Definition of Family Care
Primary care is a level of medical services provided outside the hospital, that should be differentiated from secondary care (consultant or specialty services) and tertiary care (hospital services). It incorporates several tasks:
- * medical diagnosis and treatment;
- * psychological assessment and management;
- * personal support of patients of all backgrounds, all ages and genders, in all stages of illness;
- * communication of information about illness;
- * prevention of disability and disease through detection, education, behavioral change, and preventive treatment;
- * maintenance of patients with chronic illness.
Family physicians are not only concerned with the doctor's definition of disease but with the patient's illness (the cognitive, communicative, and behavioral processes by which the patient defines being ill).
Medical Diagnosis and Treatment remain central tasks, although they are by no means the end point of care.
Psychological Diagnosis and Treatment and Personal Support complements the medical components of care. Studies documenting the relationship between emotional reactions and illness, coupled with surveys showing a high frequency of such reactions in office practice, underscore their importance in patients seeking medical help.
Eliciting and Addressing Patient Expectations and Requests are also important. Expectations often play a major part in seeking help, complying with treatment, and feeling satisfied with care. These expectations may explain why patients decide to go to see the doctor. If attention is not paid to the patient's reason for coming the patient would become dissatisfied and may not stay in treatment.
Communication of Information about Illness. The need to inform, explain, reassure, and advise patients is essential to primary care. This task is often dependent on knowledge of the patient's attributions (ie, what the patient thinks is the cause of illness). If the patient's attributions differ from the doctor's and are not uncovered, his anxieties may not be relieved, nor will the doctor's explanation be accepted. Knowing how and what to tell the patient about his illness is often difficult, especially if the patient's interpretation of the illness has not been elicited.
Maintenance of the Chronically Ill requires continuous, long-term treatment and is a distinct task of primary care. Here, obtaining patient compliance is essential because most long-term treatment now takes place without daily medical supervision, and most of that treatment requires the self- administration of drugs. To improve adherence to therapy, it has become increasingly important to learn about the patient's views of treatment and actual self-treatment. Knowledge about patients' views and behaviors can be used to design more effective therapeutic regimens and to alter therapeutic directions.
Prevention of Disease and Disability, an essential task of primary care emphasizes screening and the assessment of risk and function. With early intervention through health education, behavioral change, and preventive treatment, some of the expected morbidity, disability, and mortality may be delayed—if not prevented—and costly technologic interventions and therapies avoided. The primary physician needs to know which conditions and risk factors are worth screening for and how best to detect and effectively manage them. A less commonly considered but no less important aspect of prevention involves attention to the patient's social network, because illness is often precipitated by disruption of interpersonal relationships.
Doctor-Patient Relationship: Patient-centered treatment in primary care practice implies a doctor-patient relationship in which the doctor acts out several behaviors that will enhance the patient's participation in care and treatment:
- Making the relationship more democratic by eliciting and responding to patients' preferences in decisions about the scope of diagnosis and alternatives of treatment.
- Attending to patients' feelings about illness and treatment with regard, genuine concern, and empathy.
- Providing helping actions that are person-centered by eliciting, acknowledging, and responding to patients' own perspectives of their illness and care.
- Responding by negotiation to the patients' choices, decisions, and requests; similarly, acknowledging and negotiating conflict even if in the relationship itself.
- Promoting health education, self-help, and preventive behaviors by communicating information about diagnosis, treatment, and prevention.
- Conveying respect for the person of the patient without regard to the patient's gender, race, ethnicity, age, or social class.
Prevention. The ideal of prevention in practice has been to deal with the individual patient seeking help. Primary care medicine also examines the epidemiology of the entire practice, and perhaps even the community base, to institute a program of effective preventive intervention.
