety netting

Needed for patient satisfactionNeeded for patient satisfaction

Involving patient in the managementInvolving patient in the management

Essentials of a Family Medicine Consultation Meet & greetMeet & greet All the components of history, including medication, All the components of history, including medication,

personal and Psychosocial with patient centered approachpersonal and Psychosocial with patient centered approach SummarizationSummarization ICE: Ideas, concerns &expectations and effects on ICE: Ideas, concerns &expectations and effects on

patient’s day to day life & workpatient’s day to day life & work Examination/Diagnosis ? Differential diagnosis?/ Red Examination/Diagnosis ? Differential diagnosis?/ Red

flagsflags Investigations & Management with patient’s involvement, Investigations & Management with patient’s involvement,

safety netting , appropriate F/U & Referral?safety netting , appropriate F/U & Referral?

CONCLUSIONCONCLUSION

The principles and competencies required for the The principles and competencies required for the practice of Family Medicine are universal.practice of Family Medicine are universal.

They are applicable to all cultures and all social They are applicable to all cultures and all social groups, from richest to the poorest in the communitygroups, from richest to the poorest in the community

THANK YOU

Have a nice dayHave a nice day