Introduction to Family medicine
Family Practice
• Is the medical specialty that provides
continuing comprehensive health care for the
individual and the family. It is the specialty
that integrates the biological , clinical and
behavioral sciences. The scope of Family
Practice encompasses all ages ,both sexes,
each organ system and every disease entity.
Family physician
• Is a physician who is educated and trained in the
discipline of family practice and possesses unique
attitudes , skills and knowledge that qualifies him (her)
to provide continuing and comprehensive medical care
, health maintenance and preventive services to each
member of the family regardless of sex , age, or type of
problem, be it biological , behavioral, or social . The
World Organization of Family Doctors defines the
family doctor as the physician who is primarily
responsible for providing comprehensive health care to
every individual seeking medical care, and arranging
for other health personnel to provide services when
necessary.
Characteristics and functions of family
physician
• 1.A strong sense of responsibility for the total
,ongoing care of the individual and the family
during health , illness, and rehabilitation.
• 2.Compassion and empathy ,with a sincere
interest in the patient and family
• 3.A curious and constantly inquisitive attitude
• 4.An interest in the broad spectrum of clinical
medicine
• 5.The ability to deal with multiple problems
occurring simultaneously in one patient
• 6.The ability to support children during growth
and development and during their adjustment to
family and society
• 7.The ability to assist patients in coping with
every day problems and in maintaining stability
in their family and community
• 8.The capacity to act as coordinator of all health
resources needed in the care of patient
9.A desire to identify problems at the earliest possible
stage (or to prevent disease entity)
10.The skills necessary to manage chronic illness and to
ensure maximal rehabilitation following acute illness
11.A feeling of personal satisfaction derived from
intimate relationship with patients that naturally
develop overlong periods of continuous care , as
opposed to the short term pleasures gained from
treating episodic illness
12.A skill for and commitment to educate patients and
families about disease process, and the principles of
good health
Continuing Responsibility
One of the essential functions of the family physician is
the willingness to accept ongoing responsibility for
managing the medical care of patients. The
commitment of the family physician to patients does
not cease at the end of illness but is a continuing
responsibility , regardless of the state of health or
disease process.
The greater degree of continuing involvement with a
patient , the more capable the physician becomes in
detecting early signs and symptoms of organic disease
and differentiating it from a functional problem.
Patients with problems arising from emotional and
social conflicts can be managed most effectively
by a physician who has intimate knowledge of the
individual and his or her family and community
background.
Chronic illness : the family physician must also be
committed to managing the common chronic
illnesses that have no known cure but for which
continuing management by a personal physician
is all the more necessary to maintain an optimal
state of health for the patient.
The family physician as coordinator:
The family physician , has unique insights into the skills
possessed by physicians in the more limited specialties. The
family physician is best prepared to select specialists whose
skills can be applied most appropriately to a given case as
well as to coordinate the activities of each .
As medicine becomes more specialized and complex , the role
of family physician as integrator of health services becomes
increasingly important. The family physician not only
facilitates the access of patients to the whole health care
system but also interprets the activities of this system to
the patient, explaining the nature of the illness , the
implications of the treatment , and the effect of both upon
the way of patient in life.
Quality of care:
Primary care provided by physicians specifically trained to
care for problems presenting to personal physicians
and who know their patients over a spam of time is of
higher quality than that provided by other physicians.
Primary care, to be done well, requires extensive training
specifically tailored to problems frequently seen by
physicians in ambulatory care. These include the early
detection , diagnosis of cancer (especially of the breast
and colon ); the management of gynecologic problems;
and the care of those with chronic and terminal
illnesses.
1.Cost – effective care: The physician who is well
acquainted with the patient not only provides
personal and human medical care but also
does so more economically than the physician
involved only in episodic care. The physician
who knows his or her patients well can assess
the nature of their problems more rapidly and
accurately.
Because of the intimate, ongoing relationship the family
physician is under less pressure to exclude diagnostic
possibilities by use of expensive laboratory and
radiologic procedures and is more likely to use time as
an ally in diagnosing a less urgent problem than is the
physician who is unfamiliar with the patient. Medical
care should be available to patients in the precise
degree needed – neither too expensive nor too limited.
Specialists generally treat their patients more recourse
– intensively than do generalists , resulting in increased
cost of care. Family physician order fewer tests than do
specialists, perhaps because they know their patients
well.
2.Comprehensive care :the term “comprehensive medical care” spans
the entire spectrum of medicine. The effectiveness with which a
physician delivers primary care depends upon the breadth of
problems encountered during training and practice. The family
physician must be comprehensively trained to acquire all the
medical skills necessary to care for the majority of problems of
patients. The greater the number of skills omitted from the family
physicians training and practice, the more frequent is the need to
refer minor problems to another physician. A truly comprehensive
primary care physician adequately manages acute infections ,
biopsies skin and other lesions, repairs lacerations, treat
musculoskeletal sprains and minor fractures , removes foreign
bodies, treat vaginitis , provides obstetric care and care for the
newborn infant , gives supportive psychotherapy , and supervises or
performs diagnostic procedures.
Management of an illness involves much more than a diagnosis and an
outline for treatment . It also requires an awareness of all the
factors that may aid or hinder an individual recovery from illness.
This requires consideration of religious beliefs; social, economic, or
cultural problems; personal expectations; and heredity. Family
practice is a comprehensive specialty involving varying depths of
knowledge and skills of varying degrees in each specialty area ,
depending upon the prevalence of problems encountered in every
day practice and the degree of skills needed to become an excellent
diagnostician. A physician specializing in only one discipline,
however, will have a much shallower base in comprehensive
medicine and a much greater depth in the chosen discipline. The
specialist is an excellent consultant but is not trained and cannot
function effectively as a primary generalist.
3.Accessibility : it is an essential feature of
primary care. Services must be available when
needed and should be within geographic
proximity . When primary care is not available,
many individuals turn to hospital emergency
departments . Emergency room care is, of
course, fine for emergencies, but it is not a
substitute for the personalized , long – term ,
comprehensive care that a family physician
can provide.
Diagnostic skills- undifferentiated
problems
The family physician must be an outstanding diagnostician.
Skills in this area must be honed to perfection , since
problems are usually seen in their early , undifferentiated
state and without the degree of resolution that usually is
present by the time patients are referred to consulting
specialists. This is a unique feature of family practice,
because symptoms seen at this stage are often vague and
nondescript, with signs being either minimal or absent.
Unlike the consulting specialist, the family physician does
not evaluate the case after it has been preselected by
another physician, and the diagnostic procedures used by
the family physician must be selected from the entire
spectrum of medicine.