Introduction to Community and Family Medicine

Objectives
At

the end of the session, the student will be able to: 1. Define key terms 2. Discuss the development of FM 3. Describe the characteristics of family practice 4. Discuss the scope and categories of public health activities

Development of Family Medicine

General

Practitioner

Development of Family Medicine

General

Practitioner

Prototype

of the present day family physician.

Treated

individuals and family members of all age groups.

Development of Family Medicine

General Has

Practitioner

skills attributed to surgeons, OBs, pedias, and internists. care provided was personal, continuous, and comprehensive. with different members of the household.

The

Deals

Development of Family Medicine

General Coincidental

Practitioner

family.

concern with

Not Has

versed in family systems.

little recognition of the family as a medicosocial unit in which heath and disease concepts could be better understood and executed.

Development of Family Medicine

Clinical

Specialists

As medical knowledge expanded and technology advanced, many physicians chose to limit their practices to specific, defined areas of medicine

Focused on different organ system or diseases Fragmented or depersonalized care

Development of Family Medicine

Curative medicine was given more emphasis over preventive medicine.

Development of Family Medicine

Specialists GPs

The public became increasingly vocal about the fragmentation of their care and the shortage of personal physicians who could provide initial, continuing and comprehensive care.

Development of Family Medicine

FAMILY MEDICINE the 20th specialty

Unique process

Development of Family Medicine

At the center of this process is the patient-physician relationship with the patient viewed in the context of the family. It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties

Development of Family Medicine

The development of family practice led to the formulation of an educational content of family medicine, which is unique among medical disciplines in its emphasis on the family as the unit of concern in health and illness.

Family Medicine: definition

A discipline of medicine with distinct core knowledge and characteristics of care, which refers to individuals, family and community, and functions within economic, cultural and social environments and resources.
WONCA, 1979

Family Medicine
Academic

discipline Encompasses a distinct body of knowledge appropriate to the needs of changing society. Roots from general practice Centered on the family as the basic social unit. Health and disease oriented

Family Medicine
Emphasizes 1. 2.

3.

the importance of: disease prevention health maintenance curative medicine

Family Medicine: characteristics

1. Primary- first contact care at the ambulatory, emergency and home setting -point of first medical contact within the health care system, providing open and unlimited access to its users, dealing with all health problems regardless of the age, sex, or any other characteristic of the individual.

Family Medicine: characteristics

1. Primary- has a unique consultation process, which establishes a relationship over time, through effective communication between doctor and patient - The value of this personal relationship is determined by the communication skills of the family doctor and is in itself therapeutic.

Family Medicine: characteristics

2. Continuing- is responsible for the provision of longitudinal continuity of care as determined by the needs of the patient. - makes efficient use of health care resources through co-ordinating care, working with other professionals in the primary care setting, and by managing the interface with other specialities taking an advocacy role for the patient when needed

Family Medicine: characteristics

2. Continuing- chronologically, geographically, interdisciplinary

Family Medicine: characteristics

3. Comprehensive- develops a personcentred approach, orientated to the individual, his/her family, and their community. - understand how the patient copes with and views their illness as dealing with the disease process itself. The common denominator is the person with their beliefs, fears, expectations and needs.

Family Medicine: characteristics

3. Comprehensive- deals with health problems in their physical, psychological, social, cultural and existential dimensions. - The discipline has to recognise all these dimensions simultaneously, and to give appropriate weight to each. Illness behaviour and patterns of disease are varied by many of these issues and much unhappiness is caused by interventions which do not address the root cause of the problem for the patient.

Family Medicine: characteristics

4. Preventive- promotes health and well being both by appropriate and effective intervention. - Interventions must be appropriate, effective and based on sound evidence whenever possible. Intervention when none is required may cause harm, and wastes valuable health care resources.

Family Medicine: characteristics

5. Curative- manages illness at an early stage in its development, which may require urgent intervention. - manages simultaneously both acute and chronic health problems of individual patients.

Family Medicine: characteristics

5. Curative- must deal with all of the health care problems of the individual patient. It cannot limit itself to the management of the presenting illness alone, and often the doctor will have to manage multiple problems. The simultaneous response to several demands renders necessary a hierarchical management of the problems which takes account of both the patient's and the doctor's priorities

Family Medicine: characteristics

6. Rehabilitative- assist patient to go back to society.

Family Medicine Specialist

physician

who is primarily responsible for providing comprehensive care to every individual seeking medical care and arranging for other health personnel to provide services when necessary.

functions

as a generalist who accepts everyone seeking care, whereas other health providers limit access to their services on the basis of age, sex or diagnosis.

Family Medicine Specialist

cares

for the individual in the context of the family and the family in the context of the community, irrespective of race, religion, culture or social class. clinically competent to provide the greater part of their care after taking into account their cultural, socioeconomic and psychological background.

Family Medicine Specialist

takes

personal responsibility for providing comprehensive and continuing care for patients. also exercises his/her professional role by providing care, either directly or through the services of others according to their health needs and resources available within the community he/she serves.

Family Medicine Specialist

A

five star physician 1. Doctor 2. Social mobilizer 3. Counsellor 4. Teacher 5. Researcher

Philippine Academy of Family Physicians

the largest medical specialty composed of about 6,500 FM specialists

Philippine Academy of Family Physicians

dedicated

to providing holistic, accessible, continuous, comprehensive, coordinated, compassionate and culturally effective health care. patient centred, family focused, community oriented approach to health care.

Family practice
In

the dimension of process, the family physician functions as the patient's means of entry into the health care system and as the physician of first contact in most situations is in a unique position to form a bond with the patient

Family practice
The

family physician's care is both personal and comprehensive and not limited by age, sex, organ system or type of problem, be it biological, behavioral or social. This care is based on knowledge of the patient in the context of the family and the community, emphasizing disease prevention and health promotion.

Family practice
When

referral is indicated, the family physician refers the patient to other specialists or caregivers but remains the coordinator of the patients health care.

Family practice
This

prevents fragmentation of care in both the outpatient and inpatient settings. The family physician serves as the patients advocate in dealing with other medical professionals, third party payers, employers and others and as such is a cost-effective coordinator of the patients health services.

Family practice
Although

all family physicians share a core of information, the dimensions of knowledge and skill vary with the individual family physician.

Family practice
the

scope of an individual family physician's practice changes over time, evolving as competency in current skills is maintained and new knowledge and skill are obtained through continuing medical education.

Family practice
This

growth in medical information also confers on the family physician a responsibility for the assessment of new medical technology and for participation in resolving ethical dilemmas brought about by these technological advances

Community Medicine
a

discipline concerned with the identification and solution of health care problems of communities or other defined populations.

Community Medicine
Aims

to ensure personal health services that each individual in the population will have comprehensive care encompassing the 3 levels of prevention.

Community Medicine
The

inclusion of training experiences in the identification and solution of health care problems of communities has two basic advantages for family practice: it fosters a contextual approach in the care of individual patients and it builds knowledge and skills for those who will work with communities in future practices.

Public health
the

science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.

Public health

It is concerned with threats to the overall health of a community based on population health analysis.

Public health
Public

health is typically divided into epidemiology, biostatistics and health services. Environmental, social, behavioral, and occupational health are other important subfields.

Public health: characteristics

1. It deals with preventive rather than curative aspects of health 2. It deals with population-level, rather than individual-level health issues

Public health
focus

of public health intervention is to prevent rather than treat a disease through surveillance of cases and the promotion of healthy behaviors. In addition to these activities, in many cases treating a disease may be vital to preventing it in others, such as during an outbreak of an infectious disease.

Public health
The

goal of public health is to improve lives through the prevention and treatment of disease

Public health: scope

Health

service system Health behavior and motivation Environmental Hazards

Public health: activities

Community

based Designed to prevent illness, disability or premature death Related to comprehensive health care Concerned with collection and use of vital records

Public health: activities

Conducts

public education and motivation in personal and community health Involved comprehensive health planning and evaluation Incorporates research- scientific, technical and administrative.

Public health: activities

Hand

washing, vaccination programs and distribution of condoms are examples of public health measures.

Assignment:
Compare

FM Discuss the uniqueness of FM Give the importance and interrelatedness of CFM Discuss the relationship of public health and community medicine.

and contrast GP with