Teaching Family Medicine

1. Family Medicine;
History and Definition
Prof Faisal Abdullatif AlnasirFPC,MICGP,FRCGP,FFPH,PhD
Chairman; Dept of Family & Community Medicine
Arabian Gulf University

2. PRIMARY HEALTH CARE
Is the care that is provided in comprehensive first
contact care for ill persons or those with an
undiagnosed sign, symptom or health concern.
Primary care includes, in addition to diagnosis and
treatment of acute and chronic illnesses, health
promotion, disease prevention, health maintenance,
counseling, and patient education.

3. Family medicine
Medical specialty that provides comprehensive
health care for the individual and the family
that includes;
•Responsibility for total health care from the first
contact and initial assessment to the chronic
problems.
•Prevention and early recognition of disease.

4. Family medicine
Caring for the whole family

5. Family medicine
Medical specialty that provides
continuing
health care.

6. Qurashi Dom

7. Family medicine
• Coordination and integration of all necessary
health.
• Provide cost-effective health care.
• Take care of 95% of the patient’s heath needs.
• personalized care.

8. Family medicine
•Maintenance of health.
•Management of patients in a community setting.

9. Family medicine
•Early detection and management of
illness.

10. Sharp Vision

11. Holistic Approach

20. Early Diagnosis

26. Early Management

30. Personalized and Family
Care

33. Strong Roots
Very skilled
Very knowledgeable

37. Wide
Thoughts

46. Unique

48. Avoid Errors

51. Behavior
Attitude
Passion

55. Skills to be acquired:
• Communication
• History taking
• Hypothesis generation
• Proper physical examination
• Use of different equipments
• Management
• Writing
• Education
• Minor surgery
• Procedures
• Investigation Lab Xray
• Emergency

57. Family physician
Provides primary, continuing, Comprehensive
medical care in a personalized manner to
patients and to their families of all ages,
regardless of the presence of disease or the
nature of the presenting complaint. They also
provide maintenance and preventive services to
each member of the family regardless of sex, or
type of problem be biological, behavioral, or
social.

58. Charter of General
Practice/Family Medicine
(WHO-EURO, 1998)
• General (unselected health problems)
• Continuous
• Comprehensive
• Collaborative (team Work)
• Family-oriented
• Community-oriented
• Coordinated

59. Other Important attributes of
Primary Care
• First contact care
• Accessibility
• Continuity
• Case-management (responsibility for
coordinating all the care that a person
needs)

60. Misconcepts &
Misinterpretations
•PHC is only for poor
•Care only for organic problems
•Use only low “Tech”
•Is cheap
•PHC is only community-based health care
•PHC is referral level of care

61. Thank You

63. Family physician:
They accept responsibility for managing an
individual’s total health needs while maintaining an
intimate, confidential relationship with the patient.

64. Participating in these rewards in family practice comes
from knowing patients intimately, sharing their trust,
respect, friendship and the close bond that develops
with patients.
Family physician cares for a newly married couple,
delivers, and provides ongoing care that no other
medical specialty is so privileged.

65. Family physician:
The physician who is primarily responsible for
providing comprehensive health cares to every
individual seeking medical care and arranging
for other health personnel to provide services
when necessary.
The family physician functions are as a
generalist who accepts everyone seeking care,
whereas other health provides limit access to
their services on the basis of age, sex, and/or
diagnosis
(WONCA, 1991).

66. Components Of Family Medicine

67. PRIMARY CARE PHYSICIAN
Provides definitive care to the undifferentiated patient,
the personal primary care physician serves as the entry
point for substantially all of the patient’s medical and
health care needs-not limited by problem origin, origin
system, gender, or diagnosis.
(AAFP Directors’ Newsletter, 1994).

68. CLINIC
Hospital
Primary Care Secondary Care
Complementation not Competition the goal

69. Providing optimal generalist care requires broad and
comprehensive training that cannot be gained in brief
and uncoordinated educational experiences.
The generalist physician defined as one “who provides
continuing, comprehensive, and coordinated medical
care to a population undifferentiated by gender, disease,
or organ system”
(Kimball and Young, 1994).

70. History of Family Medicine
In 1923, Francis Peabody commented that modern
medicine had markedly fragmented the health care
delivery. He called for return of the generalist physician.

71. In 1966, the concept of a new specialty in primary care
received official recognition in two separate reports;
1.Report of the Citizens’ Commission on Graduate
Medical Education of the American Medical
Association, also known as the Millis Commission
Report.
2.The Ad Hoc Committee on Education for Family
Practice of the Council of Medical Education of
American Medical Association also called the Willard
Committee.

72. •Three years later, in 1969, the American Board of
Family Practice (ABFP) came into being as the
twentieth medical specialty board.
•The American Academy of General Practice was
renamed the American Academy of Family Physicians
(AAFP) in 1971.

73. Why Family Medicine?
Unique
–Training is based on outpatient setting
–Unit of care is the family
–Model of care is bio-psycho-socio-spiritual
Unrestrictive
–Care provision for all patients,
regardless of…
Gender
Race
Age
Organ system of illness

74. PRINCIPLES OF PRIMARY
CARE (CFPC)
• The doctor-patient relationship is central to
job of family physicians
• The practice of family medicine is
community-based
• The family physician is a resource to a
defined population
• The family physician must be a skilled and
effective clinician

75. Walk-in Clinics
• Convenient for patients, flexible for physicians
• Fee-for-service payment
• Little continuity of care
• Skim off the “easy” (remunerative) patients,
leaving the older, multi-problem patients to
family physicians and making family practice
less financially viable

76. Emergency Departments
• Accessible (with long waits)
• Ready access to technology
• Appropriate training?
• Very limited social supports
• Poor continuity of care
• Expensive

77. Solo Practice/Partnerships
• Maximum autonomy, individual responsibility
• Minimum professional support
• Fee-for-service payment rewards hard work (too
hard?)
• Rewards “talking” services less well than
“doing” services; discourages prevention and a
global approach to patients’ problems

78. Group Practice
• Provides colleague support, sharing of expenses
and call duty, reduced capital costs
• Fee-for-service payment
• For patients, one-stop provision of medical care

79. STRENGTHS OF PRIMARY Health
CARE IN BAHRAIN
• Fairly good supply of trained family physicians
(although on a longer run not enough)
• Primary Health Care Centres
• Catchments areas
• Family Folders
• Referral only by FP
• Community participation
• Paramedical support

80. WEAKNESSES OF PRIMARY CARE
IN Arab Countries
• No Good Model for Family Medicine Clinics
and Practice
• Limited training
• Patient not linked to the physician; free to
“shop around”
• Physicians can practise where they want,
rather than where they are needed
• Limited support for family physicians
• Little linkage to public health
• Fee-for-service discourages prevention and
thorough care

81. The New Concept
•Accept Family Medicine as a specialty
•Status
•Remuneration
•Involve the Setting as a whole (People,
Environment & Community)
•Integration of Health Policies’ maker into all
decisions
•Outreach of the Setting Into the Community

82. CLINIC
Hospital
Primary Care Secondary Care
Complementation not Competition the goal