Family Medicine History


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History of Family Medicine

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Family Medicine History

  1. 1. FAMILY MEDICINE Crisbert I. Cualteros, M.D.
  2. 2. <ul><li>Family practice arose during 1960’s </li></ul><ul><li>coincided with a decline in access to broad-based health care in the US </li></ul><ul><li>In response, they created a physician who specialized in personal health care – the family physician </li></ul>
  3. 3. FAMILY PRACTICE <ul><ul><li>Is a medical specialty w/c is concerned with the total health of the individual and the family </li></ul></ul><ul><ul><li>Is a specialty w/c integrates the biological, clinical, and behavioral sciences </li></ul></ul><ul><ul><li>It is not limited by age, sex, organ system, or disease entity </li></ul></ul>
  4. 4. <ul><li>A specialty certifying board - American Board of Family Practice established in 1969 </li></ul><ul><li>All candidates for specialty certification must be graduates of approved 3-year FP residency programs </li></ul>
  5. 5. <ul><li>In US and Canada – FP have an active role in hospital care </li></ul><ul><li>In UK and Latin America – FP is chiefly office-based, supplemented by home care </li></ul><ul><li>World Org of National Colleges, Academies, and Academic Asso of GP/FP(WONCA) - international group uniting FP </li></ul>
  6. 6. PHILOSOPHICAL TENETS AND THEIR IMPACT ON MEDICINE <ul><li>ENDURING VALUE </li></ul><ul><ul><li>Continuing care of individual and family </li></ul></ul><ul><ul><li>Comprehensive care – care of both sexes and all ages “from conception to resurrection” </li></ul></ul><ul><ul><li>Coordinated care – made FP the ideal primary care physician </li></ul></ul><ul><ul><li>Family centered approach </li></ul></ul>
  7. 7. <ul><li>Relationship-based health care – form relationships with our patients before we know what are their illnesses </li></ul><ul><li>Community-based health care orientation – influence the health of a community </li></ul><ul><ul><li>Volunteer health clinic </li></ul></ul><ul><ul><li>Adult day care center </li></ul></ul>
  8. 8. Advances in medical thinking <ul><li>Comprehensive clinical reasoning: </li></ul><ul><ul><li>Consideration of life events </li></ul></ul><ul><ul><li>family’s contribution to the disease </li></ul></ul><ul><ul><li>Impact of illness on the family </li></ul></ul>
  9. 9. <ul><ul><li>Recognize how problems of living influence health: </li></ul></ul><ul><ul><li>-pt. with stressfull life seldom present stress as chief complaint </li></ul></ul><ul><ul><li>Systems approach to health care- there is a hierarchy of natural systems that includes molecules,cells, organs, body systems, person, family …. </li></ul></ul>
  10. 10. Challenges to Family Practice <ul><li>The increasing complexity of clinical practice </li></ul><ul><li>- today’s office patient may be more likely to be sick and to require more time </li></ul><ul><li>- this patient received advice through the nurse triage line </li></ul><ul><li>- only those who cannot be manage by telephone are given appointments </li></ul>
  11. 11. <ul><li>Resisting commercialization of medicine </li></ul><ul><li>-FP new role is to be the patient’s advocate in a system that appears to treat health care as a commodity </li></ul><ul><li>-We must put the patient first </li></ul><ul><li>-Give patient enough time </li></ul><ul><li>-Eliminate incentive payments for physicians </li></ul>
  12. 12. <ul><li>Family practice, subspecialization and specialty choice </li></ul><ul><li>– rise in doctors entering subspecialty and decline in those selecting FP as careers </li></ul><ul><li>FP leaders are working to increase attention to student activities, </li></ul><ul><li>Efforts to close the income gap between primary care and consulting specialist </li></ul>
  13. 13. History of Medicine <ul><li>Medicine – is both an art and science </li></ul><ul><li>Science – is knowledge of facts, phenomena, laws, proximate causes gained and verified by exact observation </li></ul><ul><li>Art – is the skillful, systematic means for the attainment of some end </li></ul>
  14. 14. <ul><li>The patient must be treated as a whole </li></ul><ul><li>In order to be holistic and caring physician, one must be </li></ul><ul><li> adept in both the art and science of medicine. </li></ul>
  15. 15. Prehistoric Medicine <ul><li>Before written records </li></ul><ul><li>No written evidence about what disease people suffered from </li></ul><ul><li>How they contacted the disease </li></ul><ul><li>How they managed injuries </li></ul>
  16. 16. <ul><li>Prehistoric skulls have been found with holes bored into them </li></ul><ul><li>Modern technology has enabled us to ascertain that trepanation was done as early as 5000 B.C. to relieve the victim of the effects of head injuries and let evil spirits out </li></ul>
  17. 17. <ul><li>From about 3000 BC, people began to keep written records </li></ul><ul><li>This art was handed down from generation to generation through word of mouth and apprenticeship with its own set of knowledge, beliefs and tradition </li></ul>
  18. 18. <ul><li>Greeks thought of disease as an affliction sent by their gods and only gods could cure them </li></ul><ul><li>Egyptians considered Imhotep, chief counselor and minister of the Pharaoh Zoser as their first physician </li></ul>
  19. 19. <ul><li>Among Sumerians, in the Code Of Hammurabi, there were laws stating that a doctor was to be held responsible for surgical errors and failures </li></ul><ul><li>It was also stated that Sesame oil be used for post –operative care of wounds </li></ul>
  20. 20. <ul><li>Starting 1600 BC, the influence of Greek medical arts was wide- spread, then considered the civilized world </li></ul><ul><li>persist through the Roman period up to the middle ages </li></ul><ul><li>For nearly a thousand years, the Grecian Temple of Ascelepius was one of the most famous healing centers </li></ul>
  21. 21. The Science of Medicine <ul><li>In Greece – Hippocrates delineated medicine from philosophy and religion by remarkable case histories and vivid descriptions of diseases, making the practice more of a science than an art </li></ul><ul><ul><li>Stressed the importance of observation, diagnosis and treatment. </li></ul></ul>
  22. 22. <ul><ul><li>Developed the theory of 4 body humours: </li></ul></ul><ul><ul><li>Black bile </li></ul></ul><ul><ul><li>Yellow bile </li></ul></ul><ul><ul><li>Phlegm </li></ul></ul><ul><ul><li>blood </li></ul></ul><ul><ul><li>- Illness occurred if one of these humours is out of balance </li></ul></ul>
  23. 23. <ul><li>Aristotle the first biologist who laid the foundation of comparative anatomy and embryology </li></ul>
  24. 24. <ul><li>Galen – an adherent of the Hippocratic method </li></ul><ul><ul><li>Stressed the value of anatomy and experimentation in medical practice </li></ul></ul><ul><ul><li>Found out that the brain controls the rest of the bodies through the nerves </li></ul></ul><ul><ul><li>father of experimental physiology </li></ul></ul>
  25. 25. 4 th Century: <ul><ul><li>Cosmas and Damian : showed great charity to their patients </li></ul></ul><ul><ul><li>Every opportunity they had, they told their patients about Jesus Christ </li></ul></ul><ul><ul><li>persecuted in 300 A.D. </li></ul></ul>
  26. 26. Middle Ages: <ul><li>-several outbreaks of Bubonic Plague, most people thought that it was: </li></ul><ul><li>a punishment from God </li></ul><ul><li>caused by a poison in the air </li></ul><ul><li>-superstitious remedies and herbals were used </li></ul>
  27. 27. <ul><li>The Persian Rhazes: </li></ul><ul><li>-first to describe Measles and Smallpox </li></ul><ul><li>-first to write on children’s disease </li></ul><ul><li>- best known Arabian contributor to scientific medicine </li></ul>
  28. 28. Renaissance period: <ul><ul><li>revival of Greek and Roman ideas </li></ul></ul><ul><ul><li>Paracelus advocated the use of chemicals in medicine </li></ul></ul><ul><ul><li>Fracastoro of Verona – is a scholar whose interest in epidemic infection led to the publication of De Contagione </li></ul></ul>
  29. 29. <ul><li>1590 – Johannes Janssen invented the microscope </li></ul><ul><li>1628 – William Harvey – describe the circulation of human blood in the body </li></ul>
  30. 30. 17 th Century <ul><li>James Lind of Edinburgh – recommended lemon juice for scurvy </li></ul><ul><li>Leopard Auenbrugger – discovered the application and effects of percussion </li></ul><ul><li>Matthew Dobson – proved the presence of sugar in the urine of diabetic patients </li></ul><ul><li>William Withering – discovered digitalis </li></ul>
  31. 31. 18 th Century <ul><li>John Hunter – an ob-gyn that laid the foundations of surgical anatomy </li></ul><ul><li>Bernardino Ramazzini – was the first physician to write on occupational diseases </li></ul><ul><li>Edward Jenner - acclaimed by the medical world as the conqueror of smallpox </li></ul>
  32. 32. 19 th Century <ul><li>Johannes Muller- raised physiology to a distinct science </li></ul><ul><li>Rudolf Virchow- originated the concept of the cell as the center of pathological changes </li></ul><ul><li>Marshall Hall – discovered the reflex action </li></ul>
  33. 33. 19 th Century <ul><li>Sir Charles Bell – researcher of the nervous system </li></ul><ul><li>Pasteur and Koch – Bacteriologist who correlated microorganisms with specific diseases </li></ul><ul><li>Joseph Lister – introduced antiseptic system in surgery with the use of Carbolic Acid </li></ul><ul><li>William T.G. Morton- first to successfully control pain with ether anesthesia </li></ul>
  34. 34. 20 th Century <ul><li>German Erhlich- discovered the treatment of syphilis </li></ul><ul><li>Sir Alexander Fleming- a British bacteriologist who discovered Penicillin </li></ul><ul><li>Goudfrey Houndsfield - invented the computerized tomography scanner </li></ul>
  35. 35. <ul><li>These events and discoveries are great milestones in the history of medicine </li></ul><ul><li>A practice which ostensibly started as an art and evolved into a highly complicated science </li></ul><ul><li>These two disciplines should not be separated </li></ul>
  36. 36. Pre-Spanish and Spanish Era: <ul><li>Early Filipinos used herbal drugs and perform rituals to cure the sick </li></ul><ul><li>Development of Institution of Health Care </li></ul><ul><li>San Juan De Dios Hospital - 1596 </li></ul><ul><li>San Lazaro Hospital – 1631 </li></ul><ul><li>UST – was granted the right to establish College of Medicine and Pharmacy </li></ul>
  37. 37. <ul><li>Dr. Jose Rizal took his pre-med at UST but proceeded to University of Madrid for his licentiate in medicine </li></ul><ul><li>Specializes in ophtha in Paris and Germany </li></ul><ul><li>His 1 st cataract operation on his mother in 1887 </li></ul>
  38. 38. American Era: <ul><li>Medical contributions: </li></ul><ul><ul><li>Devotion to public health </li></ul></ul><ul><ul><li>Fight against communicable diseases </li></ul></ul><ul><ul><li>Improvement of sanitary condition </li></ul></ul><ul><ul><li>Significant milestone – organization of PMA in 1939 </li></ul></ul>
  39. 39. <ul><li>1908 - UP College of Medicine was established </li></ul><ul><li>1910 – PGH was established </li></ul><ul><li>Eliodoro Mercado – devised the chaulmoogra method of treatment of leprosy </li></ul><ul><li>Manuel Guerrero – introduced tiki-tiki in the treatment of beri-beri </li></ul>
  40. 40. <ul><li>Pedro Lantin – introduced the exsanguination-transfusion treatment of typhoid fever </li></ul><ul><li>Juan Salcedo Jr. – proved the efficacy of vit B1 enriched rice for the prevention of beri-beri </li></ul><ul><li>Faustino Garcia – studied the lowering action of banaba on the blood sugar of diabetic patients </li></ul>
  41. 41. Japanese Occupation: <ul><li>1943 – provisional gov’t was instituted, </li></ul><ul><li>formed the Commission on Education, Health and Public Welfare, Claro M. Recto as commissioner </li></ul><ul><li>UP and PGH continue organizing CME lectures on provincial physicians </li></ul>
  42. 42. Philippine Republic: <ul><li>1951 – Rural Health Units were created </li></ul><ul><li>1961 – Obstetrics Specialty Boards and PAFP (Philippine Society of Gen Practioners) were created </li></ul><ul><li>1969 – Phil Medical Care Act was approved by congress </li></ul>
  43. 43. The Martial Law Regime: (1972 – 1986) <ul><li>1972 – RA 6245 - Dangerous Drugs Act – enacted to confront the increasing number of drug addiction </li></ul><ul><li>1973 – Association of Accupuncturists was organized </li></ul><ul><li>1979 – fullly immunized child rate of 90% was attained </li></ul>
  44. 44. <ul><li>1980 – National TB program was relaunched </li></ul><ul><li>1981 – RITM was opened </li></ul><ul><li>national reference center for HIV </li></ul><ul><li>for antimicrobial resistance surveilance </li></ul><ul><li>for problematic infectious and tropical diseases </li></ul>
  45. 45. <ul><li>1982 – BFAD was created </li></ul><ul><li>To ensure the safety and purity of food, drugs, medical devices, and cosmetics </li></ul>
  46. 46. Restored Democracy <ul><li>1987 – Phil Society of Teachers in Famed was recognized as an academic society by APMC </li></ul><ul><li>1988 – enactment of RA 6675 – Generics Act </li></ul><ul><li>Aug 1988 – 1 st successful liver transplant was performed </li></ul>
  47. 47. <ul><li>1989 – Phil National Drug Formulary published </li></ul><ul><li>May 28, 1994 – 1 st heart transplant in the country was performed </li></ul><ul><ul><li>At the Makati Medical Center by Dr. Jorge Garcia </li></ul></ul>
  48. 48. <ul><li>1995 – National Health Insurance Act replaced the Medicare Act of 1969 </li></ul><ul><li>April 12, 1996 – 1 st partial liver transplant done at NK and Transplant Institute by Prof Chao Tony Chan with the team of Dr. Enrique Ona but succumed infection 75 days post-operatively </li></ul>
  49. 49. Science and Technology <ul><li>continuously offer improvement, but their application must have cultural, social and political acceptance. </li></ul><ul><li>Our country must learn from the history of other nations as well as its own in providing solutions in the health problem of the country… </li></ul>
  50. 50. <ul><li>Thank you </li></ul>