session-1-the-origins-of-fm-2013 phop.ppt

7/27/2019 session-1-the-origins-of-fm-2013 phop.ppt

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D E P T . O F P U B L I C H E A L T H & P R E V E N T I V EM E D I C I N E

F A C U L T Y O F M E D I C I N E - P A D J A D J A R A N U N I V E R S I T Y2 0 1 3

THE ORIGINS OF FAMILYMEDICINE


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SPECIFIC LEARNING OBJECTIVES

Understand family medicine as a discipline (C1)

Recognize the changes in paradigm in medicine (C1)

Understand the growth and background of family

medicine (C1) Describe the definition and scope of family medicine

(C2)

Understand the place of Family Medicine and

integrating Family Medicines efforts in Health Care(C1)


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DEFINITION OF PUBLIC HEALTH

The science and the artof:

(1) preventingdisease,(2) prolonginglife, and

(3) promotingphysical health and efficiency through organizedcommunity efforts for:

(a) the sanitation of the environment,

(b) the control of community infections,(c) the education of the individual in principles of

personal hygiene,

(d) the organization of medical and nursing service for

the early diagnosis and preventive treatment of disease,

(e) the development of the social machinery which will ensureto every individual in the community a standard of living adequatefor the maintenance of health so organizing these benefits as toenable every citizen to realize his birthright of health and longevity

(Winslow, 1920)


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PREVENTIVE MEDICINE:

a Specialized field of medical practice composed ofdistinct disciplines which utilize skillsfocusing on thehealth of defined populations in order to promote and

maintain health and well-being and prevent disease,disability, and premature death(Last, 1987)


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SOCIAL MEDICINE :

A term used to emphasize theimportance of mansenvironment to his health. In this sense, environment

includes the human society in which man lives and the

multitude of complex interpersonal relationships that soprofoundly affect his health

(Leavell & Clark, 1958)


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COMMUNITY MEDICINE

that branch of medical science which is concerned with thehealth needs and interventions of population groups ofknown size and composition. That is, it is concerned

with health of what is commonly known as definedpopulation groups

(Lathem, 1979)


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DEFINITION OF FAMILY MEDICINE

Family Medicine (FM) is the medical specialtythat provides continuing and comprehensivehealth care for the individual and the family. It isthe specialty in breadth that integrates thebiologic, clinical, and behavioral sciences. Thescope of FM encompasses all ages, both sexes,each organ system and every disease entity

(American Academy of Family Physicians/AAFP, 1993)


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FAMILY MEDICINE AS A DISCIPLINE(LEE GAN, AZWAR AND WONODIREKSO, 2004)

The other names: general practice or primary caremedicine

Family medicine is a discipline concerned with theprovision of personal, primary, comprehensive andcontinuing health care of the individual in relation tohis family, community and his environment

The term is preferred to emphasize the family as asociological unit providing support to the individual aswell as to reiterate the importance of the family in thecause and effect of health and disease in theindividual.


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SCIENTIFIC APPROACHES IN PUBLIC HEALTH

Epidemiology, Biostatistics ,Biological & physical sciences ,Social sciences,

Demographic science, Surveillance, Intervention and Evaluation

PREVENTIVEMEDICINE

SOCIAL

MEDICINE

FAMILY/PRIMARY

CARE MEDICINECOMMUNITY

MEDICINE


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FAMILY DOCTOR/ PHYSICIAN(WONCA, 1991)

The physicianwho is primarily responsible forproviding comprehensive health care to everyindividual seeking medical care, and arranging for

other health personnel to provide services whennecessary.

The FP functions asa generalistwho accepts

everyone seeking care whereas other healthproviders limit access to their services on the basisof age, sex, and/ or diagnosis.


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FAMILY DOCTOR(LEE GAN, AZWAR AND WONODIREKSO, 2004)

is a qualified medical practitioner who provides personal, primary,comprehensive and continuing health care of the individual inrelation to his family, community and his environment.

he may attendto his patients in his clinic, in their homes orsometimes in the hospital.

in treating his patients, must take into consideration the wholeperson, their psyche as well as their body systems and must nottreat just the signs and symptoms.

in providing comprehensive and continuing care , he will need tointeract with his medical colleagues.

in promoting health, he will not only treat therapeutically but also

educate and counsel his patients


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PRIMARY CARE (AAFP, 1993)

Primary Careis that care provided by physicians specifically trainedfor and skilled in comprehensive first contact and continuing care

for ill persons or those with undiagnosed sign, symptom, or health

concern not limited by problem origin (biologic, behavioral orsocial), organ system or gender.

Primary Care includes, in addition to diagnosis and treatment ofacute and chronic illnesses, health promotion, disease prevention,

health maintenance, counseling and patient education, in a

variety of health care settings such as office, inpatient, critical care,long term care, home care and day care.

Primary Care is performed and managed by a personal physicians,

using health professionals for consultation or referral as appropriate.


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PRIMARY CARE( AMERICAN BOARD OF FAMILY MEDICINE,

2004)

PC is a form of delivery of medical care that encompassesthe following functions:

1. Its first-contact care, serving as a point of entry for the

patient into health care system2. It includes continuity by virtue of caring for patients

over a period of time in sickness and in health

3. Its comprehensive care

4. It serves a coordinative function for all the health careneeds of the patient.

5. It assumes continuing responsibility for individualpatient follow-up and community health problem.

6. It is a highly personalized type of care


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FAMILY MEDICINE

HOW DID FAMILY MEDICINE BEGIN ?

WHAT ARE THE REASON WHY FAMILYMEDICINE HAS INCREASED ?


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FAMILY

MEDICINE

2. NEW

DISCIPLINE

3. HAS EVOLVED

FROM G.P

1. PARADIGM CHANGES IN

MEDICINE

Old paradigm new paradigm

HOWDID FAMILY MEDICINE BEGIN ?


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1. WHAT IS THE OLD PARADIGM IN MEDICINE ?

IS ALSO KNOWN AS THE BIOMEDICAL MODEL

A DISEASE CAN BE VIEWED INDEPENDENTLY FROM THEPERSON WHO IS SUFFERING FROM IT AND FROM HISSOCIAL CONTEXT

MENTAL AND PHYSICAL DISEASE CAN BE CONSIDEREDSEPARATELY

EACH DISEASE HAS A SPECIFIC CAUSAL AGENT

THE PHYSICIANS MAIN TASK IS TO REMOVE THE CAUSEAND RELIEVING THE SYMPTOMS

THE CLINICAL METHOD AND THE CLINICIAN USUALLYBECOMES AS AN OBSERVER AND THE PATIENT BECOMES AS

A PASSIVE RECIPIENT


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THE ANOMALIES ENCOUNTERED BYTHE OLD PARADIGM

1. THE DISEASE ANOMALY: A LARGE PROPORTION OF

ILLNESSES CANNOT BE DIAGNOSED TO A SPECIFIC DISEASE

CATEGORY

2. THE SPECIFIC ETIOLOGY ANOMALY: NOT ALL THE

POPULATION WILL GET SICK FROM THE SAME AGENT

3. THE MIND/ BODY ANOMALY: MIND AND BODY WERE

SEPARATED

4. THE PLACEBO EFFECT AS A MIND/ BODY ANOMALY

5. PHYSIOLOGICAL PATHWAYS

6. NEW KNOWLEDGE OF THE IMMUNE SYSTEM


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2. THE NEWPARADIGM IN MEDICINE

DISEASE IS NOT SEPARATED CONCEPTUALLY FROM THE PERSON, NORTHE PERSON FROM ENVIRONMENT

ALL ILLNESSES AFFECT THE PATIENT AT MULTILEVELS

THE TASK OF THE PHYSICIAN IS TO UNDERSTAND THE NATURE OF THEILLNESS ON ALL ITS LEVELS

ALL LIVING SYSTEMS ARE OPEN SYSTEMS, IN THAT EXCHANGE BOTHENERGY AND INFORMATION ACROSS THE SYSTEM INVOLVESINTERFACES OR BOUNDARIES

SYSTEM HIERARCHY IN THE HUMAN BODY ARE MOLECULES, CELLS,TISSUES, ORGAN SYSTEMS, NEUROENDOCRINE IMMUNE SYSTEMS,

PERSON, FAMILY, COMMUNITY, CULTURE AND SOCIETY.


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3. FAMILY MEDICINE HAS EVOLVED FROM G.P

G.P

F.M

A. CHANGESIN MORTALITY

AND

MORBIDITY

B. GROWTH OF

SPECIALIZATION

C. THE AGE OF G.P

AND

SPECIALIZATION

D. NEW DEVELOPMENTS IN THE

BEHAVIORAL SCIENCES

E. CHANGING ROLE OF THEHOSPITAL

F. THE AGE OF

MANAGED CARE


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A. CHANGES IN MORTALITY AND MORBIDITY

DEVELOPED COUNTRY

THE SUCCESSFUL CONTROL OFTHE MAJOR INFECTIOUS DISEASE

SEVERE ACUTE ILLNESSES

CHRONIC DISEASE

THE REDUCED MORTALITY

INCREASED THEPROPORTION OF ELDERLY

PUBLIC HEALTH TO PRIVATEHEALTH

DEVELOPING COUNTRY

DOUBLE BURDEN OF

DISEASE

COMMUNICABLE ANDNONCOMMUNICABLE DISEASES(Behavioural causes e.x. life style,smoking, abused etc)

CLEAN WATER, A BALANCED DIET AND GOOD HOUSING ARE

STILL MAJOR DETERMINANTS OF HEALTH


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B. THE GROWTH OF SPECIALIZATION

HEALERS

PROFESSION

GENERAL

PRACTITIONER

SPECIALIZATION

(MEDICAL , SURGICAL)

PUBLIC

NEEDS

SOCIAL

PRESSURES


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GEYMAN (1971), FAMILY DOCTOR/PHYSICIAN IS:

1. GENERAL PRACTITIONER

2. A SPECIALIST ( GENERAL PRACTITIONER + 3

YEARS) USA3. GENERAL PRACTITIONER OR SPECIALIST

WHO PROVIDE HEALTH SERVICES WITH THEBASIC PRINCIPLES OF FAMILY MEDICINE/

FAMILY MEDICINE APPROACHINDONESIA

4. DEVELOPED GENERAL PRACTITIONER


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D. NEW DEVELOPMENTS IN THE BEHAVIORALSCIENCES

INSIGHTS INTUITIVELY ORGANIZEDAPPROACH TO PROBLEMS

BEHAVIORAL SCIENCES HAS DIRECTED TO THEPROCESS BY WHICH PEOPLE SEEK MEDICAL CARE, ACRUCIAL FOR ALL PRIMARY PHYSICIANS

ITS MAKING US MORE AWARE OF THE

IMPORTANCE OF OUR BEHAVIOUR INDETERMINING OF THE QUALITY OF CARE

IT HAS INCREASED OUR INSIGHTS INTO THEDOCTOR PATIENT, FAMILY RELATIONSHIP AND

BEHAVIORAL ASPECTS OF ILLNESS


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NEW DEVELOPMENTS IN THE BEHAVIORALSCIENCES (CONTD)

IT HAS MADE US THINK ABOUT SOME OF THEFUNDAMENTAL ASPECTS OF MEDICINE

( CONCEPTS OF HEALTH, DISEASE AND ILLNESS, THE

ROLE OF PHYSICIAN AND THE ETHIC OF MEDICINE)

IT HAS BROUGHT TO OUR ATTENTION THE POOL OFILLNESS THAT NEVER REACHES THE MEDICAL

PROFESSION

IT HAS INCREASED OUR KNOWLEDGE OFBEHAVIORAL AND SOCIAL ECONOMIC FACTORSINVOLVED IN THE CAUSATION OF DISEASE


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50 %

20 %

20 %

10 %

Global burden of

disease, Murray &

Lopez, WHO, 1996


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E. THE CHANGING ROLE OF THE HOSPITAL

THE COST OF INPATIENT

CARE HAS BECOME SO

PROHIBITIVE THAT

CRITERIA FOR ADMISSION

TO THE HOSPITALS so

strict

FOR THOSE WHO NEED CARE FOR A

VARIETY OF PROBLEMS OVER A LONG

PERIOD OF TIME, THE HOSPITAL IS A

MUCH LESS SATISFACTORY FORM OF

CARE

FRAGMENTATION OF CARE FREQUENT CHANGES OF

PERSONNEL

THE ANTITHESIS OF

INTEGRATED PERSONAL

MEDICINE

THE HOSPITAL

PROVIDES

SPECIALIZEDSUPPORT WHEN IT

IS NEEDED

WHAT ABOUT PRE AND POST

HOSPITAL CARE ? Who provides

them ?


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F. MANAGED CARE AND THE AGE OFINTEGRATION

PRIMARY LEVEL:

FAMILY PHYSICIAN

/ GATE KEEPER

SECONDARY

LEVEL

TERTIARY LEVEL

THE OTHER HEALTHPROFESSIONALS

AND

COMMUNITY SUPPORT

SERVICES

ECONOMIC FORCES

MANAGED CARE

(HMO- US)


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WHAT TYPE OF PHYSICIAN IS DEMANDED ?

Charles Boelen :Family doctor isNOT ASOLUTION but

the bridgebetweenhospital careand publichealth.

He is able tohelp save coststhrough being afive stars doctor

DECISION MAKER

CARE and CURE PROVIDER

COMMUNICATORCOMMUNITY LEADER

MANAGER OFHEALTH

CARE

RESOURCES

DECISION MAKER


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THE FIRST THREE OF CENTRAL VALUES, ARE ATTITUDESTHAT WE WOULD WANT TO INFECT ALL DOCTORS WITH:

PATIENTS CENTRED CARE AND ATTENTION TO THEDOCTOR-PATIENT RELATIONSHIP.

HOLISTIC APPROACH TO THE PATIENT AND HISPROBLEMS THAT RECOGNIZES CONTRIBUTIONS TO ILL -HEALTH AND WELL- BEING COME FROM NOT ONLYPHYSICAL DISEASE BUT EQUALLY IF NOT MORE FROMSOCIAL ECONOMY AND PSYCHOLOGICAL DIMENSIONSIN THE PATIENT AS WELL AS FROM THE FAMILY AND HIS

COMMUNITY.

EMPHASIS ON PREVENTIVE MEDICINE BECAUSE THIS HASGREATER LONG TERM IMPACT ON HEALTH STATUS THANCURATIVE MEDICINE.


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THE NEXT THREE CENTRAL VALUES DEFINETHE FAMILY DOCTORS WORK

THE FAMILY DOCTOR LOOKS AFTER HEALTHPROBLEMS THAT MAY BE INITIALLY UNCLEAR INTERMS OF SERIOUSNESS

THE FAMILY DOCTOR LOOKS AFTER PEOPLEACROSS THE WHOLE SPECTRUM OF AGE GROUP ~HE IS A SPECIALIST IN BREADTH

THE FAMILY DOCTOR IS WILLING TO LOOKAFTER THE PATIENT NOT ONLY IN THECONSULTING ROOM BUT ALSO IN THE HOMEAND OTHER SETTINGS AS WELL


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THE PLACE OF FAMILY MEDICINE IN HEALTHCARE: DIVISION OF LABOR

FIRST CONTACT CARE (GENERAL

PRACTITIONER/ FAMILY MEDICINE

SERVICE/ PUSKESMAS)

LOOKING AFTER PATIENTSTHAT COULD BE MANAGED

OUTSIDE THE HOSPITAL


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Definition of Primary Care:The setting within a health care system, usually in the patients own

community in which the first contact with the health professional occurs

The European Definition of General

Practitioners/Family Medicine, WONCA Europe, 2002


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THE PLACE OF FAMILY MEDICINE IN HEALTH CARE:WORKING TOWARDS UNITY FOR HEALTH

INTEGRATION OF CLINICALACTIVITIES ( TO INTEGRATEWITH HOSPITAL BASEDDISCIPLINES: PAEDIATRICS,INTERNAL MEDICINE,

GERIATRICS etc)

INTEGRATION

WITH PUBLIC

HEALTH

INTEGRATION WITH SOCIAL

AND ECONOMIC

DEVELOPMENT OF THE

COUNTRY

STAND ALONE ~

DANGER

HAS THE ROLE OF INTEGRATING IN

THE MIND OF EVERY DOCTOR THE

BALANCE BETWEEN SPECIALIZATION

AND GENERALIST APPROACH IN THE

PATIENT CARE


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INTEGRATING FAMILY MEDICINES EFFORTSIN HEALTH CARE DELIVERY

1. GOOD PREVENTIVE CARE

2. GOOD ACUTE CARE

3. GOOD CHRONIC DISEASECARE MANAGEMENT

4. GOOD STEP-DOWN CARE ~ ISVERY IMPORTANT WITH THERISING COST OF ACUTEHOSPITAL CARE AND THEINCREASING NUMBERS OFTHE ELDERLY WHO TAKE ALONGER TIME TO RECOVERFROM MEDICAL ILLNESSES.

5. GOOD ELDERLYCARE

6. GOOD

DOMICILIARY CARE

7. GOOD PALLIATIVE

CARE

+


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FAMILY MEDICINE IN INDONESIA

THE CONCEPTS FIRSTLY REVEALED IN THE NATIONAL CONFERENCEOF INDONESIAN MEDICAL ASSOCIATION IN 1980

INDONESIA IS ONE OF WORLD ORGANIZATION OF NATIONAL

COLLEGE, ACADEMIC & ACADEMIC ASSOCIATION OF G.P/F.P(WONCA) MEMBERS, REPRESENTED BY THE INDONESIAN COLLEGEOF FAMILY PHYSICIANS (KDKI)

NOW: THE INDONESIAN ASSOCIATION OF FAMILY MEDICINE (PDKI)

INDONESIAN NEEDS FAMILY MEDICINE ORIENTED PRIMARY CAREDOCTORS TO BE EFFECTIVE GATE KEEPERS IN THE HEALTH CAREDELIVERY SYSTEM


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REFERENCES

1. Mc Whinney. A textbook of Family Medicine. ThirdEdition, Oxford New York, 2009. pp 5 -12.

2. Lee Gan, Azwar.A, Wonodirekso. Family MedicinePractice. Singapore, 2004. Section 3 chapter 1 pp 24-5,42-8

3. Azrul Azwar. Dokter Keluarga. Direktorat Jenderal BinaKesmas Departemen Kesehatan RI. Jakarta, 2002. pp1-15.

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