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Basic Principles – Family Medicine | Lecturio

February 25, 2020

And so now we’re going to be
discussing the principles and philosophy of my specialty
family medicine. And in particularly how that
applies to United States Medical Licensing Examination. Because I think it is important
to understand some of the background. It will influence the types
of answers that you see on the exam. And I believe the answers
that you get right. So I’m going to start
with a quote and I’m going to read it. And then we are going to come
back to some key points. In the increasingly fragmented
world of health care, one thing remains constant:
Family physicians are dedicated to treating the whole person. Family medicine’s cornerstone
is an on going personal patient physician relationship,
focusing on integrated care. Now that comes from our
Academy of Family Physicians. I just want to focus on a few
of the key elements in that statement. First of all family
medicine is highly personal. We follow patients overtime. And the specialties really based
on good communication principles and empathy. We order fewer tests. We order fewer expensive
procedures. Stakeholders in medicine really
love us. And I’m talking about
governments. I’m talking about insurance
companies. Because we provide quality care. We improve morbidity. We also improve mortality
substantially and we do so at a low cost. Why? Because it starts with
the patient. The patient is at the center
of what we do. And so good communication skills
with the patient in bringing out all the history and treating
the patient in the context of their values and what’s
available to them is very important to us. So in that same vain we embrace
the biopsychosocial model of health care. So let’s break down that word. Bio-psycho-social. So the bio. The patient has diabetes
and heart failure and general anxiety disorder. That’s these different disease
case. This psychological. So they have anxiety. May be that’s related to
the fact that their kid isn’t doing so well in school. And they are having
trouble at their job. And may be they have been
drinking a little bit more than they normally would
with alcohol. So that’s the psychological. And then the social,
it mentioned how the impact of their child’s educational
status may be hurting their health in terms
of their mental health. May be it’s also leading to
some poor control of diabetes. Particularly if they are
drinking more alcohol. And see how it
all ties together. Every patient ties these
different domains. They are all highly interrelated
and you can’t really, I think fully understand one domain
without understanding the
others. And that’s an important
principle of our entire
specialty. And we put the patient in
the context of their relationships. So I mentioned this fictitious
patient and her son. So may be I’m seeing not just
the patient but I’m also seeing her son and her husband
and her aunt. And that allows me to get more
complete picture about what’s going on within
this family unit. And I’m also thinking
about where she lives. What kind of options for
health habits she has. Does she live in food desert? Is there any green
space next to her? And so it’s pretty the patient
in context though. Their human relationships also
the relationships to society at a larger level. We are holistic. We do cradle to grave
care and it’s complete. We treat acute illness,
and we do chronic illness and we do preventive care too. And we see examples of that
throughout these discussions I’m going today. And then finally we do
focus on preventive care. So it’s not just about
treating disease. It’s about promoting wellness. So that’s what I think in
particularly when it comes to preventive care family medicine
really owns that subject. Of course with our patients with
these many disease states as I mentioned there are going to see
different specialists. They are going to see different
health care providers such as say physical therapy. They may be going through
alternative care resources. Our job is to act as a central
station when we are organizing that care and putting
the patient at the center of a team of health care
providers. But we have to be the ones
to coordinate back there. Uncoordinate care is always
wasteful, inefficient and can be actually quite
dangerous too. And so when I say to the patient
at the center, it’s their values and their practices
and their believes what they are desiring to do. What they absolutely won’t
accept that dictates what we do as providers. And as I mentioned
we are cheap. We are driven mostly by history
and physical examination. And we do take ownership
of the whole patient. I really feel like I provide
a certain paternalistic style of care. It’s hard for me not to. Which I really cheer on
the patient successes when they lose 5 kilograms. When they get their
A1C under control. When those tension headaches
finally go away. When they get a promotion
at their job. And I definitely mourn when
they have difficulties. When they lose their home. When their heart failure
is getting out of control. We can’t do much about it. When they are
diagnosed with cancer. I really own all of
those conditions. But they also own to
a larger standard. I think some of the emotional
component of those moments with my patient. And I think that what makes
medicine that much more real and worthwhile.


  • Reply Cari July 17, 2019 at 11:42 am

    Do you guys have IV videos like infusion times etc? Please.. 🙂

  • Reply Tinka george william July 21, 2019 at 11:42 am

    You guys are saviours. I remember the first course of yours I took was anaesthesia. I just took it in preparation for my University exams (noe USMLE), and the results were just nice.

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