Family medicine
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Transcript of Family medicine
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FAMILY MEDICINE
ORIENTATION
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FAMILY MEDICINE
PROF DR M. A. BADR
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Family medicine
Prevention & health promotion
WONCA
World organization of family doctors
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Family medicine
• Provide: Primary care ethics
PERSONAL
COMPREHENSIVE
CONTINUING CARE
Primary care ethics
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FAMILY PHYSICIAN
• Ability to evaluate new information and its relevance to the practice
• Knowledge & skill
• Appropriate use of medical records and or other information system
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FAMILY PHYSICIAN
• Efficient management of the organization or business aspects of practice
• The ability to plan and implement policies screening and preventive care
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BASIC COMPONENTS
• Access to care
• Continuity of care
• Comprehensive care
• Coordination of care
• Contextual care
• Community and family based
• Evidence based health care
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FAMILY MEDICINE
• STRUCTURE Presence, access,continuity
• PROCESS EBM
• OUTCOME Prevention , health promotion
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COMPETENCIES OF F.P.
• Acute health problem• Chronic health problem• Provide health promotion services• Emergency services• Counseling• Preventive• Terminal and palliative• Home care
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COMPETENCIES IN FMWHAT KNOW
DOIN ORDER TO BE EFFECTIVE
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ORGANIZATION AND CATEGORIZATION OF
COMPETENCIES• COMMUNITY BASED
• PATIENT- PHYSICIAN RELATIONSHIP
• SKILLED CLINICIAN
• RESOURCE TO A DEFINED POPULATION
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ORGANIZATION AND CATEGORIZATION OF
COMPETENCIES FM EXPERT
• COMMUNICATOR
• COLLABORATOR
• MANAGER
• HEALTH ADVOCATE
• SCHOLAR
• PROFESSIONAL
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Reception
• Identification
• Appointment –Reminder communication
• Interpersonal communication
• Waiting room Hand-out, pamphlets, media,
• Call for file ( confidential)
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PreventionPrevention
Patient education includePatient education include::
•Careful selection of Careful selection of footwearfootwear..
•Daily inspection of the Daily inspection of the feetfeet..
•Daily foot hygieneDaily foot hygiene..•Avoidance of self-Avoidance of self-
treatmenttreatment..•Avoidance of high-risk Avoidance of high-risk
behaviorbehavior..•Consultation if an Consultation if an
abnormality arisesabnormality arises
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Documentationdouble sward
• Personal data
• Date & Time
• Communication Mobile no/ address
• File revision
• Notification about ADR allergy
• Oral anticoagulant
• Hereditary disease, sickling, G-6-P def
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Physician visit
• Complaint and history of recent c/o
• > of 70% of the diagnosis
• Try to be a good listener, no interfere, interest, concentrating
• VITAL IS VITAL Temp, pulse, Bp
• Examination in the presence of a nurse
• Rapid decision if emergency hypotension
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Process
• Safe
• Effective guidelines
• Efficient
• Timely
• Patient centered
• Equity discrimination
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Guidelines
• Consensus
• Guidelines National, International
• Evidence based care
• Use of Algorithm and chart
• Quantitative medicine, personalized, individualized medicine
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Continuous performance improvement
• Safety limit transmission of infection , hand hygiene
• Guidelines
• Keep record for your error
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SOAP
• Subjective
• Objective
• Assessment, analysis
• Plan
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PLAN
• Life style modification• Diet• Exercise• Sick leave• Medication• Consultation• Reference health education• Revision and follow up
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Medications
• Prescription, handwriting
• Pharmacological name, dose, frequency, route, initial dose, duration, ADR
• ADR avoidable , nonavoidable
• Wrong prescription
• Role of the pharmacist
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Non avoidable
• Sensitivity test
• Anaphylaxis
• Severe reaction erthyma Multiformis,Steven Jonhson
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Avoidable
• Personalized Medicine pharmacogenomic, genetic make up
• Can be predictable >25% of commonly used drug (array)
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MAR medication administration record
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COPE computerized physician order entry
• Computerized physician order entry (CPOE) is the process of entering medication orders or other physician instructions electronically instead of on paper charts. The use of a CPOE system can help reduce errors related to poor handwriting or transcription of medication orders. Physician assistance
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Personalized medicine
• Right patient
• Right treatment
• Right time
• Right dose according genetic make up of patient
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Quantitative medicine is the key to reducing healthcare costs and improving
healthcare outcomes
Patients with same diagnosis
Misdiagnosed
Non-responders,toxic responders
Non-toxic responders
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Asthma Drugs 40-70%Beta-2-agonists
Hypertension Drugs 10-30%ACE Inhibitors
Heart Failure Drugs 15-25% Beta Blockers
Anti Depressants 20-50%SSRIs
Cholesterol Drugs 30-70% Statins
Major drugs ineffective for many…
Source: Amy Miller, Personalized Medicine Coalition
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The PromiseImagine when doctors can…
• Prevent Disease by identifying risks, early interventions
• Diagnose Conditions less Predict Disease pre-symptomatically with simple testing
• invasively, more accurately
• Select Drugs that maximize benefits and minimize risks
• Calibrate Treatments to heighten efficacy and recovery
• Treat/Cure Disease using our own genes
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Take five
• BE with us
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Common clinical diagnosis
• Hypertension• Chest pain , chest infection, asthma• Diabetes• GIT, jaundice ,Diarrhea• Coma & syncope• Stroke• Trauma• fever
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Office BP Measurement
§ Use auscultatory method with a properly calibrated and validated instrument.
§ Patient should be seated quietly for 5 minutes in a chair (not on an exam table), feet on the floor, and arm supported at heart level.
§ Appropriate-sized cuff should be used to ensure accuracy.
§ At least two measurements should be made.
§ Clinicians should provide to patients, verbally and in writing, specific BP numbers and BP goals.
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BP Measurement Techniques
MethodBrief Description
In-officeTwo readings, 5 minutes apart, sitting in chair. Confirm elevated reading in contralateral arm.
Ambulatory BP monitoringIndicated for evaluation of “white-coat” HTN. Absence of 10–20% BP decrease during sleep may indicate increased CVD risk.
Self-measurementProvides information on response to therapy. May help improve adherence to therapy and evaluate “white-coat” HTN.
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Blood Pressure Classification
Normal<120and<80
Prehypertension120–139or80–89
Stage 1 Hypertension140–159or90–99
Stage 2 Hypertension>160or>100
BP ClassificationSBP mmHgDBP mmHg
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Benefits of Lowering BP
Average Percent Reduction
Stroke incidence 35–40%
Myocardial infarction 20–25%
Heart failure 50%
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Laboratory Tests
Routine Tests• Electrocardiogram • Urinalysis • Blood glucose, and hematocrit • Serum potassium, creatinine, or the corresponding estimated GFR,
and calcium• Lipid profile, after 9- to 12-hour fast, that includes high-density and
low-density lipoprotein cholesterol, and triglycerides
Optional tests • Measurement of urinary albumin excretion or albumin/creatinine ratio
More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved
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Hassan age 50 years
• Presented to you with severe throbbing headache, chills, epig pain and vomit once Past history of hypertension,dyslipidemia
• Pulse full, Bp 200/120, lung showed bilateral basal fine crepitation
• Ask the patient about important symptoms
• What you will do if you are in OPD
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Hilal 18 years old known type1
• c/o of epig pain vomiting, fever , diarrhea
• He miss last night insulin dose
• He ring you this morning at 10:00
• What is your advise to Hilal
• You propose what?
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Mr Hamdi 45 ys old
• Vomit this morning brown colouration vomitus after an overnight severe nausea
• Several days before he seeked the advise of the orthopedic surgeon for a low backache and girdle pain
• Ask him few question
• Decide what to do if you examine him home
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Amira young female 22 years old
• C/o of vertigo, vomiting , unsteady gait associated with severe headache, she was on antibiotic because of an upper respiratory tract infection few days before
• Your examination revealed afebrile, nystagmus , brisky reflex on both LL.
• Is it serious, what you will do
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Soad pregnant in her last trimest
• Referred by her obstetrician because her last urine analysis showed + sugar ,FBS is 90, her PP is 116mg%
• Is she gest diabetes
• What you will recommend
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Ali young asthmatic patient
• c/o since yesterday something giving way in his rt lower chest after cough
• Today his respiration not at ease and suffer from stitching pain on the same side during walking
• Examination revealed only mild degree of fever 37.4
• Decision
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60 ys old lady
• Fever, rigor, bilateral loin pain and scanty urine
• Past history of renal stones, gout, HTN,osteoathrosis
• What you will do as investigations
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Ahmed 34 year old
• c/o of lower left pricking sensation in the chest
• Few day later rash appear in the same area and extend , associated with general illhealth
• What you will ask him ?
• DD
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50 years old male
• C/o progressive loss of wt, anorexia, night fever
• No cough • Examination revealed significant loss wt• Few L node enlargement deep cervical
group, shotty ,rubbery not fixed • CBC lymphopenia, normocytic ,
normochromic anaemia and shooting ESR• Discuss the case and make a plan
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40 years old patient
• Irregular palpitation since last night
• Past history of similar condition
• Pulse completely irregular and rapid
• Bp 120/80
• ECG AF
• Discuss the case and manage