Orientation about family medicine

1. Orientation
About Concepts of Family Medicine
Y6 Family Medicine Rotation
Prof Faisal Abdullatif AlnasirFPC,MICGP,FRCGP,FFPH,PhD
Chairman; Dept. of Family & Community Medicine
Arabian Gulf University

4. 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

5. 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.

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

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

8. The only
equipment lack in
the modern
hospital?
Somebody to
meet you at the
entrance with a
handshake!
~Martin H. Fischer
German-born American physician (10 November 1879 – 19 January 1962)

9. Family medicine
5th Medical specialty that provides:
• first contact
• Comprehensive health care (total health care)
from the first contact and initial assessment to
the chronic problems
• Care for individual and the family
• Care for ill and those with an undiagnosed sign,
symptom or health concern

10. Family medicine
• Treatment of acute and chronic illnesses
• Early recognition
• Prevention and of disease.
• Health promotion (counseling & patient
education).
• Health maintenance,

11. Family medicine
Medical specialty that provides
continuity
of health care.

12. kurashi dom.exe
Qurashi Dom

13. Early detection
Early Diagnosis

26. Early Management

29. Sharp Vision

35. If:
5+3= 28
9+1= 810
8+6=214
5+4=19
7+3=??
Solve this if you are a genius

36. If:
5+3= 28
9+1= 810
8+6=214
5+4=19
7+3= 410
Solve this if you are a genius

37. Personalized Care

38. It is not a case we
are treating; it is a
living, palpitating,
alas, too often
suffering fellow
creature.
~John Brown

39. Family Care

41. Care for the whole Family

42. Family medicine
Caring for the whole family

44. Very skilled
Very knowledgeable

47. Wide
Thoughts

53. Attitude
Passion

56. Behavior
Uniqness

58. Mr Smooth, Gulzar Ahmed

59. Ethics

60. What to Learn during
this period
• Consultation, gender, age, nationalities
• Skills Examination
• Chart writing
• Handling instruments
• Dealing with various forms
• Writing a prescription
• Referrals

61. What to Learn during
this period
• Common and chronic cases
• Physical, psychological, social,
economical
• Emergencies
• Preventive: ANC, PNC, Child, Adolescent &
Elderly Care,
• Other service: Lab, Pharmacy, Radiology,
Dental

62. A doctor who cannot
take a good history and
a patient who cannot
give one are in danger
of giving and receiving
bad treatment.

63. What to Learn during
this period
• Surgical Procedures
• Injections
• Health education
• Administration

64. How to do it
• Two weeks orientation
• Six weeks clinical service
• Two to one basis
• Separate room
• Booklet, seminars, training guideline

65. What is required from you?
• Show interest, dedication, enthusiasm
• Punctuality, discipline
• Representation (dress code, Look)
• Self assessment
oDaily Case report
oSelf assessment at 6 weeks of training
in Consultation, examination, chart
writing.

66. A doctor must work
eighteen hours a
day and seven
days a week.
If you cannot
console yourself to
this, get out of the
profession.
~Martin H. Fischer

67. Assessment
• Tutor Assessment: = 10%
• Logbook: = 5%
• Clinical: = 30%
• WOSCE Examination: = 55%

68. Example of a WOSCE Exam
Data:
This is a video clip of a 35-year-old obese
male. He developed acute severe pain in his
left Ankle and big toe since last night after
having heavy meal in a party. He had no
similar attacks before. No history of any
trauma or falling down.
Task:
Watch the video and look at the attached
photo, then answer the following questions.

70. Questions:
Q1:What is the most probable diagnosis?
A1:_____________________________________________________
Q2:What laboratory investigation you would do to confirm your
diagnosis?
A2: ______________________________________________________
Q3: What are the complications of this condition (Mention 3)
A3:
__________________________________________________________
__________________________________________________________
__________________________________________________________
Q4: Write your management plans for this condition (Mention 3)
A4:
__________________________________________________________
__________________________________________________________
__________________________________________________________

71. A1- Acute gouty arthritis
A2: - Serum Uric acid level
A3:
• Deposits of urate crystals to form skin nodules called tophi
• Kidney stones
• Recurrent gout (recurrent attack of pain)
• Irreversible joint deformities and loss of motion
• High blood pressure, coronary artery disease, and heart failure
A4:
• Cholchicine or NSAID e.g. Indomethacin, Ibrufen, Diclofenac
sodium to be given regularly till the paid subsides.
• Prophylaxis when the pain disappears (After one week). Start with
Allopurinol or Probenecid as a prophylaxes.
• Dietary advice (stop alcohol & reduce protein)
• Reduce body weight and exercise
• Regular follow up for check up and blood test for uric acid level.

74. Thank You

75. 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.

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

77. 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.

78. 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).

79. 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).

80. 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).

81. 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

82. 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

83. 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

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

85. 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

86. 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

87. 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

88. 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

89. 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

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

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