EVOLUTION &CONCEPTS EVOLUTION &CONCEPTS OFOF

FAMILY MEDICINEFAMILY MEDICINE

Dr. Riaz QureshiDr. Riaz Qureshi

Distinguished Professor Distinguished Professor

Department of Family & Community Department of Family & Community MedicineMedicine

King Saud University, RiyadhKing Saud University, Riyadh

Objectives

- Become familiar with the history and Become familiar with the history and evolution of Family Medicineevolution of Family Medicine

- Understand the concepts of Family - Understand the concepts of Family Medicine and its central & universal role in Medicine and its central & universal role in the health care systemthe health care system

- Become aware of the desirable qualities of a - Become aware of the desirable qualities of a Family Physician and essentials of a Family Family Physician and essentials of a Family Medicine consultationMedicine consultation

History of Family Medicine

EVOLUTION: The age of the General EVOLUTION: The age of the General Practitioner / The age of Practitioner / The age of Specialization/Family Medicine as a Specialization/Family Medicine as a Clinical and Academic Discipline Clinical and Academic Discipline

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

Unequal access to disease prevention & Unequal access to disease prevention & carecare

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 option to The WHO also states, that the best option to overcome these barriers is to utilize the overcome these barriers is to utilize the services of trained Family Physiciansservices of trained Family Physicians

Health outcome indicators

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

She proved in a large multicentre study that the She proved in a large multicentre study that the health outcome indicators are significantly better health outcome indicators are significantly better in those countries in which Family Medicine plays in those countries in which Family Medicine plays a central role in the health care system a central role in 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 Family Medicine is a medical specialty of first contact with the patients and is specialty of first contact with the patients and is devoted to providing preventive, promotive, devoted to providing preventive, promotive, rehabilitative and curative care, with emphasis rehabilitative and curative care, with emphasis on the physical, psychological and social on the physical, psychological and social aspects, for the patient, his family and aspects, for the patient, his family and community.community.

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

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

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

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

Oil rich countries -- Saudi Arabia and Kuwait?Oil rich countries -- Saudi Arabia and Kuwait?

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

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

10 Cs OF FAMILY PRACTICE10 Cs OF FAMILY PRACTICE1.1. CC = Caring/Compassionate= Caring/Compassionate2.2. CC = Clinically Competent= Clinically Competent3.3. CC = Cost-effective Care= Cost-effective Care4. 4. CC = Continuity of Care= Continuity of Care5. 5. CC = Comprehensive Care= Comprehensive Care6.6. CC = Common Problems Management= Common Problems Management7.7. CC = Co-ordination of Care= Co-ordination of Care8.8. CC = Community-based Care & Research= Community-based Care & Research9. 9. CC = Continuing Medical Education= Continuing Medical Education10. 10. CC = Communication & Counseling = Communication & Counseling

Skills` with confidentiality Skills` with confidentiality

1.1. C = CARINGC = CARING

Caring/Compassionate careCaring/Compassionate care

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

Personal CarePersonal Care

2.2. C = CLINICALLYC = CLINICALLY COMPETENT COMPETENT

Only caring is not enoughOnly caring is not enough

Need for 4 years training after graduation Need for 4 years training after graduation and internshipand internship

3.3. C = COST- EFFECTIVEC = COST- EFFECTIVE

In time and moneyIn time and money

Gate keeper- Appropriate resources useGate keeper- Appropriate resources use

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

4.4. C = CONTINUITY C = 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 = COMMON PROBLEMSC = COMMON PROBLEMS MANAGEMENT MANAGEMENT

EXPERTISEEXPERTISE

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 = CONTINUING C = CONTINUING MEDICAL MEDICAL

EDUCATION (CME) EDUCATION (CME)To keep up-to-dateTo keep up-to-date

Need for breath of knowledgeNeed for breath of knowledge

8.8. C = CO-ORDINATIONC = 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 Preventive, promotive, rehabilitative and curative care in patients own environment.curative care in patients own environment.

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

10.10. C = COMMUNICATION &C = 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?Examination/Diagnosis ? Differential diagnosis? Investigations & Management with patients involvement, Investigations & Management with patients involvement,

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

CONCLUSIONCONCLUSION

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

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

Thank you

Have a nice dayHave a nice day