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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 contact In a Comprehensive care personalized manner Continuing care Confidential relationship Common chronic illnesses No that have no fragmentation with cost- known cure effective health care. Coordination and integration 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 Comprehensive 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 continuing. 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 care: 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 care: 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 care: 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 potential Families receiving continuing, comprehensive care have fewer incidences of hospitalization 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 patient. 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 family. 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 accurately. 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 as: 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 personal magic of leadership Charisma can be a magnetic a useful charm therapeutic tool Charismatic physician is most likely •compliance to have maximal •satisfaction patient Accessibility 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 convenient, - 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 experience - want "a physician who listens to them, - 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 prognosis - shared treatment decision making - 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 care 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 essential. 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 failure BUT……health is more than numbers 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: DIED WITHIN ONE YEAR Helen (American)woman: - Long visit with doctor to discuss results and options; - 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: HAD A REMISSION, SURVIVED, LIVED A NORMAL LIFE AND BECAME A VOLUNTEER TO SUPPORT OTHER WOMEN 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 family; -went through the insurance maze and the cold and harsh hospital environment Le (Vietnam) woman DECLARED CANCER-FREE, BUT EXPERIENCED FULL- BLOWN DEPRESSION, LOST HER JOB, HEALED IN BODY BUT BROKEN IN SPIRIT. A Tale of Three Women Variations in health care, Salei, Helen and Le had breast cancer… 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. How? 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 member. 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 happened? Complaints about fragmented services disappeared. Emergency room visits were reduced by approximately 50% Referrals to specialty care reduced by 30% Waiting times shortened significantly. After the reorganization what happened? 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 happened? A slow bureaucratic • customer system was responsive, thus • customer-owned transformed • customer-driven into one that is 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 following: 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 reassurance. To refer to specialists for the sole purpose of protecting yourself against malpractice is inappropriate. Evidence suggests that patients who have continuity with and trust in their physician are more likely to be adherent and commitment to the treatment plan. The relationship serves as a positive reinforcement in care of chronic disease. Trust 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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