Family medicine


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Family medicine

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  • Qualitative medicine Diagnosis  Standard care Does not work for all
  • Understanding molecular medicine, through both laboratory and imaging techniques, deepens our ability to detect, diagnose and treat disease. Genomics, the study of genes, is the most common area of study since it involves a stable, albeit large, data set. Genomic data is particularly useful in identifying certain diseases, unveiling risk factors for other diseases, and predicting how well certain drugs will work in humans. This last area, called pharmacogenomics, is an increasingly popular area of study involving both drug effectiveness (efficacy) and drug side effects. This is a critical field since many medications are only effective in 50% of the population and cause side effects in another large percentage, but we don’t know ahead of time how individuals will react. Being able to test for gene differences ahead of time will both improve effectiveness and decrease side effects for patients . Other important areas of study include proteinomics and metabolomics. While genetic markers are stable, these biomarkers are constantly changing as a function of both genetic and environmental exposures. They are particularly important in diagnosing diseases and calibrating treatment regimens. Finally, molecular imaging (e.g. PET Scans) is an increasingly important area in the field of cancer diagnosis and treatment calibration .
  • Family medicine

    3. 3. Family medicinePrevention & health promotionWONCAWorld organization of family doctors
    4. 4. Family medicine• Provide: Primary care ethicsPERSONALCOMPREHENSIVECONTINUING CAREPrimary care ethics
    5. 5. FAMILY PHYSICIAN• Ability to evaluate new information and itsrelevance to the practice• Knowledge & skill• Appropriate use of medical records and orother information system
    6. 6. FAMILY PHYSICIAN• Efficient management of the organizationor business aspects of practice• The ability to plan and implement policiesscreening and preventive care
    7. 7. BASIC COMPONENTS• Access to care• Continuity of care• Comprehensive care• Coordination of care• Contextual care• Community and family based• Evidence based health care
    8. 8. FAMILY MEDICINE• STRUCTUREPresence, access,continuity• PROCESS EBM• OUTCOMEPrevention , health promotion
    9. 9. COMPETENCIES OF F.P.• Acute health problem• Chronic health problem• Provide health promotion services• Emergency services• Counseling• Preventive• Terminal and palliative• Home care
    13. 13. Reception• Identification• Appointment –Reminder communication• Interpersonal communication• Waiting room Hand-out, pamphlets,media,• Call for file ( confidential)
    14. 14. PreventionPreventionPatient education includePatient education include::•Careful selection of footwearCareful selection of footwear..•Daily inspection of the feetDaily inspection of the feet..•Daily foot hygieneDaily foot hygiene..•Avoidance of self-treatmentAvoidance of self-treatment..•Avoidance of high-risk behaviorAvoidance of high-risk behavior..•Consultation if an abnormalityConsultation if an abnormalityarisesarises
    15. 15. Documentationdouble sward• Personal data• Date & Time• Communication Mobile no/ address• File revision• Notification about ADR allergy• Oral anticoagulant• Hereditary disease, sickling, G-6-P def
    16. 16. Physician visit• Complaint and history of recent c/o• > of 70% of the diagnosis• Try to be a good listener, no interfere,interest, concentrating• VITAL IS VITAL Temp, pulse, Bp• Examination in the presence of a nurse• Rapid decision if emergency hypotension
    17. 17. Process• Safe• Effective guidelines• Efficient• Timely• Patient centered• Equity discrimination
    18. 18. Guidelines• Consensus• Guidelines National, International• Evidence based care• Use of Algorithm and chart• Quantitative medicine, personalized,individualized medicine
    19. 19. Continuous performanceimprovement• Safety limit transmission of infection ,hand hygiene• Guidelines• Keep record for your error
    20. 20. SOAP• Subjective• Objective• Assessment, analysis• Plan
    21. 21. PLAN• Life style modification• Diet• Exercise• Sick leave• Medication• Consultation• Reference health education• Revision and follow up
    22. 22. Medications• Prescription, handwriting• Pharmacological name, dose, frequency,route, initial dose, duration, ADR• ADR avoidable , nonavoidable• Wrong prescription• Role of the pharmacist
    23. 23. Non avoidable• Sensitivity test• Anaphylaxis• Severe reaction erthymaMultiformis,Steven Jonhson
    24. 24. Avoidable• Personalized Medicinepharmacogenomic, genetic make up• Can be predictable >25% of commonlyused drug (array)
    25. 25. MAR medication administrationrecord
    26. 26. COPE computerized physicianorder entry• Computerized physician order entry(CPOE) is the process of enteringmedication orders or other physicianinstructions electronically instead of onpaper charts. The use of a CPOE systemcan help reduce errors related to poorhandwriting or transcription of medicationorders. Physician assistance
    27. 27. Personalized medicine• Right patient• Right treatment• Right time• Right dose according genetic make up ofpatient
    28. 28. Quantitative medicine is the key toreducing healthcare costs and improvinghealthcare outcomesPatients with same diagnosisMisdiagnosedNon-responders,toxic respondersNon-toxic responders
    29. 29. Asthma Drugs 40-70%Beta-2-agonistsHypertension Drugs 10-30%ACE InhibitorsHeart Failure Drugs 15-25%Beta BlockersAnti Depressants 20-50%SSRIsCholesterol Drugs 30-70%StatinsMajor drugs ineffective for many…Source: Amy Miller, Personalized Medicine Coalition
    30. 30. The PromiseImagine when doctors can…• Prevent Disease by identifying risks, early interventions• Diagnose Conditions less Predict Disease pre-symptomatically withsimple testing• invasively, more accurately• Select Drugs that maximize benefits and minimize risks• Calibrate Treatments to heighten efficacy and recovery• Treat/Cure Disease using our own genes
    31. 31. Take five• BE with us
    32. 32. Common clinical diagnosis• Hypertension• Chest pain , chest infection, asthma• Diabetes• GIT, jaundice ,Diarrhea• Coma & syncope• Stroke• Trauma• fever
    33. 33. Office BP Measurement§ Use auscultatory method with a properly calibrated and validatedinstrument.§ Patient should be seated quietly for 5 minutes in a chair(not on an exam table), feet on the floor, and arm supported atheart level.§ Appropriate-sized cuff should be used to ensure accuracy.§ At least two measurements should be made.§ Clinicians should provide to patients, verbally and in writing,specific BP numbers and BP goals.
    34. 34. BP Measurement TechniquesMethod Brief DescriptionIn-office Two readings, 5 minutes apart, sitting in chair. Confirmelevated reading in contralateral arm.Ambulatory BP monitoring Indicated for evaluation of “white-coat” HTN. Absenceof 10–20% BP decrease during sleep may indicateincreased CVD risk.Self-measurement Provides information on response to therapy. May helpimprove adherence to therapy and evaluate “white-coat” HTN.
    35. 35. Blood Pressure ClassificationNormal >120 and >80Prehypertension 120–139 or 80–89Stage 1 Hypertension 140–159 or 90–99Stage 2 Hypertension <160 or <100BP Classification SBP mmHg DBP mmHg
    36. 36. Benefits of Lowering BPAverage Percent ReductionStroke incidence 35–40%Myocardial infarction 20–25%Heart failure 50%
    37. 37. Laboratory Tests Routine Tests• Electrocardiogram• Urinalysis• Blood glucose, and hematocrit• Serum potassium, creatinine, or the corresponding estimated GFR,and calcium• Lipid profile, after 9- to 12-hour fast, that includes high-density andlow-density lipoprotein cholesterol, and triglycerides Optional tests• Measurement of urinary albumin excretion or albumin/creatinine ratio More extensive testing for identifiable causes is not generally indicatedunless BP control is not achieved
    38. 38. Hassan age 50 years• Presented to you with severe throbbingheadache, chills, epig pain and vomit oncePast history of hypertension,dyslipidemia• Pulse full, Bp 200/120, lung showedbilateral basal fine crepitation• Ask the patient about important symptoms• What you will do if you are in OPD
    39. 39. Hilal 18 years old known type1• c/o of epig pain vomiting, fever , diarrhea• He miss last night insulin dose• He ring you this morning at 10:00• What is your advise to Hilal• You propose what?
    40. 40. Mr Hamdi 45 ys old• Vomit this morning brown colourationvomitus after an overnight severe nausea• Several days before he seeked the adviseof the orthopedic surgeon for a lowbackache and girdle pain• Ask him few question• Decide what to do if you examine himhome
    41. 41. Amira young female 22 years old• C/o of vertigo, vomiting , unsteady gaitassociated with severe headache, shewas on antibiotic because of an upperrespiratory tract infection few days before• Your examination revealed afebrile,nystagmus , brisky reflex on both LL.• Is it serious, what you will do
    42. 42. Soad pregnant in her last trimest• Referred by her obstetrician because herlast urine analysis showed + sugar ,FBS is90, her PP is 116mg%• Is she gest diabetes• What you will recommend
    43. 43. Ali young asthmatic patient• c/o since yesterday something giving wayin his rt lower chest after cough• Today his respiration not at ease andsuffer from stitching pain on the same sideduring walking• Examination revealed only mild degree offever 37.4• Decision
    44. 44. 60ys old lady• Fever, rigor, bilateral loin pain and scantyurine• Past history of renal stones, gout,HTN,osteoathrosis• What you will do as investigations
    45. 45. Ahmed 34 year old• c/o of lower left pricking sensation in thechest• Few day later rash appear in the samearea and extend , associated with generalillhealth• What you will ask him ?• DD
    46. 46. 50years old male• C/o progressive loss of wt, anorexia, nightfever• No cough• Examination revealed significant loss wt• Few L node enlargement deep cervicalgroup, shotty ,rubbery not fixed• CBC lymphopenia, normocytic ,normochromic anaemia and shooting ESR• Discuss the case and make a plan
    47. 47. 40years old patient• Irregular palpitation since last night• Past history of similar condition• Pulse completely irregular and rapid• Bp 120/80• ECG AF• Discuss the case and manage
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