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Family medicine
- 2. FAMILY MEDICINE PROF DR M. A. BADR
- 3. Family medicine Prevention & health promotion WONCA World organization of family doctors
- 5. Family medicine • Provide: Primary care ethics PERSONAL COMPREHENSIVE CONTINUING CARE Primary care ethics
- 6. FAMILY PHYSICIAN • Ability to evaluate new information and its relevance to the practice • Knowledge & skill • Appropriate use of medical records and or other information system
- 7. FAMILY PHYSICIAN • Efficient management of the organization or business aspects of practice • The ability to plan and implement policies screening and preventive care
- 8. BASIC COMPONENTS • Access to care • Continuity of care • Comprehensive care • Coordination of care • Contextual care • Community and family based • Evidence based health care
- 9. FAMILY MEDICINE • STRUCTURE Presence, access,continuity • PROCESS EBM • OUTCOME Prevention , health promotion
- 10. COMPETENCIES OF F.P. • Acute health problem • Chronic health problem • Provide health promotion services • Emergency services • Counseling • Preventive • Terminal and palliative • Home care
- 11. COMPETENCIES IN FM WHAT KNOW DO IN ORDER TO BE EFFECTIVE
- 12. ORGANIZATION AND CATEGORIZATION OF COMPETENCIES • COMMUNITY BASED • PATIENT- PHYSICIAN RELATIONSHIP • SKILLED CLINICIAN • RESOURCE TO A DEFINED POPULATION
- 13. ORGANIZATION AND CATEGORIZATION OF COMPETENCIES FM EXPERT • COMMUNICATOR • COLLABORATOR • MANAGER • HEALTH ADVOCATE • SCHOLAR • PROFESSIONAL
- 14. Reception • Identification • Appointment –Reminder communication • Interpersonal communication • Waiting room Hand-out, pamphlets, media, • Call for file ( confidential)
- 15. PreventionPrevention Patient education includePatient education include:: •Careful selection of footwearCareful selection of footwear.. •Daily inspection of the feetDaily inspection of the feet.. •Daily foot hygieneDaily foot hygiene.. •Avoidance of self-treatmentAvoidance of self-treatment.. •Avoidance of high-risk behaviorAvoidance of high-risk behavior.. •Consultation if an abnormalityConsultation if an abnormality arisesarises
- 16. Documentation double sward • Personal data • Date & Time • Communication Mobile no/ address • File revision • Notification about ADR allergy • Oral anticoagulant • Hereditary disease, sickling, G-6-P def
- 17. Physician visit • Complaint and history of recent c/o • > of 70% of the diagnosis • Try to be a good listener, no interfere, interest, concentrating • VITAL IS VITAL Temp, pulse, Bp • Examination in the presence of a nurse • Rapid decision if emergency hypotension
- 18. Process • Safe • Effective guidelines • Efficient • Timely • Patient centered • Equity discrimination
- 19. Guidelines • Consensus • Guidelines National, International • Evidence based care • Use of Algorithm and chart • Quantitative medicine, personalized, individualized medicine
- 20. Continuous performance improvement • Safety limit transmission of infection , hand hygiene • Guidelines • Keep record for your error
- 21. SOAP • Subjective • Objective • Assessment, analysis • Plan
- 22. PLAN • Life style modification • Diet • Exercise • Sick leave • Medication • Consultation • Reference health education • Revision and follow up
- 23. Medications • Prescription, handwriting • Pharmacological name, dose, frequency, route, initial dose, duration, ADR • ADR avoidable , nonavoidable • Wrong prescription • Role of the pharmacist
- 24. Non avoidable • Sensitivity test • Anaphylaxis • Severe reaction erthyma Multiformis,Steven Jonhson
- 25. Avoidable • Personalized Medicine pharmacogenomic, genetic make up • Can be predictable >25% of commonly used drug (array)
- 28. COPE computerized physician order entry • Computerized physician order entry (CPOE) is the process of entering medication orders or other physician instructions electronically instead of on paper charts. The use of a CPOE system can help reduce errors related to poor handwriting or transcription of medication orders. Physician assistance
- 29. Personalized medicine • Right patient • Right treatment • Right time • Right dose according genetic make up of patient
- 30. Quantitative medicine is the key to reducing healthcare costs and improving healthcare outcomes Patients with same diagnosis Misdiagnosed Non-responders, toxic responders Non-toxic responders
- 31. Asthma Drugs 40-70% Beta-2-agonists Hypertension Drugs 10-30% ACE Inhibitors Heart Failure Drugs 15-25% Beta Blockers Anti Depressants 20-50% SSRIs Cholesterol Drugs 30-70% Statins Major drugs ineffective for many… Source: Amy Miller, Personalized Medicine Coalition
- 32. The Promise Imagine when doctors can… • Prevent Disease by identifying risks, early interventions • Diagnose Conditions less Predict Disease pre-symptomatically with simple testing • invasively, more accurately • Select Drugs that maximize benefits and minimize risks • Calibrate Treatments to heighten efficacy and recovery • Treat/Cure Disease using our own genes
- 33. Take five • BE with us
- 34. Common clinical diagnosis • Hypertension • Chest pain , chest infection, asthma • Diabetes • GIT, jaundice ,Diarrhea • Coma & syncope • Stroke • Trauma • fever
- 35. Office BP Measurement § Use auscultatory method with a properly calibrated and validated instrument. § Patient should be seated quietly for 5 minutes in a chair (not on an exam table), feet on the floor, and arm supported at heart level. § Appropriate-sized cuff should be used to ensure accuracy. § At least two measurements should be made. § Clinicians should provide to patients, verbally and in writing, specific BP numbers and BP goals.
- 36. BP Measurement Techniques Method Brief Description In-office Two readings, 5 minutes apart, sitting in chair. Confirm elevated reading in contralateral arm. Ambulatory BP monitoring Indicated for evaluation of “white-coat” HTN. Absence of 10–20% BP decrease during sleep may indicate increased CVD risk. Self-measurement Provides information on response to therapy. May help improve adherence to therapy and evaluate “white- coat” HTN.
- 37. Blood Pressure Classification Normal >120 and >80 Prehypertension 120–139 or 80–89 Stage 1 Hypertension 140–159 or 90–99 Stage 2 Hypertension <160 or <100 BP Classification SBP mmHg DBP mmHg
- 38. Benefits of Lowering BP Average Percent Reduction Stroke incidence 35–40% Myocardial infarction 20–25% Heart failure 50%
- 39. Laboratory Tests Routine Tests • Electrocardiogram • Urinalysis • Blood glucose, and hematocrit • Serum potassium, creatinine, or the corresponding estimated GFR, and calcium • Lipid profile, after 9- to 12-hour fast, that includes high-density and low-density lipoprotein cholesterol, and triglycerides Optional tests • Measurement of urinary albumin excretion or albumin/creatinine ratio More extensive testing for identifiable causes is not generally indicated unless BP control is not achieved
- 40. Hassan age 50 years • Presented to you with severe throbbing headache, chills, epig pain and vomit once Past history of hypertension,dyslipidemia • Pulse full, Bp 200/120, lung showed bilateral basal fine crepitation • Ask the patient about important symptoms • What you will do if you are in OPD
- 41. Hilal 18 years old known type1 • c/o of epig pain vomiting, fever , diarrhea • He miss last night insulin dose • He ring you this morning at 10:00 • What is your advise to Hilal • You propose what?
- 42. Mr Hamdi 45 ys old • Vomit this morning brown colouration vomitus after an overnight severe nausea • Several days before he seeked the advise of the orthopedic surgeon for a low backache and girdle pain • Ask him few question • Decide what to do if you examine him home
- 43. Amira young female 22 years old • C/o of vertigo, vomiting , unsteady gait associated with severe headache, she was on antibiotic because of an upper respiratory tract infection few days before • Your examination revealed afebrile, nystagmus , brisky reflex on both LL. • Is it serious, what you will do
- 44. Soad pregnant in her last trimest • Referred by her obstetrician because her last urine analysis showed + sugar ,FBS is 90, her PP is 116mg% • Is she gest diabetes • What you will recommend
- 45. Ali young asthmatic patient • c/o since yesterday something giving way in his rt lower chest after cough • Today his respiration not at ease and suffer from stitching pain on the same side during walking • Examination revealed only mild degree of fever 37.4 • Decision
- 46. 60ys old lady • Fever, rigor, bilateral loin pain and scanty urine • Past history of renal stones, gout, HTN,osteoathrosis • What you will do as investigations
- 47. Ahmed 34 year old • c/o of lower left pricking sensation in the chest • Few day later rash appear in the same area and extend , associated with general illhealth • What you will ask him ? • DD
- 48. 50years old male • C/o progressive loss of wt, anorexia, night fever • No cough • Examination revealed significant loss wt • Few L node enlargement deep cervical group, shotty ,rubbery not fixed • CBC lymphopenia, normocytic , normochromic anaemia and shooting ESR • Discuss the case and make a plan
- 49. 40years old patient • Irregular palpitation since last night • Past history of similar condition • Pulse completely irregular and rapid • Bp 120/80 • ECG AF • Discuss the case and manage
Notes de l'éditeur
- Qualitative medicine Diagnosis Standard care Does not work for all
- Understanding molecular medicine, through both laboratory and imaging techniques, deepens our ability to detect, diagnose and treat disease. Genomics, the study of genes, is the most common area of study since it involves a stable, albeit large, data set. Genomic data is particularly useful in identifying certain diseases, unveiling risk factors for other diseases, and predicting how well certain drugs will work in humans. This last area, called pharmacogenomics, is an increasingly popular area of study involving both drug effectiveness (efficacy) and drug side effects. This is a critical field since many medications are only effective in 50% of the population and cause side effects in another large percentage, but we don’t know ahead of time how individuals will react. Being able to test for gene differences ahead of time will both improve effectiveness and decrease side effects for patients . Other important areas of study include proteinomics and metabolomics. While genetic markers are stable, these biomarkers are constantly changing as a function of both genetic and environmental exposures. They are particularly important in diagnosing diseases and calibrating treatment regimens. Finally, molecular imaging (e.g. PET Scans) is an increasingly important area in the field of cancer diagnosis and treatment calibration .