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INTRODUCTION TO

FAMILY MEDICINE
Eka Nurhayati
Dept. Of Public Health
Faculty of Medicine-Bandung Islamic University
2017
OBJECTIVES
• To explain family medicine as a discipline
• To explain the family doctor and criteria
• To explain the place of family medicine and integrating
Family Medicine’s effforts in health care
• Recognize the changes in paradigm in medicine
• To explain the growth and background of family
medicine
OBJECTIVES (2)
• To explain the definiton and scope of family medicine
• To explain the challenges of family medicine within the
context of Indonesian Health System
• To explain the principles of family medicine
• To explain characteristics and functions of family
physicians
• To explain the elements of family medicine practice
and their interrelationship
DEFINITION (AAFP, 1993)
• Family Medicine is the medical specialty that provides
continuing and comprehensive health care for the
individual and the family.
• The specialty in breadth that integrates the biologic,
clinical and behavioral science.
• Encompasses all ages, genders, organ system and
every diseases entity
DEFINITION (WONCA)
• Family Medicine is the branch of medical practice
provided by family physicians or general practitioners.
• Is a part of primary medical care
FAMILY PHYSICIANS/FAMILY
DOCTOR
• AAFP, 1993 : A physicians who is educated and trained
in the discipline of family medicine, abrodly
encompassing medical specialty.
• WONCA : A medical practitioner who provides primary
and continuing care to patients and their families within
their community.
• Lee Gan, Azwar, Wonodirekso, 2004 : Qualified medical
practitioner who provides personal, primary,
comprehensive and continuing health care of the
individual in relation to his family, community and
environment.
THE ORIGIN OF FAMILY
MEDICINE
EGYPTIAN MEDICINE
• One of the oldest ancient
medicine
• From the beginning of
time-6th century
• simple non-invasive
surgery, setting of bones
and an extensive set of
pharmopheia
GREEK MEDICINE
• Hipocrates : The Father of
Medicine
• 8th century
ISLAMIC MEDICINE
• Ibnu Sina
• Abu Bakar Ar Razi
• Golden age of Islam (8-
9th century)
MODERN MEDICINE
• 18th century
• Terms “physicians”
• Scientific changes
• Technology changes
• Social changes
• Many new disciplines
have developed
MODERN MEDICINE
• Invention of microscope
• Epidemiology
• Invention of antibiotics
• Inventions of vaccination
ORIGIN OF FAMILY
MEDICINE
Changes in Managed Care
The Changing
Morbidity & and The Age of
Role of Hospital
Mortality Integration

New
General
The Growth of Development in
Practice/Family
Specializations Behavioral
Medicine
Science

The Age of
The Age of GP
Specializations
CHANGES IN MORBIDITY
& MORTALITY

Gradual Change
in the role of
•Emergence of a Practitioner •Public health -->
new pattern disease One private health
•Increased the •Management of •Physicians
proportion of elderly chronic disorder educational role
•No separation of
physical and mental
illness
Successful control Changes in
of infectious preventive
disease medicine
NEW PATTERN OF
DISEASES
• Chronic Disease
• Developmental Disorder
• Behavioral disorders
• Accidents
• Different Range of Infectious diseases
THE GROWTH OF
SPECIALIZATION
• Before 19th Century :
Physicians, Surgeon,
Apothecary
• Physicians did not
practice surgery or
dispense drugs
• Medical school only
available in Europe
SURGEON & APOTHECARY
THE GROWTH OF
SPECIALIZATION (2)

Apothecary

Surgeon

Physicians

General Practitioners
MODERN PHYSICIANS
THE AGE OF GP
• 19th century was the golden age of GP both in
America & Europe
• End of 19th century: Major specialties began to emerge
THE AGE OF
SPESIALIZATIONS
• The first half of 20th century saw the emergence of
major specialties of medicine
• Technological progress was rapid
• Investment in research --> good dividens
• Medical education became increasingly oriented
toward laboratory science and tchnology of medicine
• The number of GP declined steadily from 1930’s
THE AGE OF
SPESIALIZATIONS (2)
• After WW II: Disappearance of GP
• 1960 :
• Generalist physicians : continuing personal &
comprehensive care at primary level
• Specialist : provide care only to patients with disorder in
the field of expertise, usually by referral from GP
• Highly spesialized
• Serious effect: Deterioration of the doctor-patient
relationship
NEW DEVELOPMENTS
IN THE BEHAVIORAL
SCIENCE
• Making doctors more aware of the importance of their
own behavior in determining the quality of care
• Increased doctor insight in doctor-patient relationship
• Making doctors think about some fundamental aspect
of medicine
• Increased docors knowledge of behavioral and social
factors involved in the causation of disease.
THE CHANGING ROLE OF
HOSPITAL
• The cost of inpatient care has become so prohibitive
• Only patients needing higly technical and specialized
care are treated
• The services were much less satisfactory
• Fragmentation of care
• Frequent changes of personel
• Risk associated with hospitalization
MANAGED CARE
& THE AGE OF INTEGRATION

Tertiary

Secondary

Primary
MANAGED CARE
& THE AGE OF INTEGRATION
(2)
• Alma Ata, 1978 : WHO recognized the fundamental
importance of primary care.
• Family doctor :
• Key Figure
• Leader
• Manager
• Horizontal : Team member
• Vertical : Collaboration between three levels of care
GENERAL PRACTICE/FAMILY
MEDICINE ?
• Family Practices --> Family Medicine
• General Practitioners --> Family Physicians
PRINCIPLES OF FAMILY
MEDICINE
PRINCIPLES OF FAMILY
MEDICINE
1. Family Physicians are commited to the person rather
than to a particular body of knowledge, group of
diseases, or special techniques.
2. Family Physicians seeks to understand the context of
illness.
3. Family Physicians sees every contact with his patients
as an opportunity for prevention or health care
education
PRINCIPLES OF FAMILY
MEDICINE (2)
4. Family physicians views his practice as “population at
risk”
5. Family physicians sees himself as part of
communitywide network of supportive and health
care agencies
6. Family physicians share the same habitats as their
patients
7. Family physicians sees patients in their homes
PRINCIPLES OF FAMILY
MEDICINE (3)
8. Family Physicians attaches importance to the
subjective aspects of medicine
9. Family Physicians as a manager of resource
CHARACTERISTIC OF
FAMILY MEDICINE
1. 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, gender or any other characteristic of the person
concerned.
2. Makes efficient use of health care resources through
coordinating care, working with other professionals in
the primary care setting, and by managing the
interface with other specialties taking an advocacy
role for the patient when needed.
3. Develops a person centered approach, oriented to
the individual, family, and community.
4. Has unique consultation process, which establish a
relationship overtime, through effective
communication between doctor-patient.
5. Responsible for the provision of longitudinal continuity
of care as determined by the needs of the patients
6. Has a spesific decision making process determined
by the prevalence and incidence of illness in the
community
7. Manages simultaneously acute and chronic health
problems of individual patients
8. Manage illness which presents in an undifferentiated
way at an early stage in its development, which may
require urgent intervention
9. Has a spesific responsibility for the health of the
community
10. Promotes health and well being both by appropriate
and effective intervention
11. Deals with health problems in their physical,
psycological, social, cultural and existential
dimensions.
BENEFITS OF CONTINUITY
CARE
• Coordination of care
• Familiarity
• Openness in therapeutic relationship
• Opportunity for monitoring of treatment and mutual
agreement about management.
CUMULATIVE KNOWLEDGE
ABOUT PATINETS
• Contionus & comprehensive care --> build up
knowledge about patients and families.
• Most Precious assets
• Knowledge accumulates slowly during the first few
month
• Increases sharply between 3 and 12 months
• Flattens out
• Increases steadily during the nest few years
• Care
ROLE OF FAMILY PHYSICIAN
provider: pelaksana pelayanan kesehatan komprehensif,
terpadu,bersinambungan pada tingkat primer bagi pasien sebagai bagian
dari keluarganya dan untuk penapisan pelayanan spesialistis

• Decision maker; sebagai penentu dalam setiap tindakan terhadap pasien


yang menjunjung etika profesi dan memanfaatkan sumber keluarga secara
efisien, efektif

• Communicator : Pendidik, penyuluh, teman, mediator, penasehat bagi


anggota keluarga yang bermasalah, sekaligus bagi keluarganya dalam
upaya menyelesaikan masalahnya..

• Team member:/ manajer; bekerja sama atas dasar kemitraan dalam


menyembuhkan pasien dan menyelesaikan masalah keluarga

• Community leader: memantau, menelaah kegiatan pelaksanaan


pelayanan dengan memperhatikan risiko dan permasalahan pasien dan
keluarganya secara holistik bagi peningkatan mutu pelayanan kesehatan.
FAMILY MEDICINE IN
INDONESIA?
PERKEMBANGAN DOKTER
KELUARGA DI INDONESIA
• Mulai Tahun 1980 : FKUI
• Departemen Kedokteran Komunitas
• Perkembangan lambat
• Belum ada regulasi pemerintah
• Tarik ulur dari ikatan profesi
• 2000 : materi kedokteran keluarga
• 2005 : kurikulum berbasis kompetensi
9 PRINSIP DOKTER
KELUARGA (PDKI)
1. Pelayanan yang holistik dan komprehensif
2. Pelayanan yang kontinu
3. Pelayanan yang mengutamakan pencegahan
4. Pelayanan yang koordinatif dan kolaboratif
5. Penanganan personal bagi setiap pasien sebagai
bagian integral dari keluarganya
6. Pelayanan yang mempertimbangkan keluarga,
lingkungan kerja, dan lingkungan tempat tinggal.
7. Pelayanan yang menjunjung tinggi etika dan hukum
8. Pelayanan yang dapat diaudit dan
dipertanggungjawabkan
9. Pelayanan yang sadar biaya dan sadar mutu
VISI KEDOKTERAN KELUARGA

• Disiplin kedokteran yang senantiasa meningkatkan dan


mengembangkan ilmu kedokteran yang komprehensif
dengan berpedoman dalam suatu sistem pelayanan
kesehatan, sesuai dengan kebijaksanaan umum
pemerintah, yang memenuhi rangkaian pelayanan
kesehatan yang bermutu dalam sistem rujukan primer
dan kemandirian pembiayaan.
MISI KEDOKTERAN KELUARGA
• Memanfaatkan pendidikan yang memberikan pengetahuan kedokteran
terkini pada tingkat rujukan primer untuk dapat melaksanakan pelayanan
medis yang praktis terhadap individu dalam konteks kehidupan
keluarganya, tanpa membedakan kelompok umur atau keluhan
• Melakukan pendidikan kedokteran terintegrasi, berdasarkan fakta
(evidence) dan pengalaman belajar manajemen klinik terpadu
• Menjembatani pengetahuan kedokteran klinis dan dan kedokteran sosial
pada komunitas keluarga dalam suasana akademis yang kondusif
• Melakukan penelitian dan pengabdian dalam bidang yang berguna bagi
peningkatan pelayanan dari semua aspek kehidupan keluarga
• Mendidik dan mengikutsertakan individu pengguna jasa (pasien, klien)
pelayanan kesehatan (PJPK) dan keluarganya serta komunitasnya untuk
meningkatkan upaya peningkatan kesehatannya sendiri
FILOSOFI KEDOKTERAN
KELUARGA
• Pelayanan medis yang dilaksanakan dokter keluarga
adalah pelayanan kesehatan/asuhan medis yang
bertujuan mengantisipasi proses kehidupan manusia
secara keseluruhannya, yang merupakan dinamika
kehidupan biologis, psikologis, dan sosial dalam
lingkungan yang spesifik untuk setiap mahluk hidup,
secara berkesinambungan, tak dapat diputuskan dan
timbal balik sifatnya.
KONSEP BIOPSIKOSOSIAL
THE MANDALA OF HEALTH
(MONTEVIDEO, 2000)
FAMILY MEDICINE & JKN?
• Pelayanan kesehatan
primer adalah tulang
punggung pelayanan
kesehatan.
• Titik berat pelayanan
kesehatan primer adalah
promosi dan prevensi
yang mendorong
meningkatnya peran
serta dan kemandirian
masyarakat dalam
mengatasi berbagai
faktor risiko
• Keberhasilan pelayanan
kesehatan primer akan
mendukung pelaksanaan
JKN, dimana akan
menurunkan jumlah
pasien yang dirujuk
• Mengurangi biaya
pelayanan kesehatan
yang bersifat kuratif
THANK YOU