WCS12 Principles And Concepts Of Family Medicine

Question 1

Family medicine

Answer 1

• delivery of ***primary care
• emphasis on ***whole-patient
• **comprehensive + **continuous care to individual in the context of family + community

Question 2

Primary care

Answer 2

Primary care: First point of contact of professional health care system

Primary health care: Essential health care made universally available to individual and families, which include public health + self-care

Private practice: Service funded by patient out-of-pocket / private insurance, can be primary / secondary / tertiary care

Question 3

One of many vs One in many

Answer 3

One of many: One of the people who have common disease

One in many: The one guy that have a serious disease

Question 4

FM principles

Answer 4

1. Primary Care
2. Whole Person Care
3. Comprehensive Care
4. Continuous Care

Question 5

FM principle for Primary Care

Answer 5

1. Early diagnosis of undifferentiated illnesses
   - Abnormal vs Normal
   - Diseases vs Symptoms
   - Organic vs Functional
   - Serious diseases vs Self-limiting
   - Possibilities vs Probabilities (risk)
2. Gate-keeping of health services
   - accessible and available to all
   - assure equity + reverse “Inverse Care Law”
   - appropriate effective medical care
   - balance benefit vs harm + costs
   - practical + best used of resources
   - enable self-care
   - connect to community resources

Question 6

FM principle for Whole Person Care

Answer 6

1. Patient-centred bio-psychosocial diagnosis
   - Person: physiological constitution + psychosocial context
   - Illness: symptoms, pathology, disease, sickness (impairment), suffering
   - ***RICE
   —> Reason for consultation
   —> Ideas
   —> Concerns
   —> Expectation
   - impact of illness on roles, family function + dynamics
2. Patient-centred management
   - individualised benefit to harm ratio
   - address RICE of patient + family
   - acceptability + feasibility
   - side effects + impact on patient / family
   - outcomes of health + quality of life

Question 7

FM principle for Comprehensive Care

Answer 7

1. Problem solving
   - any type of patients / complaints
   - presenting illness + problems
   - other significant health problems
   - anticipatory care of problems / health risk
   —> to cure sometimes
   —> to relieve often
   —> to comfort and support always
   —> to prevent opportunistically
2. Patient-centred care starts with person
   - explanation to enable an informed choice
   - address patient’s needs + RICE
3. Multi-modality (***RAPRIOP)
   - Reassurance: be specific
   - Advice: lifestyle, self-care, help seeking
   - Prescription: drug effects + SE
   - Referral
   - Investigations: selective
   - Observe (open / scheduled FU) + monitoring red flags
   - Prevention + health promotion

Question 8

FM principle for Continuous Care

Answer 8

1. Build a trusting D-P relationship
   - accumulate medical + personal history
   - communicate effectively
   - improve diagnostic precision
   - enhance management adherence
   - use time as a diagnostic + therapeutic tool
   - coordinate and facilitate care of multiple illnesses and disciplines
2. Personal, system + management continuity

Question 9

Care continuum concept

Answer 9

Meeting changing needs from health to sickness

1. Asymptomatic —> Prevention + Screening
2. Symptomatic —> Accurate diagnosis
3. Diagnosis —> Appropriate management
4. Chronic illness —> Monitor control, prevent complications + review management
5. Multi-morbidity —> Coordinate + Facilitate
6. Complications —> Rehabilitation, Support + Care

Question 10

WHO 5 star doctor

Answer 10

1. Effective care provider
2. Good communicator
3. Sensible decision maker
4. Cost-effective manager
5. Responsible community leader

Question 11

Framingham prediction function in CVD risk calculation

Answer 11

Most important lipid parameter: ***TC / HDL-C ratio

• significant predictor of CVD
• used in calculation of Framingham 10-year CVD

Treatment target: LDL-C