PRINCIPLES OF
FAMILY MEDICINE
DEPT. OF PUBLIC HEALTH & PREVENTIVE MEDICINE
FACULTY OF MEDICINE
PADJADJARAN UNIVERSITY
Specific Learning Objectives
• Explain the philosophical foundation of family
medicine (C2)
• Understand the principles of family medicine
(C1)
• Describe characteristics and function of family
physicians (C2)
• Describe the elements of family medicine
practice and their interrelationship (C2)
The Principles
DEDICATED TO THE
PERSON
MANAGER OF
RESOURCES
UNDERSTAND THE
CONTEXT OF ILLNESS
SUBJECTIVE ASPECTS OF
MEDICINE (SENSITIVITY TO
FEELINGS, EMOTIONAL ETC)
FAMILY
PHYSICIAN
ALL CONTACT WITH PATIENTS
AN OPPORTUNITY FOR
PREVENTION & HEALTH
EDUCATION
HOME VISITS (SEES PATIENTS
AT HOME)
LIVE IN COMMUNITY/ A PART OF
THE COMPLEX OF FAMILY
RELATIONSHIP
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 (CONT’D)
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 (CONT’D)
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
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
Physicians
committed to
Family Medicine …
…..Physicians
dedicated
to the family.
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
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 HENNEN’S 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.
MISCONCEPTIONS OF THE ROLES OF
GENERALIST AND SPECIALIST PHYSICIANS
1.
THE GENERALIST HAS TO COVER THE WHOLE FIELD OF
MEDICAL KNOWLEDGE >< THE GENERALIST’S 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 (CONT’D)
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)
References
1. Mc Whinney. A textbook of Family Medicine. Third Edition,
Oxford New York, 2009. pp 13-29
2. Lee Gan, Azwar.A, Wonodirekso. Family Medicine Practice.
Singapore, 2004. Section 3 chapter 2 pp 49-56.
3. Azrul Azwar. Dokter Keluarga. Direktorat Jenderal Bina
Kesmas Departemen Kesehatan RI. Jakarta, 2002. pp 1-15,
23-31