Role of family Physicians in Jeddha by xiaopangnv


									Role of family Physicians
Family medicine has been
defined as:
   A field of specialization in medicine
    which is neither disease nor organ
    oriented. It is family oriented
    medicine or health care centered on the
    family as the unit from first contact to
    the ongoing care of chronic problems
    (from prevention to rehabilitation)
Family doctors replace
 general practitioners who
 would give:
 comprehensive and

 personalized care.
The family physician provides:
                       Health care-
                      from the first
        In a                           Comprehensive care
                                       Continuing care

                                         that have no
        with cost-
                                         known cure
       health care.      Coordination
1- Health care from the first contact

       It is first-contact care, serving as a
          point of entry for the patient into
              the health care system.

   Provides the first contact for a
    person with an undiagnosed health
    concern of varied medical
    conditions, not limited by cause,
    organ, system, or diagnosis.
       2- Comprehensive Care

   The term comprehensive medical care
    spans the entire spectrum of medicine.

   The family physician must be trained
    comprehensively to acquire all the
    medical skills necessary to care for the
    majority of patient problems
1-   Promotive
2-   Preventive
3-   Curative
4-   Rehabilitative
         3- Continuing care
        (Continuing Responsibility)
   One of the essential functions of the family
    physician is the willingness to accept
    ongoing responsibility for managing a
    patient's medical care.
   Once a patient or a family has been
    accepted into the physician's practice,
    responsibility for care is both total and
   There is no need to identify the beginning
    or endpoint of treatment because care of a
    problem can be reopened at any time.
   Advantages of continuing
1- The greater the degree of
 continuing involvement with a
 patient, the more capable the
 physician is in detecting early
 signs and symptoms of organic
 disease and differentiating it from a
 functional problem.
   Advantages of continuing
2- 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 of his or her family and
  community background.
   Advantages of continuing
3- This longitudinal view is particularly
  useful in the care of children and allows
  the physician to be more effective in
  assisting children to reach their full
 Families receiving continuing,
     comprehensive care

have fewer incidences of

fewer physician visits for illnesses

fewer operations
  4- Common chronic illnesses
    that have no known cure

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

It is a difficult to manage these continuing, unresolvable,
and progressively crippling problems, control of which
requires a remodeling of the lifestyle of the entire
5- Coordination and integration with No
fragmentation and cost-effective health care

 Coordination and integration of all
 necessary health services with the least
 amount of fragmentation and the skills
 to manage most medical problems allow
 family physicians to provide cost-
 effective health care.
         Cost-effective Care
   The physician who is well acquainted
    with the patient not only provides more
    personal and humane medical care but
    does so more economically than does
    the physician involved in only episodic
    care. The physician who knows his or
    her patients well can assess the nature
    of their problems more rapidly and
         Cost-effective Care
   Because of the intimate, ongoing
    relationship, the family physician is
    under less pressure to exclude
    diagnostic possibilities by use of
    expensive laboratory and radiographic
    procedures than is the physician who is
    unfamiliar with the patient
     6- Confidential relationship and a
      highly personalized type of care.

   Family physicians do not just treat
    patients; they care for people. This
    caring function of family medicine
    emphasizes the personalized approach
    to understanding the patient as a
    person, respecting the person as an
    individual, and showing compassion for
    his or her discomfort.
The best illustration of a caring and compassionate physician is "The
Doctor" by Sir Luke Fieldes showing a physician at the bedside of an
ill child in the preantibiotic era. This painting has become the symbol
for medicine as a caring profession.
   Caring without science is well-
    intentioned kindness, but not medicine.
   On the other hand, science without
    caring empties medicine of healing.
    The two are complement and essential
    to the art of doctoring.
 In addition to the previous role the
 family physician do the following:

1- Health maintenance
     - health promotion
     - counseling
    - screening
    - disease prevention
   - patient education

2- Diagnosis and treatment of acute
 and chronic illnesses
Does he need qualifications other than
sharing content with other medical
specialties ?
  In addition to sharing content, with other
  medical specialties family medicine
  emphasizes knowledge from areas such
 Family dynamics

 Interpersonal relations

 Counseling, and psychotherapy
  The needs of a patient from the family
          physician range from

- a routine physical examination,
when the patient feels well and wishes
to identify potential risk factors,

- to a problem that calls for referral to
one or more narrowly specialized
physicians with highly developed
technical skills.
         Interpersonal Skills
   Skill one (the specialty's most useful tool):

         understanding and
           compassion are
           important to the
         patient's comfort and
         recovery from illness
          • communicate effectively,
Skill 2

          • the ability to gather information rapidly and to
            organize it logically,
Skill 3
          • the skills required to identify all significant
            patient problems and to manage these
Skill 4     problems appropriately,
          • the ability to listen,
Skill 5

          • the skills necessary to motivate
            people, and the ability to observe
Skill 6     and detect nonverbal clues.
Much of the family physician's effectiveness in interpersonal
      relationships depends on his or her charisma.

                   Charisma is a
                     magic of

        Charisma can be               a magnetic
            a useful                    charm
        therapeutic tool
physician is
 most likely   •compliance
  to have

  Availability of the physician just as charisma is a
                   therapeutic tool

 The feeling of security that the patient gains just by
   knowing that he or she can "touch" the physician,
either in person or by phone, is in itself therapeutic and
         has a comforting and calming influence

 Accessibility is an essential feature of primary care.
Services must be available when needed and should be
            within geographic proximity.
Basic criteria in a family physician
        to satisfy patients

 - to be in their insurance plan,
 - to be in a location that is
 - to be able to schedule an
  appointment within a reasonable
  period of time,
- to have good communication
  skills, and
Basic criteria in a family physician
        to satisfy patients

- to have a reasonable amount of
- want "a physician who listens to
- who takes the time to explain
  things to them,
- who is able to effectively
  integrate their care.
Basic criteria in a family physician
        to satisfy patients

- full disclosure of diagnosis and
- shared treatment decision
- privacy
- respect and politeness
- service provider discipline
- emotional support and
- assurance
One of the main responsibilities of the
family physician is to make people in the
center of their care

Patient-centredness now a global issue
What is people
  – centered
 health care?
 Putting patient at the center of health
Patients and their families should always be treated with kindness, respect
and dignity.

 The views, beliefs and values of the patient and his family should be sought
and respected at all times.

Patient should have the opportunity to make informed decisions about their
care and treatment, in partnership with their healthcare professionals.

Good communication between healthcare professionals and the patient is

Every opportunity should be taken to provide the patient and his family with
the information and support they need.
This reinforces the notion of the people-
  centred approach to health care and
reflects the fact that this concept is not a
 new one, but originally stems from the
   human rights movement articulated
         over half a century ago.
In global health, our work requires us to deal with numbers
as infant mortality or maternal mortality but

     We remain
     focused on                   Numbers are,
    the numbers                    in fact, key
     that define                  indicators of
      our work                     progress or
 is more than
   Behind each number,
behind every statistic, are
real people – individuals,
 families and communities
whose lives are in danger
  Here are three
stories of different
   women having
   cancer breast
         Salei (African) woman:

- No health centre in the village;

- Nearest clinic was an hour’s drive away;
- Biopsy material had to be sent off-island
  for testing;
- Needed to be sent abroad to get access
 to treatment facilities;
- Protracted delays at each stage
Salei (African) woman:

        Helen (American)woman:

- Long visit with doctor to discuss results and
- Doctor was supportive and made referral to
a cancer specialist,
- A support group and a social worker;

- Initiative to read about cancer;
- Decision to have breast removed and go
through chemotherapy;
- Supportive family
 Helen (American)woman:

           Le (Vietnam) woman

- migrated to work in a metropolitan area in a
rapidly developing neighbouring country;

-company health insurance enabled access to state-
of-the-art health care;

-living alone and very much away from friends and

-went through the insurance maze and the cold and
harsh hospital environment
  Le (Vietnam) woman

           A Tale of Three Women

  Variations in health care, Salei, Helen and Le had breast
    all used one standardized set of clinical guidelines

Yet they experienced completely
       different outcomes

The differences were due, to the varying landscapes of
                   health system
 and health care and support that they encountered.
                       Some facts

• 75% of the information leading to a correct diagnosis comes
from a detailed history

• 10% from the physical examination

• 5% from simple routine tests

• 5% from costly invasive tests

• 5% undetermined
How can family medicine fulfill
 this people centered care'?

    Putting people first:

     Reorganization to
     put people first.
 Example1: The reorganization of a medical
        centre in Alaska in the USA

The center accommodating 45 000
patient per year.

There is no great satisfaction of either
staff or clients until it decided to
establish a direct relationship between
each individual and family in the
community and a specific staff
Example1: The reorganization of a
medical centre in Alaska in the USA
The staff were then in a position to know their
patients’ medical history and understand their
personal and family situation.

People were in a position to get to know and
trust their health-care provider:

They no longer had to deal with an institution
but with their personal caregiver.
  After the reorganization what

Complaints about fragmented services

Emergency room visits were reduced by
approximately 50%

Referrals to specialty care reduced by

Waiting times shortened significantly.
  After the reorganization what

The workload actually decreased and
staff job satisfaction improved.

Most importantly, people felt that they
were being listened to and respected

(a key aspect of what people value
about health care)
 After the reorganization what

    A slow
bureaucratic • customer
 system was     responsive,
     thus     • customer-owned
transformed • customer-driven
into one that
Example2: a rural district in Niger

In a very different setting, the
health centres in a rural
district in Niger, implemented
an equally straightforward
reorganization of their way
of working in order to put
people first.
Example2: a rural district in Niger

Rather than the traditional morning
curative care consultation and
specialized afternoon clinics (growth
monitoring, family planning, etc.), the
full range of services was offered at all
times, while the nurses were instructed
to engage in an active dialogue with
their patients.
Example2: a rural district in Niger
The key challenges that will affect the
future of a family medicine include the

1-A consistent basket of services.
2- Incorporating an electronic health
 record (EHR) into the system
3- Incorporating discovery and
 research into routine practice and use
 evidence based medicine
4- Work in a team
5- Moving toward patient-centeredness
 and relationship-based care
What is the primary purpose of
consultation or referral to a specialist?

   The primary purpose of consultation
    or referral is to improve the quality of
    health care by making available to
    patients and referring physicians the
    knowledge and skills of specialists or
    consultants at appropriate times.
   There may be situations in
    complicated cases in which you wish
    to validate your findings or make sure
    that nothing has been overlooked.
What is the primary purpose of
consultation or referral to a specialist?

 There also may be times when
  patients need additional
 To refer to specialists for the

  sole purpose of protecting
  yourself against malpractice is
 Evidence suggests that patients
  who have continuity with and
  trust in their physician are more
  likely to be adherent and
  commitment to the treatment
 The relationship serves as a
  positive reinforcement in care of
  chronic disease.
Trust can increase:
 patient satisfaction

   adherence to treatment

   improve continuity of care
           Cross cultural sensitivity
            (Cultural competence)
   It is the quality of being aware and accepting of
    other cultures. This is important because what seems
    acceptable in some countries can be rude in others.
   A person who is culturally sensitive is aware that
    there could be differences between their culture and
    another person’s, and that these differences could
    affect their relationship and the way they
    communicate with each other.
    A culturally sensitive person would understand other
    countries’ traditions and ways of life.
   You are expected to approach different cultures.

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