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
10. COMPETENCIES OF F.P.
• Acute health problem
• Chronic health problem
• Provide health promotion services
• Emergency services
• Counseling
• Preventive
• Terminal and palliative
• Home care
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
19. Guidelines
• Consensus
• Guidelines National, International
• Evidence based care
• Use of Algorithm and chart
• Quantitative medicine, personalized,
individualized medicine
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
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
Hinweis der Redaktion
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 .