Management in Family
practice
Dr. JAWAHER AL-AHMADI
MB. ABFM. SBFM. MD
Programme
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Management option
Problem solving
Compliance
40 MIN
60 MIN
10 MIN
Some early truths to remember
The patient is as frightened as you are
The patient think is more serious than you
Illness is frightening but understanding what
is going on helps
Diagnostic process
Cues
Clinical,behvioral
Hypothesis
Unexpected
cues
revise
Hypothesis testing
Diagnosis
managment
Outcome evaluation
Management option (CRAPRIOP)
 Clarifications
Reassurance
 Advice
 Prescribing
 Referral
 Investigation
 Observations
 Prevention
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Involve pt. in management
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Choosing options
Self–help & compliance
Clarifications
(CRAPRIOP)
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Good listing
Feedback
Flexible
Respect
Right way
Personal experience
Using patient cues
Reassurance (CRAPRIOP)
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Active listening
Objective discussion
Physical examination
The diagnosis most probably is ---It is common disease (prevalence is ----%
The treatment is (----------) safety &
effectivnss
The prognosis is ------
Advice (CRAPRIOP)
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Explanation about the disease and the
important of the management
Short accurate information
Organization
Use the right way & practical method
Response to patient cues
Feed back & encouragement
How to help himself
Prescribing
(CRAPRIOP)
prescription
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A prescription is a physician's written instruction
to a pharmacist to dispense medication for a
patient.
It includes directions to the pharmacist
regarding the preparation and to the patient
regarding use of the medication.
However, a prescription represents much more
than these directions. A prescription focuses on
one slip of paper the diagnostic and therapeutic
proficiency of the physician.
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Drug information must be provided to the
patient in an understandable manner
Communication can be both verbal and written.
Comprehensive written patient information
should be a supplement to face-to-face
discussion between the physician and the
patient.
Pharmacist colleagues also contribute to patient
education efforts
Adverse drug reactions
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Adverse drug reactions have been said to be the
inevitable price paid for the benefits of modern
drug therapy.
The reported incidence of adverse drug
reactions ranges from 1 to 28 percent.
Drug-induced hospitalizations account for
approximately 5 percent of all admissions.
Between 5 and 30 percent of hospitalized
patients experience adverse drug reactions
Referral (CRAPRIOP)
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To whom ?
What for ?
diagnosis
treatment
shared care
When ?
How ?
patient opinion
explanation
referral letter
Investigation
(CRAPRIOP)
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Why ?
How ?
Misuse
Why
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For
For
For
For
Diagnosis
follow up
reassurance
screeneening
How ?
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Explanation
Be gradual
Non invasive
misuse
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As routine
Unable to deal with it
Observation (CRAPRIOP)
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Follow up appointment
To do what
Prevention (CRAPRIOP)
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Anticipatory care
Opportunistic health
promotion
Modification of help
sickening behavior
Case 1
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Salwa is 40 yrs house wife presented with
headache. She had headache for years.
She was seen by several doctors ( ENT,allergist,
neurologist)
CT scan normal
Her pain improved by paracetamol temporally.
By history she has (tension + migraine )
Family history of DM
O/E: normal
Case 2
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Huda 32 yrs mother of two boys, complain
from diarrhea 2 days mild pain and
nausea. No fever or bloody stools. She has
6-8 stools motion per day.
O/E: normal
Case 3
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Sara 33 yrs with 6 day nasal congestion
and rhinorrhea. For 2 days her nasal
discharge became greenish. She has
headache and pain on bending.
No history of asthma on the family
O/E:
nose: swollen erythematous turbinates
sinuses: tender maxillary
Case 4
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Sami 5 yrs boy is smaller than other boys
His past medical Hx is fine
O/E : Ht below 3rd centile
other is normal
Case 5
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Sameera, a 40-year old house wife,is
diabetic. She was diagnosed 5 year ago
and always had blood sugars of 12-15
mmole/liter. She tells you that she has
stopped taking her 5 mg glibenclamide
and start taking herbal medicine
poor compliance
Disease
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Psychiatric disorders
Chronic illness (especially if asymptomatic)
Minimal disability
Asymptomatic or decreased symptoms
Therapeutic regimen
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Multiple drug therapy
Higher frequency of
administration
Longer duration of therapy
Adverse effects
Higher cost of medication
Administration of medication
Poor taste of medication
Slow onset of therapeutic
effect
Physician-patient interaction
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Poor physician-patient
relationship
Inadequate follow-up or
contact with physician
Poor understanding of
instructions
Importance that physician
places on adherence