Family Medicine Definition:
Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity .
Principles of family medicine :
1/ Family medicine is a community‐based discipline
2/ The family physician is a skilled clinician
3/ The family physician is a resource to a defined practice population
4/ The patient‐physician relationship is central to the role of the family Physician.
Family doctor provide his services mainly in PHC , but he can work also in hospitals and remote clinic .
Primary Health Care (PHC) :
Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.
Elements of PHC :
2/ Health promotion and health education
3/ Provision of essential drugs
4/ Promotion of food supply and proper nutrition
5/ safe water supply and basic sanitation
6/ Treatment of common diseases and injuries
7/ Prevention and control of locally endemic diseases
8/ Maternal and child health care including family planning
the functional unit of the community , compose of two or more person including one of the parents .
Family types :
Nuclear family : a family that includes only the father, mother, and children.
Extended family : a family that extends past the nuclear family to include other relatives such as aunts, uncles, and grandparents .
Family pedigree : a pedigree is a drawing of family tree , uses to assess families and try to spot patterns which may be helpful in diagnosing or managing an individual health .
It uses specific symbols so any one can read and understand it .
Family cycle :
Stages of family cycle :
1/ Single young adult
3/Family with young children
4/ Family with adolescents
5/ Launching children and moving out
6/ Family in late life : empty nest , retirement , graving
Family functions :
1/ socialization : The process by which children learn to become human and adopt certain behavior.
2/ affection , emotional support : a member of loving and supportive family, have a more positive self image and were also more confident, while a member of distrust and hostility families is more likely to have a negative self image and emotional problems.
3/ reproductive function : reproduce children and raise them to become contributing members of the community .
4/ economical function: family supplies their children with the necessities – food, shelter and clothing.
When families fail to provide any of the necessary element of these functions, over time or repeatedly, they are considered to be dysfunctional .
This can lead to emotional, social, and/or developmental difficulties for the family members.
is the way in which members of a family interact with each other in relation to their individual goals and preferences.
It may affect the physician-patient relationship , if not managing properly .
As many as 50–75% of patients utilizing primary care clinics have a psychosocial precipitant as opposed to biomedical problems as the main cause of their visit.
Catchment area work :
Draw a correct clear map for the catchment area , marking the important marks like schools , markets , hospitals .
Write a full population register in age and sex , in exel sheet .
Follow the local policy and gain all the registers , like vaccination , antenatal care , chronic diseases registers , ….. etc.
Medical record :
Medical records form a permanent account of the care a patient has received.
Good medical records are essential for the continuity of care of patients. And it safe the doctor in litigation cases .
paper medical record
Electronic medical record
Adequate medical record contain :
Personal patients information
clinical data ( history and physical examination)
investigations and images done by the patients
follow up instructions
any advice and heath education provided to the patient
all notes and documents should be documented with date and time and doctors (or other responsible worker) name and signature or stamp .
consultation models :
There are many models of consultation , you can practice each one till you develop your own consultation model .
Phases of consultation:
The consultation can be considered in three phases, as follows:
1 Establishment of rapport
2 Diagnostic phase
• the history
• the physical and mental examination
3 Management phase
• explanation and education
• prescribing medication
• procedural—therapeutic or extended
Examples of consultation model :
1/ Pendleton and colleagues:
defined seven key tasks to the consultation:
1 To define the reason for the patient’s attendance
2 To consider other issues: continuing problems , risk factors
3 To choose, with the patient, an appropriate action for each problem
4 To achieve a shared understanding of the problems with the patient
5 To involve the patient in the management and encourage him or her to accept appropriate responsibility
6 To use time and resources efficiently and Appropriately.
7 To establish or maintain a relationship with the patient that helps to achieve the other tasks
2/ Stott and Davis
suggests that four areas can be systematically explored each time a patient consults.
(a) Management of presenting problems
(b) Modification of help-seeking behaviors
(c) Management of continuing problems
(d) Opportunistic health promotion .
3/ pyrne and long model
4/ helman’s ‘folck model ‘
5/ neighbour model
Communication skills :
A large and compelling evidence base in communication science shows that communication is vitally important to doctors and patients.
Communication can be defined as ‘the successful passing of a message from one person to another’. There are five basic elements in the communication process:
• the communicator
• the message
• the method of communicating
• the recipient
• the response
tips for effective communication:
Use clear language
Be conscious of your non-verbal communication: It is important to maintain eye contact ,reading notes or looking at the computer screen may convey negative messages.
Negotiate an agenda: Ask patients what they need from the consultation, and explain what can be covered.
Be flexible in your consultation style
Provide the information that patients want
Empathize and listen
a problem-solving approach:
1 Listen to the problem of first presentation.
2 Define the problem .
3 Establish a contract for counseling, with an agreed number of visits initially (e.g. weekly half-hour or hour appointments for 4 to 6 weeks).
4 Define short-term and long-term goals for action.
5 Decide on one option—‘experimental action’.
6 Build an action program with the patient—negotiate ‘homework’ for the patient between visits.
7 Evaluate progress.
8 Continue action or select another option.
9 Evaluate progress.
10 Terminate or refer.
Primary prevention : includes action taken to avert the occurrence of disease.
immunization against infective diseases.
eradication, as with vector control of mosquitoes to prevent malaria.
sterilization of surgical instruments and other medical equipment
secondary prevention : includes actions taken to stop or delay the progression of disease.
Screening : measures for the detection of disease at its earliest stage, i.e. in the pre-symptomatic phase, so that treatment can be started before irreversible pathology is present.
Tertiary prevention: includes the management of established disease so as to minimize disability.