Family medicine as a specialty which cut across every sub specialty has some domains which makes it unique. This slides describe them.

1. DR OGUNTUNDE MUYIWA
JUNIOR RESIDENT FAMILY MEDICINE
O.L.A CATHOLIC HOSPITAL ,
OLUYORO, IBADAN
01/09/2023

2.  INTRODUCTION
 HISTORY OF FAMILY MEDICINE
 DEFINITION OF TERMS
 DOMAINS OF FAMILY MEDICINE
 SCOPE OF FAMILY MEDICINE
 ROLE OF FAMILY PHYSICIAN
 CONCLUSION
 REFERENCES

3.  Family medicine is an academic and scientific
discipline, and a primary care oriented clinical
specialty with his own specific educational
content, research and base of evidence.
 It is a discipline that integrates several
specialties into a new whole

4.  It is concerned with the holistic approach to
patient care in which the individual is seen in
his totality and in the context of his family
and community.
 The trainees in family medicine are trained to
have a general knowledge of all the
specialties of medicine

5. The domain of family practice finds its center in
the relationship to the person and the family.
The domain extends its range through
commitment to the community and its needs
and earns its allegiance through devotion to the
profession and its purpose.

6.  The term General Practitioner (G.P) came into
use at about the beginning of the 19th
century
Before that: Physicians
Surgeons
Apothecaries
In the beginning of the 20th century the
overwhelming majority of all physicians were
General practitioners

7.  1908 – 1910 Flexner study and report about the
medical schools in USA and Canada
shift towards specialization and sub specialization
leading to decrease number of Gps.
 Then the problem of the decreasing number of
General practitioners and its implications started
to be recognized, leading to many medical
leaders asked for decreasing specialty
residencies and increasing residencies in general
practice.

8.  Efforts to eliminate factors that contributed to
this dearth led to the establishment of
American Medical Association in 1946 and
the American Academy of General Practice in
1947 which brought about the new discipline
as a medical specialty in 1969
 In 1946, a final approval for Family practice
as the 20th specialty and the American
Academy of General Practice was established
in 1947.

9.  Millis Report (1966): emphasized
comprehensive patient’s care and the need
for training of Family physicians as
comparable in time with other specialists.
 Folsom Report (1966): emphasized
comprehensive and continuity of care by the
personal physicians and such doctors should
board certified, accorded status and income
comparable to other specialists.

10.  Willard Report (1966): endorsed board
certification for FP, defines FP and concluded
that the specialty has a body of knowledge
and a function which is significantly different
from other specialties

11.  The origin of Family Medicine as a specialty in
Nigeria can be traced back to the activities of
the Association of General Medical
Practitioners of Nigeria (AGMPN), and the
then Nigerian Medical and Dental Council
(NMDC) now Medical and Dental Council of
Nigeria (MDCN

12.  There was a rural – urban migration of
medical doctors, and the AGMPN saw the
need for CME programs which was
recognized by the NMDC, and became the
Faculty of General Medical Practice (GMP) in
the National postgraduate Medical College of
Nigeria (NPMCN), with statutory rights to train
postgraduate doctors in Family Medicine.

13.  Postgraduate training in GMP started in
Nigeria in 1979, and the curriculum for
training was adopted by the NPMCN in 1980,
with the guidance by the Royal College of
General Practitioners (RCGP).
 The faculty in WACP and NPMCN changed the
name from GMP to the faculty of Family
Medicine in 2002 and 2006 respectively.

14.  FAMILY MEDICINE : is the medical specialty
that provides continuing and comprehensive
health care for the individual, in a holistic
manner within the context of his family and
environment.
 It encompasses all ages, both sexes and
every disease entity, integrating biological,
clinical and behavioral science (Rackel)

15.  FAMILY PHYSICIAN : Is a physician generalist
who takes professional responsibility for the
comprehensive care of unselected patients
with undifferentiated problems.
Committed to the person regardless of age,
gender, illness, organ, system affected or
method used.

16. • We treat patients with acute diseases,
• Reassure patients with self-limiting diseases,
• Counsel patients with psycho-relational
problems,
• Take care acute problems,
• Take care of chronically ill patients,
• Prevent health problems through information
and screening programs

17. • Organize 24-hours continuity of care,
• Help to identify health threats in the
community,
• Strive for equity in accessibility of health care,
• Advocate health care for our patients,
• Intervene surgically.

18. FAMILY CARE
Pre-hospital Emergency Care &
Home Based Care of the
Termally ill
HEALTH
FACILITY or
Hospital Care PRIMARY CARE
Primary Medical
Care & Primary
Health Care

19.  Is governed by the concept of family dynamics in health
and disease plus the concept of family system theory.
 Individuals cannot be understood in isolation , rather as a
part of their family (emotional unit). Families are systems
of interconnected and interdependent individuals. Each
member has a role to play, and rules to respect
 Health care that includes an assessment of the health of
an entire family, identification of factors that might
influence the health of its members, and implementation
of interventions needed to maintain or improve the health
of the unit and its members.

20.  Emphasizes collaboration rather than control.
 Focuses on families’ strengths and resources
rather than on their deficits.
 Recognizes the families’ expertise as well as
that of professionals.
 Fosters empowerment rather than
dependence.
 Promotes information sharing among
patients, families, and providers.

21.  Improves quality and effectiveness of
communication
 Psychological and general cardiovascular
health are positively affected with resultant
lesser medical interventions.
 Family and close friends are more likely to
identify slight variations in the patient’s
health that health care professionals largely
unfamiliar with the patient may miss.

22.  Involving a patient’s family as part of their
health care team enables them to assist,
manage, and assess the patient’s healing
after their discharge from the health facility.
 Decrease in clinical workload.
 Improved staff success and satisfaction.
 Improved patient satisfaction

23. Consists of two areas of care, Primary medical
care and Primary health care.
 Primary Medical Care; Refers to all initial
medical care delivered at the point of first
contact with the health care system which
may be in small clinics, health centers or
general practice sections of large district
hospitals and tertiary health care delivery
centers.

24.  Is the first contact care where the family
physician initiates comprehensive and
continuing care. Serves as point of entry for
the patient into the health care system,
also includes continuity by virtue of caring
both in sickness and in health.
 The overall goal is to reduce morbidity and
mortality caused by preventable diseases.
Should focus on leading causes of death in
our environment
LEVELS OF PREVENTION:
 Primordial: Involves prevention of
emergency or development of risk factors
e.g healthy education, health promotion.

25.  Primary: Using whatever means to prevent an
individual at risk of disease from developing
it e.g lifestyle modification, immunization.
 Secondary: Risk factors are present.
Intervention is aimed at stopping further
progression e.g early diagnosis, prompt,
optimized and sustained care.

26.  Tertiary: Optimizing health after disease is
present. Must go in line with health education
given to the patient. e.g rehabilitation,
disability prevention.
 Quaternary: Prevention of over diagnosis and
treatment e.g rehabilitation, disability
prevention

27.  The WHO defines PHC as essential healthcare
based on practical, scientifically sound and
socially acceptable methods and technology,
made universally accessible to individuals and
families in the community, through their full
participation, and at a cost that the
community and country can afford to
maintain, at every stage of their development
in the spirit of self-reliance and self-
determination (Alma-Ata, 1978).

28.  It aims at delivering essential and
comprehensive health services in an
integrated manner to the people at the point
of first contact. The practice of the Family
Physician provides the patient and family
access to integrated , CURATIVE, PREVENTIVE,
REHABILITATIVE and HEALTH PROMOTION
SERVICES.

29. Health care that is
• Accessible
• Affordable
• Available
• With a focus on prevention, health promotion,
community participation, appropriate
technology, inter-sectorial collaboration.

30.  Equitable distribution
 Community participation
 Intersectoral coordination
 Appropriate technology

31.  Education about prevailing health problems and
how to prevent and control them.
 Food supply and proper nutrition.
 Adequate supply of safe water and basic
sanitation.
 Maternal and child health, family planning.
 Immunization against infectious diseases.
 Prevention and control of endemic diseases.
 Treatment of common infection
 Essential drugs.

32.  In Nigeria, the Family Physician functions as a
general physician, with competencies in
surgery, maternal care and gynecology, and
other related surgical specialties, especially in
under-served and difficult-to-reach
populations.

33.  The focus of concentration in the hospital
and clinic care areas is because of the fact
that many of the skills required could best be
accessed in the hospital environment. The
major aspects of training and family medicine
service takes place in the Department of
Family Medicine, Accident and Emergency
(A&E) and inpatient wards, where frontline
medicine is practiced.

34.  In multi-specialty health institutions, as the
patient navigates the health system, receiving
care from many linear specialists, it is the
Family Physician that coordinates that care.
 Health care provided for patients who need
other services including admission.

35. Plan out notes to address each problem
separately using the mnemonic – SOAP
 S– subjective/patient’s data (i.e. Biodata,
HPC, FSH, PMH, Systems Review)
 O– objective data from examinations & tests
 A– Assessment/clinical impression or
Diagnosis
 P– Plan (for further tests, for treatment, for
education of patient)
At follow up use same SOAP pattern.

36. SPECIALITY OF FAMILY MEDICINE
SCOPE OF FAMILY MEDICINE
OTHER MEDICAL AND SURGICAL SPECIALITIES
BREADTH OF TRAINING, KNOWLEDGE AND SKILL
D
E
P
T
H

37.  Family physicians take care of most problems
of most people most of the time.
• They not only retain their constituency, which
is the whole human being, they are like many
specialists rolled into one and can fit into any
area of medical enterprise where their
services may be required” (Oloruntoba 1997).
• Family physicians have to know more and
more about more while other specialists
know more and more about less

38.  The breadth of care of family practice with a
depth of competencies acquired by training,
quality practice and research make the
difference from GMP.
 This type of care offers a way to organize the
full range of health care, from households to
hospitals, with prevention equally important
as cure, and with resources invested
rationally in the different levels of care.

39.  Care giver
 Coordinator of care
 Communicator
 Manager
 Advocate
 Researcher

40. • Of central importance is the quality of the doctor –
patient relationship, diagnostically, therapeutically
and prognostically
• A highly personalized “first contact” care, serving as
point of entry for the patient into the health care
system
• Is committed to the person rather than the disease
and follows a patient-centered approach
• It includes continuity by virtue of caring both in
sickness and in health

41. • Serve a coordinative function for
healthcare needs of the patients by
involving other relevant medical/para
medical colleagues
 FP controls referrals and translates specialty
advice.

42.  FP can understand that they are integrated into
the overall health care system, working in a
defined way with other health care workers in the
primary, secondary and tertiary levels, especially
as regards early referral and later follow up with:
Medical and surgical specialties
Behavioural therapists
Physical, occupational therapists
Dietitian, nursing care (hospital and home)
 Practice area is the community at risk and its
health needs interest the FP

43.  The FP uses every opportunity which exist for
health promotion, preventive care, patients
education and rehabilitation.
 Listens for the story, looks for cues, touches,
explores the fears, ideas, effect on function
and expectations of the patient in that
encounter (FIFE)
 Seeks to understand the context of the
illness. i.e. the internal and external
environment

44.  Family Physician manages the 4 Ms (man,
money, material and minutes)
• FP has a major management role in the
allocation of scare health resources.
• Human, financial, material, space, time
management.
• Is acutely aware of personal and financial
costs of the decisions taken

45. • FP is the patient’s advocate in the
health
System ( involved in policy making ).
• Defines what is needed to help the
patient
with due regard to cost – effectiveness .
• Can recognize the impact of the
patient’s
problem on the family.
• Identifies with values and beliefs.

46.  Family Physician is a life-long learner

47.  FP is trained to consider the family
dimensions to the patient’s complaints
 Solutions can be obtained by exploring
biological, psychological and social aspects
 Patient’s subjective experience identified and
understood through a patient-centered
approach
 Allow a mode of healing based on all medical
and personal inner resources.

49.  Power point presentation on domains of
family medicine by Dr. Modupe M.A Ladipo,
5th August 2013.
 WACP Primary Revision Course in Family
Medicine on Family Medicine Tools by Dr. HT
Ilori, 5th August, 2020.

50.  Mash B (2017), Handbook of Family
Medicine, 4th Edition, Oxford Southern
Africa.
 Public Health Care, 1 April, 2021
https://www.Who.int
 Power point presentation on core principles
of family medicine by Dr. Olaniyan F.A, 1
August, 2019.