Principles And Skills Of Family Medicine

PRINCIPLES AND SKILLS OF FAMILY MEDICINE Dr . Nabi l Y. Al Kur as hi , MD , Asso ci at e Pro fe sso r Fami ly & Co mmuni ty Med icin e Ki ng Fai sal Uni ver si ty

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HEAL TH F OR AL L 2000 (WHO, 1978)

“The main social target of governments and of WHO should be the attainment of a level of health which would permit people to lead a socially and economically productive life.”

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PRI MAR Y HEAL TH CAR E (WHO) Al Maata,1979 To achieve health for all by Year 2000, who should provide the essential health care based on: 1) Practical 2) Scientifically sound and 3) Socially acceptable methods and technology made universally 4) Accessible to individuals and families in the community 3

PRI MAR Y HEAL TH CAR E (WHO) Al Maata,1979 5) Full participation 6) Cost that the community and country can afford to maintain at each stage of their development 7) In the spirit of self-reliance and selfdetermination” 4

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In 1981 Intermediate Goals For HFA

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Intermediate Goals For HFA Ensuring Right Kind Of Food For All By 1986 6

Immunizing Against 6 Common Diseases By 1990 7

Environmental Repair By 1990

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Wars & Disasters From 1981- 2002 World Witnessed > 60 Wars 30 Major Natural Disasters 9

Alma Ata 8 Elements A Critical Review 

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Infant and Maternal Mortality are Still High MMR in less developed countries 20 times higher than in developed countries 10

Still Global Problem Malaria   Diabetes   Hypertension   IHD   Tuberculosis   AIDS   Car Accidents   Malnutrition  

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Misconcepts & Misinterpretations  

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PHC is Only CommunityBased Health Care PHC is the first Level Of Care

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PHC is Only For Poor

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Is a Case of 8 Elments

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Use Only Low “Tech”

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Is Cheap

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Why Family Medicine? 

Unique – Training is based in the outpatient setting – Unit of care is the family – Model of care is biopsychosociospiritual

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Unrestrictive – See and treat all patients, regardless of…  Gender  Race  Age  Organ system of illness

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Draft Charter of General Practice/Family Medicine (WHO-EURO, 1998)       

General (unselected health problems) Continuous Comprehensive Coordinated Collaborative Family-oriented Community-oriented

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PR IN CI PL ES OF PR IM ARY CARE (CF PC ) 

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The doctor-patient relationship is central to what we do as family physicians The practice of family medicine is community-based The family physician is a resource to a defined population The family physician must be a skilled, effective clinician 15

Other important attributes of Primary Care First contact care  Accessibility  Continuity  Case-management (responsibility for coordinating all the care that a person needs) 

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The Role of Family Doctors Medical expert  Communicator  Collaborator  Manager  Health advocate  Professional  Scholar 

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Why Family Medicine?  

Critical Care Endoscopy – EGD – esophageal dilatation – Colonoscopic polypectomy  

Palliative Medicine Women’s Health – – – –

EMB Colposcopy Cryotherapy LEEP

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Why Family Medicine? 

Major Surgery – Cesarean section – tubal ligations

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Emergency Medicine

Minor Surgery – excisional biopsy – vasectomy

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Office Orthopedics Nursing Home Care 19

A Force for Change  93,100

family physicians, residents, students in AAFP  200 million visits to FP’s annually (more than any other specialty)  FP’s in demand by hospitals 20

Walk -in Cli nic s 

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Convenient for patients, flexible for physicians Little continuity of care Fee-for-service payment Skim off the “easy” (remunerative) patients, leaving the older, multi-problem patients to family physicians and making family practice less financially viable 21

Em ergency Departme nts Accessible (with long waits)  Ready access to technology  Appropriate training?  Very limited social supports  Poor continuity of care  Expensive (or are they?) 

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Solo Pr actic e/Pa rtnersh ip s 

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Maximum autonomy, individual responsibility Minimum professional support Fee-for-service payment rewards hard work (too hard?) Rewards “talking” services less well than “doing” services; discourages prevention and a global approach to patients’ problems 23

Group Pr actic e 

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Provides colleague support, sharing of expenses and call duty, reduced capital costs Fee-for-service payment For patients, one-stop provision of medical care Not much difference in hospital utilization, total costs of care or quality of care 24

Comm uni ty He alth Centres (C HCs) Community-sponsored clinics  Provide a range of social services  Care mainly for disadvantaged populations  Global budget with salaried staff 

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Health Maintenance Organizations (HMOs) 

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USA only; do not exist in this form in Canada Prepayment plan combined with a group practice, sometimes have own hospital Fewer hospitalizations, lower costs Commercial sponsorship (“managed care”) has given a good approach a bad name 26

STRENGTHS OF PRIMARY CARE IN SAUDI ARABIA (How?) Fairly good supply of trained family physicians (although no longer enough)  Family physicians can usually obtain hospital privileges (although they can no afford to do hospital practice)  Few direct financial barriers to prevent patients from seeking care 

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WEAKNES SE S OF PR IM ARY CARE IN SAUDI ARA BI A 

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No Good Model for Family Medicine Clinics and Practice Patient not linked to the physician; free to “shop around” Physicians can practise where they want, rather than where they are needed Limited support for family physicians Little linkage to public health Fee-for-service discourages prevention, 28 thorough care

The New Concept Involve the Setting As A

Whole (People, Environment & Community)

Integration Of HP/HE into

All Activities

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Thank You

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