Family Medicine Dr Paul T Francis, MD Community Medicine College of Medicine, Zawia https://sites.google.com/site/communitymedicinezawia/

Contents History of Family Medicine Importance of Family Medicine Principles of Family Medicine Approach to patients Genogram

History In olden days when somebody became sick he would first take ‘medical’ help from family, then other experienced people and finally from physicians Number of Physicians were very few

19th century Medical practice was mainly ‘Family medicine’ The doctor treated all medical problems – Medicine, Surgery, Gynecology, Pediatrics etc. of a family

20th Century There was rapid rise in specialization Physicians became specialists in different branches of medicine The Family doctor became General Practitioner whose role became less important compared to the specialists

Need for Family Medicine Specialists treated the disease There was no ‘doctor’ to take care of the patient There was a demand to have a good general physicians who would take care of the basic needs of a patient This led to the development of a new branch – Family Medicine

What do Family Physicians do? Family physicians provide comprehensive and continuous primary care health care to: individuals and families women and men regardless of age or disease infants, children and adolescents regardless of disease

Family Physicians provide Prevention & management of acute injuries and illnesses Health promotion Hospital care for acute medical illnesses Chronic disease management

Family Physicians provide Maternity care Well-child care and child development Primary mental health care Rehabilitation Supportive and end-of-life care

Important characteristics of Family Medicine Deep understanding of the whole person Act as a partner to patients over many years Ability to ‘humanize’ health care Ability to manage complex medical problems in the family setting

Practice of Family Medicine Considers all influences on a person’s health Knows and understands patient’s limitations, problems and personal beliefs when deciding on a treatment Proposes therapies and interventions taking into light the above knowledge

Influence of Family Physician over the patient Serves as a partner with patients to maintain well-being over time Empowers patient with information and guidance that are needed to maintain health over time Provides care that includes long-term behavioral change interventions that lead to better health

Type of cases seen by a Family Physician

Approach of Family Physician Family Physician deals with all age groups from infant to elderly The approach to the patient will depend on the age of the patient Family physician also deals with the whole patient and not just the medical problem for which the patient comes

Some important roles of Family Physician for patients - 0-19 years Observe parenting for poor limits or overprotection Focus on the whole family when making recommendations Give gentle guidance over multiple visits

2-3 years Help parents appreciate progress and accepts setbacks in growth and development E.g. Toilet training Encourage and support the parents

2-5 years Help parents if they are uncomfortable dealing with the sexual concerns of children

6-12 years Reinforce the variations of normal development Set a model for parents by addressing children as independent, intelligent people even at a very young age

13-19 years Distinguish sometimes normal development and aberrant behavior Remind parents of their considerable (if unappreciated) influence; adolescents still need parenting Always listen and try to understand

Genogram Genogram is a graphic representation of the family structure It also represents some of the medical conditions afflicting the patient The genogram is constructed around a person called the “index” family member A small arrow is placed near the symbol of the person to indicate ‘index’ member

Genogram Horizontal lines to connect married couples and siblings Draw vertical lines to indicate different generation The symbol of person is darkened to indicate death Write the name, important dates and medical conditions near the symbol of the person A circle can be drawn to include persons living together

Genogram - symbols Male Female Marriage Index member Pregnancy Divorce Dead

Genogram of a female patient

Summary Family Medicine has an important role in providing basic health care to all family members Family physician treats the patient and not merely the disease as it happens in big hospitals Family medicine takes into account the whole family when diagnosing and treating medical conditions