Definitions:
(WHO)HYPERLINK "http://dictionary.reference.com/browse/World%20Health%20Organization"World Health Organization: a United Nations agency to coordinate international health activities and to help governments improve health services.Health
Primary health care (PHC):
Levels of health care:
Primary health care
Secondary health care:
Tertiary health care:
Primary care: includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g., critical care, long-term care, home care, day care, etc.). Primary care is performed and managed by a personal physician often collaborating with other health professionals, and utilizing consultation or referral as appropriate.
Family medicine: is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences.
The scope (range) of family medicine encompasses (include) all ages, both sexes, each organ system and every disease entity.
Family medicine is a discipline concerned with the provision of personal, primary, comprehensive and continuing health care of the individual in relation to his family, community and his environment.
Personal care
This is care that is delivered with a close relationship between the patient and the doctor. The patient may consult his family doctor not only when he is unwell but may seek his counsel as a friend and adviser.
Primary care
This is first contact care. In primary care, the patient may present with one or more of the following reasons (reasons for encounter):
Pain or other symptoms; Accident and emergency; preventive health care;
Administrative requirements: physical check-up and certification;
Seeking assurance (worry about the meaning of symptoms) & problems of living;
Continuing care
Continuing care is care of a chronic medical problem which requires regular monitoring and care of acute complications.
Comprehensive care
Comprehensive care has three meanings:
(i) Comprehensive in that it cares for all age groups;
(ii) Comprehensive in that it include promotive, preventive, curative, rehabilitative and palliative care;
(iii) Comprehensive in that it deals not only with the physical but also social and psychological problems (that is, whole person medicine).
Bio-psycho-social model of illness:
It is important to recognise that every illness has varying admixtures of physical, social and psychological consequences. It is not enough to pay attention to the physical aspects only.In general practice, a proportion of patients may have a social or psychological problems as the underlying cause of ill health and these may be presented as physical complaints.
The family as the unit of care.
The family doctor looks after more than one member of the family. The doctor gets to know the health of the family as an unit. Also as the family goes through its family life cycle, there are new tasks that the family has to complete. The family doctor is often called to provide his advice and care.
Attribute of family physician (خاصية صفة مميزة)
The basic characteristics of the family medicine and their derivative attributes allow family physician to contribute substantially to health care systems in all countries despite differences in the way these systems are planned, organized and managed.The group of World Health Organization Regional Office for Europe summarized the attributes of family practice as follows :
General:
Continuous:Comprehensive:
Coordinated:
Collaborative:
Family-oriented:
Community-oriented:
Family medicine is a three-dimensional specialty, incorporating (1) knowledge, (2) skill and (3) process. Although knowledge and skill may be shared with other specialties, the family medicine process is unique. At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.
*The cornerstone of family medicine is patient-physician relationship with integrated care.
*This relationship is the key for maintaining long-term good health; this is why Family physician asks questions about the patient family health history and lifestyle to determine the patient health risk factors. Research shows that people who have an ongoing relationship with a primary care physician have better overall health outcomes; lower death rates and lower total costs of care.
*The patient-physician relationship is built on: Honesty, trust and confidentiality.
The provision of good personal care by the doctor is important in maintaining a long-term relationship with the patient.
Training of family medicine doctor:
In Iraq ;The family physician is a specialist doctor how had completed 4 years post graduate study and had aboard degree in family medicine and he is a member of the Iraqi Counsel of Medical Specializations.The post graduation specialty include three-year residency during which they receive training in several major and minor medical areas:
Care for all ages from infants to elderly and both gender.
Care for chronic conditions, such as, diabetes, asthma and heart disease.
Ear, nose and throat care (ENT).
Emergency medical care.
Minor surgical procedures.
Mental and behavioral health care.
Bone and joint care.
X-rays, ultrasound.
Care of the urinary system.
The place of family medicine in health care
General Practice/Family Medicine is concerned with primary care (first contact care) whilst the hospital is concerned with secondary and tertiary care. Such a division of labour is cost effective on available health care resources; seeing specialists for routine care is wasteful of time and money.
A well developed General Practice/Family Medicine service will relieve the workload on the hospital by looking after patients that could be managed outside the hospital:
minor illnesses,
post hospitalisation and rehabilitative care,
terminal care that the hospital can no longer help,
continuing care of chronic problems like hypertension, diabetes,
Care of conditions that can be done jointly with the hospital e.g., cardiovascular disease, bone and joint problems, chronic skin problems.
Consultation and Referral:
Consultation: It is a situation when a patient seeks medical information, advice and treatment from a doctor.
Consultation for a second opinion occurs when a family physician refers his patient to a consultant or specialist to seek an expert opinion
A consult is a request for advice or assistance with a specific question, with the understanding that the consulting physician will return the patient back to his primary physician, the primary physician will discuss the consultant's findings and recommendations with the patient and proceed with the agreeable diagnosis and treatment plan.
Referral: It is a situation when a family physician refers his patient to a specialist for his expert opinion and treatment. The consultant specialist takes over the management of this referred patient and subsequently refers the patient back to the family physician after the treatment has been completed.
A referral involves the primary physician sending the patient for the diagnosis and follow-up treatment of a specified condition.
Although the primary physician expects to be kept informed of the patient's progress, the referral physician keeps the patient for the duration of the treatment period for the original condition. The patient continues to see his primary physician for other problems and for health maintenance.
Good and proper management of the consultation or referral is of utmost importance in providing quality care to all patients.
The family doctor should realize his ethical, moral and legal duties in referring a patient. The consultant should also realize what is expected of him and his obligations. This way, the doctor-patient relationship will be maintained and any discontent experienced by the patient will be minimized.
Do and do not in consultation and referral:
Primary care (family) doctors should:
Choose consultants who are professionally competent.
Explain to patients why are being asked to see another doctor and what that doctor is likely to do (Prepare them mentally and financially especially when surgery is contemplated).
Try to match the skill and expertise of the specialist to the condition, personality and financial capability of the patient.
Do not refer your patient to a close friend or relative without the above consideration.
Try to make the appointment for your patient.
Provide clear instructions as to whether this is a consultation or a referral.
Identify the questions or problems that the consultant or referral physician is to address.
Write a good referral letter:
Brief and to the point
Include relevant history, physical examination and test results so that they are available when the patient arrives( lab results, X-rays , ultrasound, CT scan results)
Describe any treatment that have already been tried and their effectiveness.
Give your opinion, ask specific questions or identify the problems that the (consultant or referral) physician is to address or answer.
Phone directly for urgent conditions and early appointments.
Provide feedback to the consultant about the patient progress.
Physicians receiving consultations and referrals should:
Keep the primary physician informed about the status of the patient.Have copies of all reports, operative notes, laboratory tests, and pathology results sent to the primary physician.
Call the primary physician personally with results that are ominous and unexpected.
Never, except in a true emergency, send the patient on to another physician without the approval of the primary physician.
Never make remarks that may be interpreted by the patient as disparaging to the primary physician. Such concerns should be discussed privately between the two involved physicians.
Always return the patient to the primary doctor.
Medical records: (family health file family file)
A medical record, health record, or medical chart is a systematic documentation of a HYPERLINK "http://en.wikipedia.org/wiki/Patient" \o "Patient"patient's HYPERLINK "http://en.wikipedia.org/wiki/Medical_history" \o "Medical history"medical history and HYPERLINK "http://en.wikipedia.org/wiki/Health_care" \o "Health care"care. The term 'Medical record' is used both for the physical folder for each individual patient and for the body of information which comprises the total of each patient's health history.
Medical records are intensely personal documents and there are many HYPERLINK "http://en.wikipedia.org/wiki/Ethical" \o "Ethical"ethical and HYPERLINK "http://en.wikipedia.org/wiki/Legal" \o "Legal"legal issues surrounding them such as the access and appropriate storage and disposal.
Purpose:
1-The information contained in the medical record allows health care providers to provide continuity of care to individual patients.
2-The medical record also serves as a basis for planning patient care
3-documenting communication between the health care provider and any other health professional contributing to the patient's care
4-assisting in protecting the legal interest of the patient and the health care providers responsible for the patient's care, and documenting the care and services provided to the patient.
5-In addition, the medical record may serve as a document to HYPERLINK "http://en.wikipedia.org/wiki/Education" \o "Education"educate HYPERLINK "http://en.wikipedia.org/wiki/Medical_school" \o "Medical school"medical students/HYPERLINK "http://en.wikipedia.org/wiki/Medical_residency" \o "Medical residency"resident physicians.
6-to provide data for HYPERLINK "http://en.wikipedia.org/wiki/Quality_control" \o "Quality control"quality assurance, and to provide data for medical research.
A good medical records should fulfills three criteria:
It is comprehensive, relevant information about the patient.Data entry should be easy.
Confidentiality must be easily maintained.
There are two types of medical records; 1- Paper records. 2-Electronic records.
The main challenges facing family medicine in Iraq are:
Security problem, limited financial resources, poor awareness about concepts and role of Family Medicine in the community.Interrupted referral system.
Health care services fragmented and not comprehensive.
Absence of clear curriculum and guidelines for Family Medicine doctor.
Limited number of qualified doctors in the speciality of family medicine.
Presence of no clear job description for family physicians.
Absence of trained paramedical staff in family medicine.
Weakness of medical records in PHC centres
Shortage of facilities & lack of well designed plan for transferring patient to emergency unit or hospital when necessary.
Dr. Huda Adnan AL-M usawie Family medicine 2014