Family Medicine

More documents

Recommendations

Info

World Book of Family Medicine – European Edition 2015 families, communities, work, religion, and other social determinants of health provides important insights into their health. Family doctors appear today to be less likely to live in their patients’ community or remain in a single locale. Critical question: How well do the family doctors know their patients’ context? Comprehensive – Better outcomes and lower costs result when family doctors provide most of the care needed by their patients (4). Fragmenting care across more professionals, even within the primary health care team, diminishes the skills of the family doctors (5). Decisions to delegate tasks or to limit clinical activities to narrow areas of interest shrink the scope of services provided by the family doctors. Critical question: How comprehensive are the services that the family doctors provide? Competence – Patients deserve and expect competence. Particular individuals, both within or outside the primary care team, may perform certain services more skilfully than the family doctor. Yet, the small marginal gain in a specific technical skill may be offset by too limited a perspective of or trust by the patient, with better overall outcomes when that specific service is provided by the family doctor. Moreover, family doctors with inadequate training, time, or motivation often fall victim to a self-fulfilling prophecy: “The less I do, the less I feel confident and skilled to do.” Critical question: How skilled are the family doctors to provide the services needed by their patients? Continuity – One of the most important attributes of primary care is the continuity of the interpersonal relationship between the family doctor and the patient (6). Continuity permits greater knowledge of the patient by the physician and promotes greater trust in the physician by the patient (7). It is possible to extend, but not delegate, the continuity relationship to other members of the care team. In other words, the family doctor must have sufficient direct involvement with the patient for a trusted relationship to develop. Building on that relationship, other members of the care team can then be trusted to provide various services for, and develop their own relationships with, the patient. Critical question: How strong is the relationship between patients and their family doctors? Practices and family doctors that answer “VERY” to all six critical questions provide better primary care. Health care systems that have strong primary health care do better. Thus, the best health care systems are those that respond positively to a single essential question: How well do the family doctors know, foster trust in, and provide services for their patients? Conclusion In essence, good family doctoring comes down to leveraging trusted relationships and providing comprehensive services, thereby achieving better outcomes (8). The risk today is that in our pursuit to measure well against diseaseoriented metrics and to manage growing patient needs and demands, we will give in to the temptation to limit our availability to our patients and fragment their care across more disease-focused professionals. Our challenge is to develop new strategies and technologies to better know and better serve our patients. Family doctors are not valued because of what we think we do or say we do or used to do. We are valued because of what we do. Take Home Messages Health care systems do better when they are built on strong primary care. Strong primary care depends on six key attributes: convenience, coordination, context, competence, comprehensiveness, and continuity. Recent trends suggest that family doctors, and their practices, may not be performing on the six attributes as well as before or as desired. Family doctors must develop improved strategies to better know, foster trust in, and provide more services to their patients, or their relevance will decline. References 1. Primary health care: report of the International Conference 1. on Primary Health Care, Alma-Ata, USSR, 6–12 September, 1978, jointly sponsored by the World Health Organization and the United Nations Children’s Fund. Geneva, World Health Organization, 1978 (Health for All Series No. 1). 2. The world health report 2008: primary health care now more than ever. Geneva, World Health Organization, 2008. 306
World Book of Family Medicine – European Edition 2015 3. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Quarterly 2005;83(3):457-502. 4. Franks P, Fiscella K. Primary care physicians and specialists as personal physicians. Health care expenditures and mortality experience. J Fam Pract 1998;47: 105–109. 5. Campbell SM, McDonald R, Lester H. The experience of pay for performance in English family practice: a qualitative study. Ann Fam Med 2008;6:228-34. 6. Starfield B, Horder J. Interpersonal continuity: old and new perspectives. Br J Gen Pract. 2007; 57(540):527-9. 7. Roberts RG. The art of family doctoring: a global view. Eur J Gen Pract. 2013 Mar;19(1):59-61. 307
Page 1 and 2:
The World Book of Family Medicine -
Page 3 and 4:
World Book of Family Medicine - Eur
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
The WP workshops on Ethics describe
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
References: World Book of Family Me
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Original Abstract World Book of Fam
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Original abstract World Book of Fam
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
References World Book of Family Med
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Original abstract World Book of Fam
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Take home messages World Book of
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256: World Book of Family Medicine - Eur
Page 257 and 258: References World Book of Family Med
Page 281 and 282: References World Book of Family Med
Page 287 and 288: Quaternary Prevention rubric (www.p
Page 305: World Book of Family Medicine - Eur
show all

Family Medicine

Create successful ePaper yourself

Delete template?

Save as template?