Introduction Flashcards
Family medicine def
Academic , scintific discpline
With eductional content research
Evidence based clinical activity
What is role of family doctor
Is needed to translate acadeic def into reality of specialist
Rachp def
Intial
Comprehensive
Coordinated
continued
Aafp def
Comtinuing
Comprehesive
Integrates biological
Clinical
Behaviroal sciences
Wonca def
Family medicine is an academic and scientific discipline with its own educational content. Research evidence based clinical activity.
Mention diff between phc services
pHC (safe dleveries
Family health centre
Inpatient services
Hospital
Outpatient preventive and curative
Family health unit
Mr MA, a 47 years old male patient is
presenting to you complaining of sore throat,
no fever, no cough or any other symptom.
• He is not diabetic or hypertensive. He is
smoker. His father is diabetic.
• Examination shows BMI: 38, throat exam
shows congested pharynx, rest of the exam if
free
• What will you do next??
The 10 most common clinician-reported reason for visits
the most common clinician-reported RFVs.
upper respiratory tract infection and hypertension
were the most common clinician-reported RFVs.
Family Medicine Depart
The 10 most common patient-reported RFVs were
symptomatic conditions
cough, back pain,
abdominal symptoms, pharyngitis, dermatitis, fever,
headache, leg symptoms, unspecified respiratory concerns,
and fatigue.
Priciples of health care
Factors associated with PHC utilization
Interchest rule for cad
Points
Risk group
Clinical predictor
Marburg heart score
Patients with localized pain that
is reproducible by palpation of
the parasternal
costochondral
joints likely have chest wall pain
or costochondritis.
burning retrosternal pain,
acid regurgitation, and a sour or
bitter taste in the mouth.
Gastroesophageal reflux disease
Panic disorder and anxiety states
often cause chest pain and
shortness of breath; physicians
should consider using
single
validated screening question to
confirm the diagnosis.
Secobary care of cad
Patients who have chest pain with a
low to intermediate probability of
coronary artery disease not requiring
immediate referral to the emergency
department should be evaluated for
coronary artery disease with
exercise stress testing, coronary
computed tomography angiography,
or cardiac magnetic resonanc
When we do echo
Teritray car
Mention teritary care incase of cas
Electrocardiography should be
performed on all patients in whom
cardiac ischemia is suspected. The
presence of ST segment changes,
new-onset left bundle branch block,
presence of Q waves, and new T-
wave inversion increases the
likelihood of acute coronary
syndrome and acute myocardial
infarction; these patients should be
referred immediately to the
physical, psychologi cal social. culturall and existential
Holistic approach
Lonitudinacontiuty
Person centered approach
Doctor patient relation ship
Person centered approach
Acute , chronic health problems
Comprehensive approach
Promotes health well being
Comprenhesive approach
Care coordination and adovacu
Primary care managemnt
First contact open acess
Primary care management
Health of community
Community orientation
Early undifferentiated
Specific problem sloving skills
Descion making based on evidence and prevelenace
Specific problem solving skills
Care is
Quality life centered
Post mi care
All Patients Should Receive Therapy:
• Smoking cessation
• Anti-platelet therapy
• Beta blocker post-MI or with LV dysfunction
• ACE-inhibitor (or ARB) if post-MI or LVEF ≤ 40%
• Add aldosterone blockade if CHF
• Statin
• Weight loss of 5-10% if BMI ≥ 30 kgm?
• Physical activity at least 30 minutes per day
• Cardiac Rehabilitation- Angina/Post MI/ Post-stent/ Post valve surgery/Heart Failure
Influenza vaccine
When return sexual activity post mi
6 weeks
When return work after mi
Return to work:
Sedentary workers 4-6wk. after uncomplicated MI
Light manual workers 6-8wk. after uncomplicated MI
Heavy manual workers 3months after uncomplicated MI
How to return physical activity post mi
2wk. after Ml stroll in garden or street
4wk. after Ml walk @½ mile/d.
4 to 6wk. after Ml increase to 2 miles/d. by 6wk.
From 6wk increase the speed of walking; aim 2 miles in <30 min.
Dercibe levels of health care system
Pyrimadl
No of chracters of displine of phc
11
Greatest number of patients are seen in
First level of phc
How to return physicsl activity post mi
Physical activity: advise gradual increase in activity
1.
2.
3.
4.
0
1.
2.
3.
2wk. after Ml stroll in garden or street
4wk. after Ml walk @½ mile/d.
4 to 6wk. after Ml increase to 2 miles/d. by 6wk.
From 6wk increase the speed of walking; aim 2 miles in <30min.
involves sending a patient to another physician for ongoing management of specific problem , with the exception that the patient will continue to see the original physician for coordination of total care.
Referal system
Levels of referal
4
From specialist to another
2 nd level refersl
From junior to senior
3rd level referal
From general hospital to spceislzed hospital
4th;evel of referal
From family physion to hospital specialist
1st level of referal
Secondary/Tertiary
hospitals are a better
alternative to seeing my
doctor because they are
more convenient and less
Unfortunately, they won’t
know your medical
history like your doctor
does and may not be able
to provide the correct
form of treatment plans
for you.
• Secondary/tertiary care
doesn’t fix the problem, it
just covers it with a band-
aid until it resurfaces
Teritary care
Is highly specialized medical care and complex diagnosis
Secondary care
Is specialized tt and support provided by doctors in hospital or clinic
Primary care
Is people centered rather than disease centerd
Primary care comptencey
Interpersonal relationships
Care management
Integrated health care systems
Proffesiinal accountability
