1.
3
PRINCIPLES OF
FAMILY MEDICINE
DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINE
FACULTY OF MEDICINE
PADJADJARAN UNIVERSITY
THE PRINCIPLES ARE:
DEDICATED TO
THE PERSON
MANAGER OF
RESOURCES
SUBJECTIVE ASPECTS
OF MEDICINE
(SENSITIVITY TO
FEELINGS
,EMOTIONAL ETC
HOME VISITS (SEES
PATIENTS AT HOME)
LIVE IN COMMUNITY/ A
PART OF THE COMPLEX OF
FAMILY RELATIONSHIP
UNDERSTAND THE
CONTEXT OF ILLNESS
ALL CONTACT WITH
PATIENTS AN
OPPORTUNITY FOR
PREVENTION & HEALTH
EDUCATION
FAMILY
PHYSICIAN
THE PRACTICE AS A
POPULATION AT RISK
DOES COMMUNITY
NETWORKING
THE PRINCIPLES ARE:
1.
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.
2.
THE FAMILY PHYSICIAN SEEKS TO UNDERSTAND
THE CONTEXT OF ILLNESS.
3.
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
6.
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 SELFREFLECTIVE PRACTICE
9. THE FAMILY PHYSICIAN IS A MANAGER OF
RESOURCES
THE IMPLICATIONS OF THE PRINCIPLES
BASED ON:
COMMUNITY
RELATIONSHIP
EXPERIENCE
EMOTIONS
INTEGRATION OF
KNOWLEDGE: AN
ABILITY TO SEE THE
UNIVERSAL IN THE
PARTICULAR
F. P
HABITAT
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
MANAGEMENT
FAMILY PHYSICIANS
ATTENTION TO THE
EMOTIONS IS A
REQUIREMENT
AND
ATTENTION TO SOCIALECONOMIC 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 CARE
FOR 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:
1. INTERPERSONAL
2. CHRONOLOGICAL Continuity between sites: home,hospital, office
3. GEOGRAPHIC
4. INTERDISCIPLINARY : meeting a variety of needs (other proffesions)
5. 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.
1. HAVE PERSPECTIVE OF THE WHOLE SITUATION :
ITS HISTORY AND TRADITIONS
ITS GENERAL STRUCTURE
ITS GOALS AND OBJECTIVES
ITS RELATIONSHIP WITHIN THE ENVIRONMENT
2. UNDERSTAND HOW EACH PART FUNCTIONS WITHIN THE WHOLE
3. ACT AS A COMMUNICATION CENTER: INFORMATION FLOWS FROM
THEM AND FROM THE OUTSIDE
4. HELP THE PATIENT/FAMILY TO ADAPT THE CHANGES,BOTH INTERNAL
AND EXTERNAL
5. ASSESS PROBLEM (PATIENT, FAMILY AND ENVIRONMENT)
6. MAY DEAL WITH THE PROBLEM OR REFER IT TO A SPECIALIST
MISCONCEPTIONS OF THE ROLES OF
GENERALIST AND SPECIALIST PHYSICIANS
1.
THE GENERALIST HAS TO COVER THE WHOLE FIELD OF
MEDICAL KNOWLEDGE >< THE GENERALISTS KNOWLEDGE IS
JUST AS SELECTIVE AS THE SPECIALIST
2.
IS ANY GIVEN FIELD OF MEDICINE, THE SPECIALIST ALWAYS
KNOW MORE THAN THE GENERALIST >< WE BECOME
KNOWLEDGEABLE ABOUT THE PROBLEMS WE COMMONLY
ENCOUNTER
3.
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)
4.
ONLY BY SPECIALIZING CAN ONE ATTAIN DEPTH OF
KNOWLEDGE >< DEPTH OF KNOWLEDGE DEPENDS ON
THE QUALITY OF THE MIND, NOT ON ITS INFORMATION
CONTENT
5.
AS SCIENCE ADVANCES, THE LOAD OF INFORMATION
INCREASE >< THE IMMATURE BRANCHES OF SCIENCE
THAT HAVE THE GREATEST LOAD OF INFORMATION
6.
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
KNOWLEDGE
BASIC CLINICAL KNOWLEDGE
THE NATURAL HISTORY OF DISEASE
HUMAN DEVELOPMENT
HUMAN BEHAVIOUR
KNOWLEDGE OF PATIENT COMMUNITY AND CHANGING
TRENDS
EACH COMMUNITY HAS ITS CULTURAL,ETHNIC,
DEMOGRAPHIC, GEOGRAPIC AND ECONOMIC
CHARACTERISTICS THAT MAY BE RELEVANT TO
PRACTICE
KNOWLEDGE OF PROFESSIONAL COMMUNITY & CHANGING
TRENDS
EXISTING AND NEW SERVICES,COMPLEMENTARY &
ALTERNATIVE MEDICINE (CAM), HERBAL MEDICINE
OTHER PROFFESION
SKILLS
GENERAL CLINICAL SKILLS, PRACTICAL AND PROCEDURAL
SKILLS.
HISTORY TAKING, PHYSICAL EXAMINATION
SIMPLE LAB SKILLS
SIMPLE OPERATIVE SKILLS ETC
SPECIAL CLINICAL SKILLS OF IMPORTANCE TO GENERAL
PRACTICE
DOCTOR PATIENT RELATIONSHIP
COMMUNICATION SKILLS
COUNSELLING AND HEALTH EDUCATION
SKILLS IN MANAGING SPECIAL GROUPS OF PATIENTS
THE SOLUTION OF UNDIFFERENTIATED PROBLEM
IDENTIFICATION OF RISKS AND EARLY DEPARTURES FROM
NORMALITY.
SKILLS IN RESOURCE MANAGEMENT
PRACTICAL MANAGEMENT SKILLS (MANAGER)
