Family Medicine

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World Book of Family Medicine – European Edition 2015 non-verbal signals, especially the micro signals of contempt (7) designing a family tree designing a diagram of bonding and loyalty signals of abuse or other malfunctioning. Moreover, communication, transaction and interaction analysis are essential skills. “Active listening” narrows the boundaries of interpretation and understanding, clarifying the picture; “What do you mean by …?” This helps us to get away from overmedicalisation, away from only using the medical microscope and learning to use the telescope that is required in such a setting. The concept “medically unexplained symptoms” is inappropriate here, since the symptoms can very well be explained but the doctor needs to be able to use the right “scope”. A doctor that stays in touch with himself and as humble as possible will go a long way. Conclusion Primary care or family doctors can learn additional skills to engage in untangling the puzzle a family presents. It is not a recipe that you learn from a cook-book, rather you learn it by observation, training, re-training and intervision. Take home messages Pay attention to family interactions and consider them with regard to your patient. Explore the perception of chronic disease and its management in your patient's family. Family-oriented approach in general practice is not family therapy. GPs with special interest can become family therapy specialists after completing training and adjustment of practice organizations. Original abstract http://www.woncaeurope.org/content/14-w-family-therapy-skills-medical-practitioners References: 1. Rakel R, Rakel D. Textbook of Family Medicine, Elsevier, 2011; chapter 1. The Family Physician, page 5-9 2. Altamash S. Family Therapy. Indian J Endocrinol Metab. 2013; 17(Suppl 1):S292-4. doi: 10.4103/2230-8210.119619 3. McDaniel S, Campbell T, Hepworth J, Lorenz A. Family-Oriented Primary Care, Springer Science-Business Media, Inc, 2005 ISBN: 978-0-387-98614-2 (Print) 978-0-387-26310-6 (Online) 4. The European definition of general practice, revision 2011, WONCA Europe, www.woncaeurope.org 5. Graham H, Senior R, Lazarus M, Mayer R, Asen, K. Family therapy in general practice: views of referrers and clients, BJGP, 1992; 25-28 6. Senior R. Family therapy in general practice: „We have a clinic here on Friday afternoon“, Journal of Family therapy, 1994; 16: 313-327 7. John Gottman in: Malcolm Gladwell, Blink (2005). Little, Brown and Company 304
World Book of Family Medicine – European Edition 2015 Richard G Roberts, MD, JD Richard.Roberts@fammed.wisc.edu 100 – What We Do Richard G Roberts, MD, JD FAAFP, FCLM, FPAFP (Hon), FRACGP (Hon), FRCGP (Hon) Professor of Family Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA Immediate Past President, World Organization of Family Doctors (WONCA) Past President, American Academy of Family Physicians Family doctors and primary health care professionals are currently in vogue. International agencies, health ministries, and health systems proclaim the value of health services based on primary care. Thus, it is understandable that family doctors assume that their place in health care is secure. While that assumption is understandable, it is risky. The Declaration of Alma-Ata (1) concluded in 1978 that primary care produced better outcomes, improved equity, and cost less than specialist-based systems. The 2008 World Health Report (2) confirmed that primary care remains essential in the 21 st century. In the thirty years between those two documents, a number of studies demonstrated the key attributes that make primary care valuable (3). This chapter will review the attributes and contrast them against the changing reality of Family Medicine, and the potential for family doctors to lose their hard earned status. I will focus on what I believe are the six most important attributes. To make them easier to remember, I will use alliteration and name the attributes with a word beginning with “C.” At the end of the brief discussion for each attribute, a critical question is posed that can be used to assess the performance of a family doctor, primary care practice, or health system on that attribute. What is there to “C” in family doctors and primary care? Convenience – Historically, primary care has been where people first enter the health care system. Yet, there is a growing array of other settings where people now enter: emergency departments, urgent care, out of hours or home care services, hospitals, specialist practices. People also engage the system through telephone advice lines, websites or other electronic portals, and so on. Consequently, the number of first contact visits in primary care has diminished. Even within primary care, the number of first contacts with the family doctor has decreased relative to other members of the primary care staff. Health systems are under pressure to make it easier and more convenient to enter the system. Family doctors with reduced hours and limited availability are less easy and convenient for patients. Critical question: How easy it is for patients to contact their family doctors? Coordination – A vital role of primary care is to assure coordination of the many services a patient may require. In many systems, professionals other than family doctors provide these functions. Known as care managers or coordinators or navigators, the training of these professionals ranges from nursing to social work to on-the-job. There is also a wide variation in their ability to integrate and make coherent the often disparate care plans generated by various consultants or other specialists. Critical question: How involved are the family doctors in coordinating and integrating their patients’ care? Context – A crucial element of knowing the patient is an awareness of her or his context. Understanding patients’ 305
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Family Medicine

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