EVOLUTION

1
EVOLUTION CONCEPTS OFFAMILY MEDICINE

• Dr. Riaz Qureshi
• Distinguished Professor
• Department of Family Community Medicine
• King Saud University, Riyadh

2
Objectives

• Become familiar with the history and evolution of
  Family Medicine
• - Understand the concepts of Family Medicine and
  its central universal role in the health care
  system
• - Become aware of the desirable qualities of a
  Family Physician and essentials of a Family
  Medicine consultation

3
History of Family Medicine

• EVOLUTION The age of the General Practitioner /
  The age of Specialization/Family Medicine as a
  Clinical and Academic Discipline

4
Major barriers to equitable health care - WHO

• Unequal access to disease prevention care
• Rising cost of health care
• Inefficient health care system
• Lack of emphasis on Generalists (Family
  Medicine) training

5
How to overcome these barriers ?

• The WHO also states, that the best option to
  overcome these barriers is to utilize the
  services of trained Family Physicians

6
Health outcome indicators

• Barbra Starfield study confirmed that the central
  role of Family Medicine in the health care system
  of a country results in enhanced quality
  cost-effective care .
• She proved in a large multicentre study that the
  health outcome indicators are significantly
  better in those countries in which Family
  Medicine plays a central role in the health care
  system

7
Problems in the community
75 Self care
25 Consult FP
Hosp
2.5
8
Concepts of Family Medicine
DEFINITION Family Medicine is a medical
specialty of first contact with the patients and
is devoted to providing preventive, promotive,
rehabilitative and curative care, with emphasis
on the physical, psychological and social
aspects, for the patient, his family and
community. The scope is not limited by system,
organ, disease entity, age or sex.
9
The Need For Trained Family Physicians

• The central role of a well trained Family
  Physician in health care is well recognized in
• Developed countries -- UK, USA and Canada
• Oil rich countries -- Saudi Arabia and Kuwait?
• Developing countries -- ? ? ? ? ?
• The need is even greater in all less developed
  countries.

10
10 Cs OF FAMILY PRACTICE
1. C Caring/Compassionate 2. C Clinically
Competent 3. C Cost-effective Care 4. C
Continuity of Care 5. C Comprehensive
Care 6. C Common Problems Management 7. C
Co-ordination of Care 8. C Community-based
Care Research 9. C Continuing Medical
Education 10. C Communication Counseling
Skills with confidentiality
11
1. C CARING

• Caring/Compassionate care
• An essential quality in a Family Physician
• Personal Care

12
2. C CLINICALLY COMPETENT

• Only caring is not enough
• Need for 4 years training after graduation and
  internship

13
3. C COST- EFFECTIVE

• In time and money
• Gate keeper- Appropriate resources use
• Use of time as a diagnostic tool

14
4. C CONTINUITY OF CARE

• For acute, chronic, from childhood to old age,
  and terminal care patients and those requiring
  rehabilitation.
• Preventive care/ Promotion of health
• Care from cradle to grave

15
5. C COMPREHENSIVE CARE

• Responsibility for every problem a patient
  presents with
• Physical, Psychological Social
• Holistic approach with triple diagnosis

16
6. C COMMON PROBLEMS MANAGEMENT
EXPERTISE

• e.g. Hypertension, Diabetes, Asthma, Depression,
  Anemia, Allergic Rhinitis, Urinary Tract
  Infection
• Common problems in children and women

17
7. C CONTINUING MEDICAL
EDUCATION (CME)

• To keep up-to-date
• Need for breath of knowledge

18
8. C CO-ORDINATION OF CARE

• Patients advocate
• Organizing multiple sources of help

19
9. C COMMUNITY BASED CARE AND
RESEARCH

• Care nearer patients home
• Preventive, promotive, rehabilitative and
  curative care in patients own environment.
• Relevant research within the patients own
  surroundings

20
10. C COMMUNICATION COUNSELING SKILLS

• Essential for compliance of advice and
  treatment/sharing understanding
• Confidentiality and safety netting
• Needed for patient satisfaction
• Involving patient in the management

21
Essentials of a Family Medicine Consultation

• Meet greet
• All the components of history including
  medication, personal and Psychosocial with
  patient centered approach
• Summarization
• ICE Ideas, concerns expectations and effects on
  patients day to day life work
• Examination/Diagnosis ? Differential diagnosis?
• Investigations Management with patients
  involvement, safety netting , appropriate F/U
  Referral?

22
CONCLUSION
The principles and competencies required for the
practice of Family Medicine are universal. They
are applicable to all cultures and all social
groups, from richest to the poorest in the
community.
23
Thank you

• Have a nice day