General structures of Health care and Population service principles.The organization of the family doctor

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Theme 1.The place of family medicine in the general structure of
health care and the population service principles. The organization of the
family doctor or GP work.
1. What does the primary medical sanitary aid mean? What international
approaches to health service exist according to the principles of family medicine
in the developed countries?
The primary health care is the main and the most important link between
the organization of the health care and population. It is given mainly according to
the territorial principle, so a health care worker serves a definite number of people
who live in an area which the worker is assign to.
World Health Care Organization gives following definition of primary
medical sanitary aid. “The primary medical sanitary aid consists of the main
treatment such as the simple diagnostics and the treatment of main widespread
illnesses, trauma and poisoning, sending to the most senior type of
doctors(consultant) in occasion of more serious medical problems ( sending the
patients to be given special and qualified aid): disease-prevention service and the
main sanitary educational measures.” In the main developed countries the
leading health care worker is a family doctor or a GP. The advantages of the
family medicine are proved by the long period of time and the realization of the
idea for family medicine.
Firstly, a family doctor is totally responsible for the health of each family.
He concentrated about 90% of all necessary medical aid.
Secondly, the institution of a family doctor system appeared the most
successful organizational form which provided the economical efficiency of all
health care system. The requirement for an increasing number of doctors has
disappeared, auxiliary services were considerably reduced.
The number of the family doctors hesitates from 15% in the USA to 50%
in Canada. It is the most widespread doctor’s job everywhere. The average number
of inhabitants who are served by a family doctor is 1300 people in America, 1500
people in Canada and 2000 people in England. The functioning of family
medicine in the developed countries of the world has such common principles:
1. The family doctor is free elected by his patients, he provides the aid around
the clock.
2. As a rule, the ambulance station belonging to the family doctor consists of
three rooms: a waiting room, a room for patient’s examination and a room
for auxiliary examinations.
3. The main part of his activities is the preventive work .Observing all family
members,the doctor defines the risk of chronic diseases, he makes
preventive examinations to find out the symptoms of arterial hypertension,
pancreatic diabetes, glaucoma , ischemic heart disease, peptic ulcer,
neoplasms. The family doctor gives each patient individual advice about
diet, physical exercises and other free time activities and how to find out the
early stage of disease.

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4. Treatment and diagnostic activity. The family doctor diagnoses and treats
all major illnesses. If it needs the aid of the consultant or hospitalizing, he takes an
active part in it giving advice and consultation.
5. Preventive education means having the conversations about keeping a
healthy lifestyle, a harmful influence of smocking on human organism, alcohol
abuse, environment protection and each patient’s care of his health.
6. As a rule, the doctors assistant is a nurse who takes an active part in all his
activities.
7. In the most number of countries has the autonomic status, it doesn’t belong
to the common structure of medical establishments and isn’t subordinate to the
local bodies .The administrative and management personnel doesn’t superintend
the doctor’s work. The doctor’s work is controlled directly by the patient who he
has been chosen by or a local body which finances him. But in any occasions
( directly or by the insurance company) the state gives money.
2.What the peculiarities and the content of a family doctor’s work are
formulated according to legislation norms? For example, who is a family
doctor? Where can he work? Who does he work with? What legal basis regulate
their cooperation? Who submits to whom? Etc.
 1.1GP/a family doctor is a specialist who has a high education and the legal
right to provide emergency medical and sanitary aid to the families he is
attached to and other people of both sexes, with any disease and of any age
who are officially attached to the certain hospital according to the place of
their residing.
 1.2A specialist who is appointed to be a family doctor must be trained in the
internship on a speciality of “The General Practice and Family Medicine” or
“ The medical business” and “Pediatrics” also the doctors who have
completed the postgraduate upgrading courses at the high educational
establishments with different forms of training on a speciality ”General
Practices (Family Medicine)” .
 1.3 A family doctor carries out a medical practice
- at the state medical establishment( an outpatient clinic, a medical unit, an
outpatient medical room)
- or at the private medical establishment (private, incorporated, public etc)
 1.4 A family doctor can work individually or in a group of family doctors
(group practice). It depends on the population structure which is served by
the doctor’s brigade, it is expedient to involve other specialists, including
social workers.
 1.5 A family doctor is on a contract to the state or municipal authority,
medical insurance companies or other medical establishments.
 1.6 The groups of population and their total number are formed in response
to the right of free choice and they are confirmed by contractual
requirement.

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 1.7 A family doctor carries out the reception of patients and also visits them
at their places, takes the complex of preventive, medical diagnostics,
rehabilitative actions among all age groups, affected by any disease in
response to the doctor’s qualification on a speciality “General Practices (The
Family Medicine)” provides the urgent medical aid in case of emergency or
injury, favours the solving of social and medical family problems.
 1.8 According to the agreement a family doctor can be allowed to have some
beds in-patient hospital to cure the patients of illnesses,.
 1.9 A family doctor abuses the special grounded junior staff and also social
workers due to the agreement with social security.
 1.10 A family doctor is guided by the legislative and normative documents
as a matter of health care.
 1.11 The family doctor’s work is controlled by health care bodies at his
working place in the manner prescribed by law.
 1.12 The family doctor’s work is estimated in accordance with quantitative
and qualitative indices of his practices.
 1.13 The family doctor’s appointment or discharge is carried out in
accordance with the active legislation and contract terms.
3. What are the family doctor’s main functions?
 2.1Providing the first medical aid to the people in response to the
qualification characteristic requirements and a certificate.
 2.2 Carrying out the sanitary and educational work to educate people about
matter of their and members of their families health forming, protection and
strengthening, self and mutual aid. Consulting the families about the matter
of family planning, ethic, psychology, hygiene, carrying out “parents
school”.
 2.3 Carrying out preventive measures to appreciate the role of the
environmental factors, discovering the diseases in their early stages(early
signs of disease) and the hidden forms of illnesses.
 2.4 Being on the dynamic watch for the state of people’s health and giving
all necessary examinations and health improvement in accordance with
complex of medical measures.
 2.5 Providing the urgent medical aid to the sick people and victims
independently of their residing.
 2.6 Providing the complete diagnostics and treatment in due time in the
outpatient settings, day ward or at home within the limits of GP
competence.
 2.7 Directing the sick people to the consultant or outpatient hospital, in a
purposeful manner in due time when the disease is out of GP competence ,
planned and urgent hospitalization with medical order.
 2.8 Carrying out rehabilitation measures.

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 2.9 Making working capacity examination in response to active legislation
and directing to attend Medical and Sanitary Commission of Experts.
 2.10 Carrying out the diagnostics of early signs of infectious diseases and
their proper treatment, taking anti-epidemic measures.
 2.11 Immunizing people from illnesses.
 2.12 Support organizing medical and social aid and household help to the
elderly , disabled and chronic diseased people together with social security.
 2.13 Taking part in the purposeful state and regional medical programmes.
 2.14 Analysis of the state of health of serving by a family doctor people.
 2.15 Planning the content and volumes of work for him and his staff.
 2.16 Carrying out of regular work in the purpose of the professional
development of the subordinate medical staff.
 2.17 Own professional development by self-education or medical refreshing
courses.
4. Deontological aspects of GP practice. The peculiarities of relations between a
family doctor and his patient or the patient’s family.
 Since the doctor has made a decision on giving his personal medical aid to
any person or involving a person as a volunteer to take part in the scientific
experiments he must relate to this person on the basis of human ethic and
morals of doctor’s deontology proclaimed in “Oath of the doctor of
Ukraine” and in “The ethical code of the doctor of Ukraine”
 The doctor is responsible for the quality and humanity of medical aid which
is given to the patients and any other professional actions which are
connected with intervention during the life and health of the person. Doing
his work he must be guided by the Constitution and the legislation of
Ukraine (or other country where he works), active normative documents
relating to doctor’s practice (medical standards) but being within limits of
these clauses, choose the prevention techniques, diagnostics and treatment
taking in consideration features of disease the ones he considers to be the
most effective in each certain case, being guided by interests of patient.
When it is necessary the doctor must use his colleagues help.
 In situation of giving medical aid to a sick person unforeseen by the law ,
normative acts and instructions, first of all, the doctor must be guided by
interests of the patient and professional etiquette and morals principles and
follow his own conscience
 The doctor’s actions must be directed to be maximally useful for life and
health of the patient, for his maximal social support . The doctor mustn’t
intervene the patient privacy or his family one without sufficient reasons.
 The doctor mustn’t put the patient at unjustified risk , moreover, he mustn’t
use his knowledge in inhumane purposes Choosing any methods for
treatment , first of all, the doctor must be directed by principle “Don’t do
much harm!”

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 The doctor must spare the patient enough time and give him enough
consideration to make out the right disease, give the complete volume of
help, to substantiate his recommendations for the further treatment, to give
them clearly and in detail to his patient.
 The doctor mustn’t exaggerate or underestimate severity of disease in the
conscience way for the purpose of gaining social protection and pecuniary
aid if it doesn’t correspond to the real state of his health.
5. “A free choice of the doctor and the patient”. Formulate the main clause of
this deontological principle.
 Except for a case which demands urgent steps, the doctor has rights to
refuse to treat the patient if he that there is no necessary trust between him
and his patient, when he feels he isn’t enough competent to treat him or he
doesn’t have all necessary possibilities of treating the patient and in any
other case, if it doesn’t contradict the Hippocratic oath. In this case the
doctor must give the patient all necessary information and corresponding
recommendations .
 The doctor mustn’t interfere the patient right to be consulted by another
doctor, he must respect the patient right to chose the doctor and to take part
in decision-making on treatment and preventative steps. (except for
compulsory treatment in prescribed order)
 The patient’s voluntary consent to examination, treatment or medical
experiments with his participation is allowed doctor at personal meeting.
This consent should be given consciously, the patient should be informed
about treatment modes, consequences of their using, about possible
complications or after-effects and about other alternative treatment modes.
If the patient isn’t able to give the permission consciously, it should be
given by the legal representative or a tutor-at law.
 Treatment and diagnostics measures without patient’s permission are
allowed only in a case of threat to patient’s health and life if the patient isn’t
able to estimate the situation adequately. In similar cases the decision should
be taken jointly and with the participation of his relatives.
 Treating the child at the age to 14 or the patient under the guardianship, the
doctor must give his parents or the tutor-at-law the full information about
treatment modes or the way treatment and take under consideration the
patient’s will as much as it possible. Except for case when it needs the
urgent aid because of the vital requirements.
 The doctor must protect the interests of a child or a patient who isn’t able to
make a decision without somebody’s help, if it is obviously that the
interests of his life are indifferent to associates or they are understood
insufficiently.

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6. “Keeping a medical secret by GP” Formulate the main clauses of this
deontological principle. When can a medical secret be uncovered? When can’t a
medical secret be uncovered?
 The doctor must respect the honour and the dignity of the patients, his
rights to not be intervened in private life, have a benevolent attitude to a
patient.
 The patient has rights to keep his own secret.
 The doctor the same as the other people must the doctor’s secret even after
the patient’s death the same as a fact of applying for medical aid unless the
patient gave another order and his disease doesn’t threaten his associates and
the society.
 The secret concerns all information which have been received during the
treatment or applying (diagnose, treatment modes, prediction etc.)
 The medical information can be uncovered :
1) If there is a written permission of the patient;
2) I a case of unjustified demand of agency of inquiry, investigation agencies
bodies, offices of a public prosecutor and courts;
3) If keeping a secret threatens the health and life of a patient or other people
(dangerous infectious diseases);
4) If another specialists , who have a legal access to medical information, are
involved in the process of treatment, they must keep all information about
the patient a secret, and must be informed by the doctor about responsibility
connected with its divulging;
5) The doctor’s secret must be kept during scientific researches, training of
students or doctors who attend refreshing courses. The patient can be shown
with his consent.
7. “The GP’s duty to inform the patient” Give the definition of this deontological
principle:
 The patient has the rights to get the exhaustive information about the state of
his health, but he can refuse it or abuse another person who should be
informed about it.
 Giving the patient the information about the state of his health and
recommended treatment, the doctor must take into consideration the
individual peculiarities of the patient and watch if he estimates the situation
in the right way.
 The information can be hidden from the patient if there is a serious reason to
think it will cause him much harm. In a case of unfavourable predictions, the
patient must be informed delicately and cautiously giving the hope for
further life and possible successful result.
 Making a mistake or in a case of anti-effect of his mistake the doctor must
inform his chief or a senior colleague, if they are absent he must inform the

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administration of the hospital (other medical establishment) he works in, and
immediately do everything to improve harmful anti-effects not waiting for a
special order to improve his mistake, he must involve the consultants if it is
necessary and inform them honestly about he mistake or after-effect.
 The doctor must practice using his own name not using unofficially taken
titles, degrees or status.
8. “The interaction between the GP and the serious or fatal case” Make the
definition of deontological principles of this interaction:
 The doctor must stay with the dying patient till the moment of his death,
provide all necessary treatment modes and care, support or prolong his
possible way of life, make his physical and mental suffering easier and
support the patient’s relatives.
 The doctor must encourage the patient in his rights to have a spiritual
support of the representatives of any religion.
 The stoppage of reanimation must be decided jointly (if it is possible) when
the patient’s status is considered to be nonreversible death in accordance to
the criteria which are given by the Ministry of Health Care in Ukraine. The
doctor mustn’t hasten the patient’s death deliberately or resort to euthanasia
or involve another people in doing it.
 The doctor mustn’t leave his patients in a case of a total danger.
9. “The interaction between the GP and other medical workers”
Make the definition of the main deontological principles of this interaction.
 The doctor must respect and owe a debt of gratitude to a person who has
taught him the doctoring art during his life.
 The doctor must keep the honour and noble traditions of medical
cooperation , respect the colleagues and be benevolent to them.
 The doctor mustn’t doubt or discredit the professional qualification of
another doctor in public. When the doctor admits his colleague ‘s mistakes it
should be argued, inoffensive and told at a private talk before this question
will be put under discussion of medical commonwealth or ethic commission.
 In complicated clinical cases doctors must advise and help each other in the
correct way. There is only one doctor who is responsible for treatment who
has the rights whether to take the colleagues recommendations in
consideration or refuse to do it being guided only by the interests of the
patient.
 Doctors must respect medical and auxiliary workers and constantly favour
the improvement of their professional level.