• PRINCIPLES OF FAMILY MEDICINE

• What is Family medicine:

• Family Practice
• General Practice
• Primary Care

• Misconceptions about
• FM Brief History of FM
• The Principle
 Family medicine

• Medical specialty: continuing and

comprehensive care to indiv & family
• Integrates biological, clinical & behavioral
science
• Scope encompasses all ages, sexes, each organ
system and every dx entity
• Family medicine is the medical specialty which
provides continuing, comprehensive health
care for the individual and family. It is a
specialty in breadth that integrates the
biological, clinical and behavioral sciences.
The scope of family medicine encompasses all
ages, both sexes, each organ system and every
disease entity”. (1984) (2010 COD)
• FM is concerned with the holistic approach to
patient care in which the individual is seen in
his totality, and in the context of his family,
community and culture.
• The Family Physician is the specialist trained
to work in the front line of health care system
and to take the initial steps to provide care for
ANY health problem(s) that the patient have”

(Olesen Def. 2006) A lot of confusion existed

within and outside the field:- Family pract, GP,
Prim Care & FM
• Family Medicine:- Wider term of Family
practice including academic part of the
discipline*** use in Univer & Acada.
• Family Practice:- Emphasizes service &
practical aspect; shared knowledge & skill with
other specialties:- unique practice!!
• General Practice:- “GP” practice in PHC
without post grad FM training BUT same as FP
in some areas!
• MISCONCEPTIONS Myth 1: Melting major
clinical specialties and nothing new in FM:- by
Colleagues in other specialties.
• Myth 11: New specialty which specialized in
family:- by FM to resolve their identity under
the pressure of misunderstanding by specialist
colleagues.
 HISTORY
• Family medicine is the natural evolution of
historical medical practice
• For thousands of years, generalists provided
all of the medical care
• Limit practice with expanded knowledge &
technology
• With World War II, the age of specialization
began to flourish.
 History
• Two decade after WW II = ↑ in
Specialization/specialist with↓ in Generalist
• Intense public outcry about fragmentation of
their care and lack of personal physicians
• Thus began the reorientation of medicine back
to personal, primary care.
• The concept of the generalist was reborn with
the establishment of family medicine as
medicine's twentieth specialty
 History
• In 1923, Dr Francis Peabody (Prof. of Med at
Harvard) called for rapid return to
GP=Comprehensive care
• American Academy of GP was founded in
1947 & residency started in 1950
• In 1960 FM was created in USA base on 3
Committee report
• In 1969 Am Board of FM was formed & FM
recognized 20 th Am Medical specialty
• In the UK Royal College of GP was founded in
1952
• In 1972 the World Organization of Family
Doctors(WONCA) made up of National Colleges
or org. concern with academic aspects of FM was
founded
• Nigerian hx…. Role of missionary/NPMCN in the
late 1970s with training started in 1980s
• Most FM concentrations are in the Southern part
 THE PRINCIPLE
• Family medicine is a three-dimensional specialty,
incorporating: KNOWLEDGE, SKILL & PROCESS
• 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.
 Principle
• The process = fnx as a means of entry of the pt
to health system & as physician of first contact
in MOST situation.
• Have unique position to form a bond with the
patient.
• FM’s care is both personal and
comprehensive and not limited by……be it
biological, behavioral or social.
DOMAINS OF FAMILY MEDICINE
 TENETS OF FAMILY MEDICINE
• 1.Primary care management.
• 2.Person-centred care.
• 3.Comprehensive approach.
• 4.Holistic approach.
• 5.Specific problem solving skills.
• 6.Community orientation.
 Comprehensive approach
• Every contact with the patient is an
opportunity for health promotion, prevention,
and health education.
• Manages simultaneously both acute and
chronic health problems of individual
patients.
 Holistic
• Deals with health problems in their physical,
psychological, social, and cultural dimensions.

• When referral is indicated, the FP refers the

patient to other specialists or caregivers but
remains the coordinator of the patient’s
health care
 Specific problem-solving skills
• Manages illness which presents in an
undifferentiated way at an early stage in its
development, which may require urgent
intervention.
• Unique consultation process, which
establishes a relationship over time, through
effective communication between doctor and
patient.
 FAMILY FOCUS
• Can recognize the impact of family factors on the
patient’s health when considering preventive and
curative measures.
• Can recognize the impact of the patient’s
problem on the family.
• Involves multiple family members
• Involves Home care
• Involves Family Dynamics Family Health Beliefs
and
• practices Social, work and religious factors
 Community orientation
• Responsible for the health of the community.
• Each patient is seen as representing a “population at
risk.”
• The FP sees himself as part of a community-wide
network of supportive and health care agencies.
• He tries to deploy the resources of the community for
the benefit of his patients.
• He tries to see his patients in their home environment.
• This helps to understand the context or ecology of the
illness.
• Although all FPs share a core of information,
the dimensions of knowledge and skill vary
with the individual family physician.
• Pts needs differ in various geographic areas,
and the content of the family physician's
practice varies accordingly.
• The scope of an FP's practice changes over
time, evolving in current skills and new
knowledge and skill are obtained through CME
 CONCLUSION
• FM is rooted in the historical generalist
tradition
• Three dimensional, combining knowledge and
skill with a unique process
• The patient-physician relationship in the
context of the family is central to this process
• The scope of family medicine is dynamic,
expanding, and evolutionary.
62 nd W.H.A. Resolution May 2009

Improving PHC through Family Medicine:

UN member-nations to “… intensify the

training of family physicians as the means to
improving PHC and helping to achieve the
MDGs.”
 ‘’a clinical leader and consultant in the
primary health care team, ensuring primary,
continuing, comprehensive, holistic, and &
personalized care of high quality to
individuals, families & communities”