It is much more important to know what sort of
patient has a disease than what sort of disease a patient has.
Sir William Osler
The treatment of a disease may be entirely impersonal;
the care of patient must be completely personal.
Peabody
Family physicians do not just treat patients, they care for people. This caring function of family medicine emphasises the personalised approach to understanding the patient as a person, respecting the person as an individual, and showing compassion for his or her discomfort.
The patient is seen as a whole person and this involves the breadth of knowledge about each person, not just the depth of disease. The family physician thinks in terms of patients who have problems needing attention and is thus patient orientated rather than disease orientated. The whole person approach includes physical, psychological, social, economic and spiritual considerations. The patient is also viewed as a member of a family system and the family physician recognises the influence of illness on families as well as the influence of families on the unexpected illness. The family is after all the patient's main support system.
The family physician emphasises on preventive care health maintenance and promotion and would include such activities as patient education, counselling, immunisation, screening, early diagnosis and rehabilitation. He encourages the role of the patient as a partner in health care. Preventing illness has many aspects. This include recognising the risk factors of disease, delaying the consequences of chronic disease, and promoting healthy lifestyle. Prevention is more than telling people not to smoke, to exercise and to eat properly. It is also recognising risk factors for disease, such as family history, and using screening tools to pick up disease in is early phases.
The family physician is community based giving easy access to patients who needs their care. He is also community orientated viewing the patient in the context of his family and/or social group, within the community. Occupation, culture and environment are aspects of the community that affect patient care. Knowing which diseases or health problems have the highest incidence in the community influences the diagnosis made by family physicians and helps them make decisions about community education and service. There are many community resource that the family physician can use to provide optimum patient care.
Continuity of care involves one physician seeing the patient (and ideally, the family) over many episodes of illness and during well person visits. With continuity of care, a trusting, long-term relationship develops between the physician and patient. If the patient does not trust the physician, the chances for effective care are minimised. Continuity is probably the most important principle of family medicine. In family medicine the continuum of care is the patient, the episodes is the disease. For other specialties, the continuum is the disease and the episode is the patient. Family physicians are committed to providing care to patients and their families over time. Family physicians use time as a diagnostic and theurapeutic tool and are committed to contracting with patients for long-term care. The physician who practices continuity recognises and accepts as a commitment to the patient's future.
The family physician must be trained comprehensively to acquire all the medical skills necessry to care for the majority of patient's problems. A truly comprehensive family physician adequately manages acute infections, biopsies skin and other lesions, repairs lacerations, treats musculoskeletal sprains and minor fractures, removes foreign bodies, treats vaginitis, provides obstetric care, gives psychotherapy and so on. A family physician requires knowledge and skills of varying degrees in each specialty area. Comprehensive care also implies that the patient is viewed not only from a biological perspective but also from a social and psychological one. The family physician view the individuals in the context of their total needs.
The family physician co-ordinates the care of the individual patient. The family physician identifies other health care providers and health care resources that are needed to assist in the patient's overall care. It is the family physician's responsibility to guide the patient throught the health care system. Family physicians act as patient advocates. It is better for the patient to go through the family physician to the consultant. Then the consultant mus not only satisfy the patient but also satisfy the family physician.
The family doctor should have a deep commitment to people and obtain his greatest professional fulfilment from his relations with people, to believe in the primacy of the person, to use technology with skill but to make it always subservient to the interest of the person.
Attempts to produce a family doctor by putting together conventional training in paediatrics and internal medicine and adding some psychiatry are doomed to failure. The whole is different from the sum of its parts. Family doctors may emerge in this way but they will do so by the arduous route of rising above their training and learning from thir own experience.
Family physicians have distinctive values and ways of thinkgin and feeling. It follow that nobody is going to learn family medicine from those who are not family physicians or in an environment that is alien to its ethos. The core and essence of his education must be the experience of family practice.