PRINCIPLES OF FAMILY MEDICINE

DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINE FACULTY OF MEDICINE PADJADJARAN UNIVERSITY

Specific Learning Objectives

• • • • Explain the philosophical foundation of family medicine (C2) Understand the principles of family medicine (C1) Describe characteristics and function of family physicians (C2) Describe the elements of family medicine practice and their interrelationship (C2)

The Principles

DEDICATED TO THE PERSON MANAGER OF RESOURCES SUBJECTIVE ASPECTS OF MEDICINE (SENSITIVITY TO FEELINGS, EMOTIONAL ETC) UNDERSTAND THE CONTEXT OF ILLNESS ALL CONTACT WITH PATIENTS AN OPPORTUNITY FOR PREVENTION & HEALTH EDUCATION HOME VISITS (SEES PATIENTS AT HOME) FAMILY PHYSICIAN LIVE IN COMMUNITY/ A PART OF THE COMPLEX OF FAMILY RELATIONSHIP DOES COMMUNITY NETWORKING THE PRACTICE AS A POPULATION AT RISK

THE PRINCIPLES ARE: 1.

FAMILY PHYSICIANS ARE COMMITTED TO THE PERSON RATHER THAN TO A PARTICULAR BODY OF KNOWLEDGE, GROUP OF DISEASES OR SPECIAL TECHNIQUES. IT IS NOT LIMITED BY THE TYPE OF HEALTH PROBLEM AND HAS NO DEFINED END POINT. 2.

THE FAMILY PHYSICIAN SEEKS TO UNDERSTAND THE CONTEXT OF ILLNESS.

3.

THE FAMILY PHYSICIAN SEES EVERY CONTACT WITH HIS PATIENTS AS AN OPPORTUNITY FOR PREVENTION OR HEALTH EDUCATION.

THE PRINCIPLES ARE (CONT

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D) 4. THE FAMILY PHYSICIAN VIEWS HIS OR HER PRACTICE AS A

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POPULATION AT RISK

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5. THE FAMILY PHYSICIAN SEES HIMSELF OR HERSELF AS PART OF A COMMUNITYWIDE NETWORK OF SUPPORTIVE AND HEALTH CARE AGENCIES 6.

IDEALLY, FAMILY PHYSICIANS SHOULD SHARE THE SAME HABITAT AS THEIR PATIENTS

THE PRINCIPLES ARE (CONT

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D) 7. THE FAMILY PHYSICIAN SEES PATIENTS IN THEIR HOMES.

8. THE FAMILY PHYSICIAN ATTACHES IMPORTANCE TO THE SUBJECTIVE ASPECT OF MEDICINE. FAMILY MEDICINE SHOULD BE A SELF REFLECTIVE PRACTICE 9. THE FAMILY PHYSICIAN IS A MANAGER OF RESOURCES

WHAT ARE THE IMPLICATIONS OF THE PRINCIPLES?

THE IMPLICATIONS ARE :

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we know people before we know what their illnesses will be

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F.M. may become part of its complex of family relationships and many of them share with their patients at the same community and habitat

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long term relationships lead to a build up of particular knowledge about patients

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F.M. can not divide body and soul as a separate subject. attention to emotions is a requirement

Physicians committed to Family Medicine … …..Physicians dedicated to the family.

WHAT ARE THE MOST IMPORTANT DIFFERENCES ABOUT : CLINICIANS NOT NORMALLY EXPLORE THE EMOTIONS OR THAT EXCLUDES ATTENTION TO THE EMOTIONS AS AN ESSENTIAL FEATURE OF DIAGNOSIS AND MANAGEMENT FAMILY PHYSICIANS ATTENTION TO THE EMOTIONS IS A REQUIREMENT AND ATTENTION TO SOCIAL ECONOMIC OF THE PATIENTS IS REQUIRED ALSO

CONTINUITY OF CARE FOR A DISCIPLINE THAT DEFINES ITSELF IN TERMS OF RELATIONSHIP, CONTINUITY IN THE SENSE OF AN ENDURING RELATIONSHIP BETWEEN DOCTOR AND PATIENT IS FUNDAMENTAL OR IS A MUTUAL COMMITMENT THE HENNEN

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S FIVE DIMENTIONS OF CONTINUITY ARE: 1. INTERPERSONAL 2. CHRONOLOGICAL Continuity between sites: home,hospital, office 3. GEOGRAPHIC 4. INTERDISCIPLINARY : meeting a variety of needs (other proffesions) 5. INFORMATIONAL : through medical record

CUMULATIVE KNOWLEDGE OF PATIENTS CONTINOUS AND COMPREHENSIVE CARE ALLOWS THE FAMILY PHYSICIAN TO BUILD UP, PIECE BY PIECE, KNOWLEDGE ABOUT PATIENTS AND FAMILIES.

THE ROLE OF GENERALIST FAMILY PHYSICIAN IS BY NATURE AND FUNCTION , A GENERALIST.

MISCONCEPTIONS OF THE ROLES OF GENERALIST AND SPECIALIST PHYSICIANS 1.

THE GENERALIST HAS TO COVER THE WHOLE FIELD OF MEDICAL KNOWLEDGE >< THE GENERALIST

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S KNOWLEDGE IS JUST AS SELECTIVE AS THE SPECIALIST 2.

IS ANY GIVEN FIELD OF MEDICINE ENCOUNTER , THE SPECIALIST ALWAYS KNOW MORE THAN THE GENERALIST >< WE BECOME KNOWLEDGEABLE ABOUT THE PROBLEMS WE COMMONLY 3.

BY SPECIALIZING, ONE CAN ELIMINATE UNCERTAINTY >< THE WAY TO ELIMINATE UNCERTAINTY IS TO REDUCED THE PROBLEMS TO THEIR SIMPLEST ELEMENT AND ISOLATE THEM FROM THEIR SURROUNDINGS.

MISCONCEPTIONS OF THE ROLES OF GENERALIST AND SPECIALIST PHYSICIANS (CONT

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D) 4.

5.

6.

ONLY BY SPECIALIZING CAN ONE ATTAIN DEPTH OF KNOWLEDGE CONTENT >< DEPTH OF KNOWLEDGE DEPENDS ON THE QUALITY OF THE MIND, NOT ON ITS INFORMATION AS SCIENCE ADVANCES, THE LOAD OF INFORMATION INCREASE >< THE IMMATURE BRANCHES OF SCIENCE THAT HAVE THE GREATEST LOAD OF INFORMATION ERROR IN MEDICINE IS USUALLY CAUSED BY LACK INFORMATION >< MUCH MORE IS CAUSED BY CARELESSNESS, INSENSITIVITY, FAILURE TO LISTEN, ADMINISTRATIVE INEFFICIENCY, FAILURE OF COMMUNICATION, ATTITUDE AND SKILL

KNOWLEDGE AND SKILLS REQUIRED IN PRACTICE OF THE FAMILY DOCTOR

KNOWLEDGE

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BASIC CLINICAL KNOWLEDGE

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THE NATURAL HISTORY OF DISEASE

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HUMAN DEVELOPMENT

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HUMAN BEHAVIOUR

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KNOWLEDGE OF PATIENT COMMUNITY AND CHANGING TRENDS

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EACH COMMUNITY HAS ITS CULTURAL,ETHNIC, DEMOGRAPHIC, GEOGRAPIC AND ECONOMIC CHARACTERISTICS THAT MAY BE RELEVANT TO PRACTICE

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KNOWLEDGE OF PROFESSIONAL COMMUNITY & CHANGING TRENDS

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EXISTING AND NEW SERVICES,COMPLEMENTARY & ALTERNATIVE MEDICINE (CAM), HERBAL MEDICINE

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OTHER PROFFESION

SKILLS

• GENERAL CLINICAL SKILLS, PRACTICAL AND PROCEDURAL SKILLS. – HISTORY TAKING, PHYSICAL EXAMINATION – SIMPLE LAB SKILLS – SIMPLE OPERATIVE SKILLS ETC • SPECIAL CLINICAL SKILLS OF IMPORTANCE TO GENERAL PRACTICE – DOCTOR PATIENT RELATIONSHIP – COMMUNICATION SKILLS – COUNSELLING AND HEALTH EDUCATION – SKILLS IN MANAGING SPECIAL GROUPS OF PATIENTS – THE SOLUTION OF UNDIFFERENTIATED PROBLEM – IDENTIFICATION OF RISKS AND EARLY DEPARTURES FROM NORMALITY. • SKILLS IN RESOURCE MANAGEMENT • PRACTICAL MANAGEMENT SKILLS (MANAGER)

References

1. Mc Whinney. A textbook of Family Medicine. Third Edition, Oxford New York, 2009. pp 13-29 2. Lee Gan, Azwar.A, Wonodirekso. Family Medicine Practice. Singapore, 2004. Section 3 chapter 2 pp 49-56.

3. Azrul Azwar. Dokter Keluarga. Direktorat Jenderal Bina Kesmas Departemen Kesehatan RI. Jakarta, 2002. pp 1-15, 23-31