This document provides an orientation to family medicine. It discusses the key principles of family medicine including providing comprehensive, continuous, and personal primary care. It outlines the core competencies of a family physician including managing acute/chronic health problems, providing health promotion/preventative services, counseling, emergency care, and more. The document also discusses specific skills like communication, collaboration, management, and advocacy. It provides examples of common clinical presentations family physicians encounter and guidelines for evaluating and managing conditions like hypertension, diabetes, chest pain, fever, and more.

1. FAMILY MEDICINE
ORIENTATION

2. FAMILY MEDICINE
PROF DR M. A. BADR

3. Family medicine
Prevention & health promotion
WONCA
World organization of family doctors

5. Family medicine
• Provide: Primary care ethics
PERSONAL
COMPREHENSIVE
CONTINUING CARE
Primary care ethics

6. FAMILY PHYSICIAN
• Ability to evaluate new information and its
relevance to the practice
• Knowledge & skill
• Appropriate use of medical records and or
other information system

7. FAMILY PHYSICIAN
• Efficient management of the organization
or business aspects of practice
• The ability to plan and implement policies
screening and preventive care

8. BASIC COMPONENTS
• Access to care
• Continuity of care
• Comprehensive care
• Coordination of care
• Contextual care
• Community and family based
• Evidence based health care

9. FAMILY MEDICINE
• STRUCTURE
Presence, access,continuity
• PROCESS EBM
• OUTCOME
Prevention , health promotion

10. COMPETENCIES OF F.P.
• Acute health problem
• Chronic health problem
• Provide health promotion services
• Emergency services
• Counseling
• Preventive
• Terminal and palliative
• Home care

11. COMPETENCIES IN FM
WHAT KNOW
DO
IN ORDER TO BE EFFECTIVE

12. ORGANIZATION AND
CATEGORIZATION OF
COMPETENCIES
• COMMUNITY BASED
• PATIENT- PHYSICIAN RELATIONSHIP
• SKILLED CLINICIAN
• RESOURCE TO A DEFINED
POPULATION

13. ORGANIZATION AND
CATEGORIZATION OF
COMPETENCIES
FM EXPERT
• COMMUNICATOR
• COLLABORATOR
• MANAGER
• HEALTH ADVOCATE
• SCHOLAR
• PROFESSIONAL

14. Reception
• Identification
• Appointment –Reminder communication
• Interpersonal communication
• Waiting room Hand-out, pamphlets,
media,
• Call for file ( confidential)

15. PreventionPrevention
Patient 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 abnormality
arisesarises

16. Documentation
double sward
• Personal data
• Date & Time
• Communication Mobile no/ address
• File revision
• Notification about ADR allergy
• Oral anticoagulant
• Hereditary disease, sickling, G-6-P def

17. 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

18. Process
• Safe
• Effective guidelines
• Efficient
• Timely
• Patient centered
• Equity discrimination

19. Guidelines
• Consensus
• Guidelines National, International
• Evidence based care
• Use of Algorithm and chart
• Quantitative medicine, personalized,
individualized medicine

20. Continuous performance
improvement
• Safety limit transmission of infection ,
hand hygiene
• Guidelines
• Keep record for your error

21. SOAP
• Subjective
• Objective
• Assessment, analysis
• Plan

22. PLAN
• Life style modification
• Diet
• Exercise
• Sick leave
• Medication
• Consultation
• Reference health education
• Revision and follow up

23. Medications
• Prescription, handwriting
• Pharmacological name, dose, frequency,
route, initial dose, duration, ADR
• ADR avoidable , nonavoidable
• Wrong prescription
• Role of the pharmacist

24. Non avoidable
• Sensitivity test
• Anaphylaxis
• Severe reaction erthyma
Multiformis,Steven Jonhson

25. Avoidable
• Personalized Medicine
pharmacogenomic, genetic make up
• Can be predictable >25% of commonly
used drug (array)

27. MAR medication administration
record

28. COPE computerized physician
order entry
• Computerized physician order entry
(CPOE) is the process of entering
medication orders or other physician
instructions electronically instead of on
paper charts. The use of a CPOE system
can help reduce errors related to poor
handwriting or transcription of medication
orders. Physician assistance

29. Personalized medicine
• Right patient
• Right treatment
• Right time
• Right dose according genetic make up of
patient

30. Quantitative medicine is the key to
reducing healthcare costs and improving
healthcare outcomes
Patients with same diagnosis
Misdiagnosed
Non-responders,
toxic responders
Non-toxic responders

31. Asthma Drugs 40-70%
Beta-2-agonists
Hypertension Drugs 10-30%
ACE Inhibitors
Heart Failure Drugs 15-25%
Beta Blockers
Anti Depressants 20-50%
SSRIs
Cholesterol Drugs 30-70%
Statins
Major drugs ineffective for many…
Source: Amy Miller, Personalized Medicine Coalition

32. The Promise
Imagine when doctors can…
• Prevent Disease by identifying risks, early interventions
• Diagnose Conditions less Predict Disease pre-symptomatically with
simple 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

33. Take five
• BE with us

34. Common clinical diagnosis
• Hypertension
• Chest pain , chest infection, asthma
• Diabetes
• GIT, jaundice ,Diarrhea
• Coma & syncope
• Stroke
• Trauma
• fever

35. Office BP Measurement
§ Use auscultatory method with a properly calibrated and validated
instrument.
§ Patient should be seated quietly for 5 minutes in a chair
(not on an exam table), feet on the floor, and arm supported at
heart 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.

36. BP Measurement Techniques
Method Brief Description
In-office Two readings, 5 minutes apart, sitting in chair. Confirm
elevated reading in contralateral arm.
Ambulatory BP monitoring Indicated for evaluation of “white-coat” HTN. Absence
of 10–20% BP decrease during sleep may indicate
increased CVD risk.
Self-measurement Provides information on response to therapy. May help
improve adherence to therapy and evaluate “white-
coat” HTN.

37. Blood Pressure Classification
Normal >120 and >80
Prehypertension 120–139 or 80–89
Stage 1 Hypertension 140–159 or 90–99
Stage 2 Hypertension <160 or <100
BP Classification SBP mmHg DBP mmHg

38. Benefits of Lowering BP
Average Percent Reduction
Stroke incidence 35–40%
Myocardial infarction 20–25%
Heart failure 50%

39. 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 and
low-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 indicated
unless BP control is not achieved

40. Hassan age 50 years
• Presented to you with severe throbbing
headache, chills, epig pain and vomit once
Past history of hypertension,dyslipidemia
• Pulse full, Bp 200/120, lung showed
bilateral basal fine crepitation
• Ask the patient about important symptoms
• What you will do if you are in OPD

41. 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?

42. Mr Hamdi 45 ys old
• Vomit this morning brown colouration
vomitus after an overnight severe nausea
• Several days before he seeked the advise
of the orthopedic surgeon for a low
backache and girdle pain
• Ask him few question
• Decide what to do if you examine him
home

43. Amira young female 22 years old
• C/o of vertigo, vomiting , unsteady gait
associated with severe headache, she
was on antibiotic because of an upper
respiratory tract infection few days before
• Your examination revealed afebrile,
nystagmus , brisky reflex on both LL.
• Is it serious, what you will do

44. Soad pregnant in her last trimest
• Referred by her obstetrician because her
last urine analysis showed + sugar ,FBS is
90, her PP is 116mg%
• Is she gest diabetes
• What you will recommend

45. Ali young asthmatic patient
• c/o since yesterday something giving way
in his rt lower chest after cough
• Today his respiration not at ease and
suffer from stitching pain on the same side
during walking
• Examination revealed only mild degree of
fever 37.4
• Decision

46. 60ys old lady
• Fever, rigor, bilateral loin pain and scanty
urine
• Past history of renal stones, gout,
HTN,osteoathrosis
• What you will do as investigations

47. Ahmed 34 year old
• c/o of lower left pricking sensation in the
chest
• Few day later rash appear in the same
area and extend , associated with general
illhealth
• What you will ask him ?
• DD

48. 50years old male
• C/o progressive loss of wt, anorexia, night
fever
• No cough
• Examination revealed significant loss wt
• Few L node enlargement deep cervical
group, shotty ,rubbery not fixed
• CBC lymphopenia, normocytic ,
normochromic anaemia and shooting ESR
• Discuss the case and make a plan

49. 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