PRINCIPLES OF FAMILY MEDICINE

DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINEFACULTY OF MEDICINEPADJADJARAN UNIVERSITY

1.3

THE PRINCIPLES ARE:FAMILY PHYSICIANDEDICATED TO THE PERSONUNDERSTAND THE CONTEXT OF ILLNESSALL CONTACT WITH PATIENTS AN OPPORTUNITY FOR PREVENTION & HEALTH EDUCATIONTHE PRACTICE AS A POPULATION AT RISK DOES COMMUNITY NETWORKINGLIVE IN COMMUNITY/ A PART OF THE COMPLEX OF FAMILY RELATIONSHIPHOME VISITS (SEES PATIENTS AT HOME)SUBJECTIVE ASPECTS OF MEDICINE (SENSITIVITY TO FEELINGS ,EMOTIONAL ETCMANAGER OF RESOURCES

THE PRINCIPLES ARE:

FAMILY PHYSICIANS ARE COMMITTED TO THE PERSON RATHER THAN TO A PARTICULAR BODY OF KNOWLEDGE, GROUP OF DISEASES OR SPECIAL TECHNIQUES. IT IS NOT LIMITED BY THE TYPE OF HEALTH PROBLEM AND HAS NO DEFINED END POINT.

THE FAMILY PHYSICIAN SEEKS TO UNDERSTAND THE CONTEXT OF ILLNESS.

THE FAMILY PHYSICIAN SEES EVERY CONTACT WITH HIS PATIENTS AS AN OPPORTUNITY FOR PREVENTION OR HEALTH EDUCATION.

THE PRINCIPLES ARE (CONTD)

4. THE FAMILY PHYSICIAN VIEWS HIS OR HER PRACTICE AS A POPULATION AT RISK

5. THE FAMILY PHYSICIAN SEES HIMSELF OR HERSELF AS PART OF A COMMUNITYWIDE NETWORK OF SUPPORTIVE AND HEALTH CARE AGENCIES

IDEALLY, FAMILY PHYSICIANS SHOULD SHARE THE SAME HABITAT AS THEIR PATIENTS

THE PRINCIPLES ARE (CONTD)

7. THE FAMILY PHYSICIAN SEES PATIENTS IN THEIR HOMES.

8. THE FAMILY PHYSICIAN ATTACHES IMPORTANCE TO THE SUBJECTIVE ASPECT OF MEDICINE. FAMILY MEDICINE SHOULD BE A SELF-REFLECTIVE PRACTICE

9. THE FAMILY PHYSICIAN IS A MANAGER OF RESOURCES

THE IMPLICATIONS OF THE PRINCIPLES BASED ON:F. PCOMMUNITYHABITAT RELATIONSHIP EXPERIENCE EMOTIONS INTEGRATION OF KNOWLEDGE: AN ABILITY TO SEE THE UNIVERSAL IN THE PARTICULAR

WHAT ARE THE IMPLICATIONS OF THE PRINCIPLES?THE IMPLICATIONS ARE :we know people before we know what their illnesses will be

F.M. may become part of its complex of family relationships and many of them share with their patients at the same community and habitat

long term relationships lead to a build up of particular knowledge about patients

F.M. can not divide body and soul as a separate subject. attention to emotions is a requirement

WHAT ARE THE MOST IMPORTANT DIFFERENCES ABOUT :CLINICIANS

NOT NORMALLY EXPLORE THE EMOTIONS OR THAT EXCLUDES ATTENTION TO THE EMOTIONS AS AN ESSENTIAL FEATURE OF DIAGNOSIS AND MANAGEMENTFAMILY PHYSICIANS

ATTENTION TO THE EMOTIONS IS A REQUIREMENTAND ATTENTION TO SOCIAL-ECONOMIC OF THE PATIENTS IS REQUIRED ALSO

WHAT ARE POTENTIAL CONFLICTS BETWEEN FAMILY DOCTORS ROLES AND RESPONSIBILITIES ?

THE FIRST PRINCIPLE (DEDICATED TO THE PERSON) IS ONE OF COMMITMENT TO THE INDIVIDUAL PATIENT, TO RESPOND TO ANY PROBLEM THE PATIENT MAY BRING THE PATIENT WHO DEFINES THE PROBLEM.

THE THIRD PRINCIPLE (OPPORTUNITY FOR PREVENTION & HEALTH EDUCATION) THE DOCTOR WHO DEFINES THE PROBLEM

THE FOURTH PRINCIPLE (THE PRACTICE AS A POPULATION AT RISK) ADD ANOTHER DIMENSION THE FOCUS IS SWITCHED FROM INDIVIDUAL TO THE GROUP

THE NINTH PRINCIPLE (MANAGEMENT OF RESOURCES) CONFLICT OF INTEREST

CONTINUITY OF CAREFOR A DISCIPLINE THAT DEFINES ITSELF IN TERMS OF RELATIONSHIP, CONTINUITY IN THE SENSE OF AN ENDURING RELATIONSHIP BETWEEN DOCTOR AND PATIENT IS FUNDAMENTAL OR IS A MUTUAL COMMITMENT THE HENNENS FIVE DIMENTIONS OF CONTINUITY ARE:INTERPERSONALCHRONOLOGICAL Continuity between sites: home,hospital, office GEOGRAPHICINTERDISCIPLINARY : meeting a variety of needs (other proffesions)INFORMATIONAL : through medical record

CUMULATIVE KNOWLEDGE OF PATIENTS CONTINOUS AND COMPREHENSIVE CARE ALLOWS THE FAMILY PHYSICIAN TO BUILD UP, PIECE BY PIECE, KNOWLEDGE ABOUT PATIENTS AND FAMILIES.

THE ROLE OF GENERALIST FAMILY PHYSICIAN IS BY NATURE AND FUNCTION , A GENERALIST. HAVE PERSPECTIVE OF THE WHOLE SITUATION :ITS HISTORY AND TRADITIONSITS GENERAL STRUCTUREITS GOALS AND OBJECTIVESITS RELATIONSHIP WITHIN THE ENVIRONMENTUNDERSTAND HOW EACH PART FUNCTIONS WITHIN THE WHOLEACT AS A COMMUNICATION CENTER: INFORMATION FLOWS FROM THEM AND FROM THE OUTSIDEHELP THE PATIENT/FAMILY TO ADAPT THE CHANGES,BOTH INTERNAL AND EXTERNALASSESS PROBLEM (PATIENT, FAMILY AND ENVIRONMENT)MAY DEAL WITH THE PROBLEM OR REFER IT TO A SPECIALIST

MISCONCEPTIONS OF THE ROLES OF GENERALIST AND SPECIALIST PHYSICIANS

THE GENERALIST HAS TO COVER THE WHOLE FIELD OF MEDICAL KNOWLEDGE >< THE GENERALISTS KNOWLEDGE IS JUST AS SELECTIVE AS THE SPECIALIST

IS ANY GIVEN FIELD OF MEDICINE, THE SPECIALIST ALWAYS KNOW MORE THAN THE GENERALIST >< WE BECOME KNOWLEDGEABLE ABOUT THE PROBLEMS WE COMMONLY ENCOUNTER

BY SPECIALIZING, ONE CAN ELIMINATE UNCERTAINTY >< THE WAY TO ELIMINATE UNCERTAINTY IS TO REDUCED THE PROBLEMS TO THEIR SIMPLEST ELEMENT AND ISOLATE THEM FROM THEIR SURROUNDINGS.

MISCONCEPTIONS OF THE ROLES OF GENERALIST AND SPECIALIST PHYSICIANS (CONTD)

ONLY BY SPECIALIZING CAN ONE ATTAIN DEPTH OF KNOWLEDGE >< DEPTH OF KNOWLEDGE DEPENDS ON THE QUALITY OF THE MIND, NOT ON ITS INFORMATION CONTENT

AS SCIENCE ADVANCES, THE LOAD OF INFORMATION INCREASE >< THE IMMATURE BRANCHES OF SCIENCE THAT HAVE THE GREATEST LOAD OF INFORMATION

ERROR IN MEDICINE IS USUALLY CAUSED BY LACK INFORMATION >< MUCH MORE IS CAUSED BY CARELESSNESS, INSENSITIVITY, FAILURE TO LISTEN, ADMINISTRATIVE INEFFICIENCY, FAILURE OF COMMUNICATION, ATTITUDE AND SKILL

KNOWLEDGE AND SKILLS REQUIRED IN PRACTICE OF THE FAMILY DOCTOR

KNOWLEDGEBASIC CLINICAL KNOWLEDGETHE NATURAL HISTORY OF DISEASEHUMAN DEVELOPMENTHUMAN BEHAVIOUR

KNOWLEDGE OF PATIENT COMMUNITY AND CHANGING TRENDSEACH COMMUNITY HAS ITS CULTURAL,ETHNIC, DEMOGRAPHIC, GEOGRAPIC AND ECONOMIC CHARACTERISTICS THAT MAY BE RELEVANT TO PRACTICE

KNOWLEDGE OF PROFESSIONAL COMMUNITY & CHANGING TRENDSEXISTING AND NEW SERVICES,COMPLEMENTARY & ALTERNATIVE MEDICINE (CAM), HERBAL MEDICINEOTHER PROFFESION

SKILLS GENERAL CLINICAL SKILLS, PRACTICAL AND PROCEDURAL SKILLS. HISTORY TAKING, PHYSICAL EXAMINATIONSIMPLE LAB SKILLSSIMPLE OPERATIVE SKILLS ETC

SPECIAL CLINICAL SKILLS OF IMPORTANCE TO GENERAL PRACTICE DOCTOR PATIENT RELATIONSHIPCOMMUNICATION SKILLSCOUNSELLING AND HEALTH EDUCATIONSKILLS IN MANAGING SPECIAL GROUPS OF PATIENTSTHE SOLUTION OF UNDIFFERENTIATED PROBLEMIDENTIFICATION OF RISKS AND EARLY DEPARTURES FROM NORMALITY.

SKILLS IN RESOURCE MANAGEMENT

PRACTICAL MANAGEMENT SKILLS (MANAGER)