Introduction to Family Medicine

Family Medicine is the medical specialty that provides continuing and comprehensive health care for the individual, in a holistic manner within the context of his family and environment. It encompasses all ages, both sexes, and every disease entity, integrating biological, clinical, and behavioral science (Rackel).

Family Medicine is the body of medical knowledge required to be transferred to the physician to enable him to function as a Family Physician.

Family Practice is the care given.

The Family Physician is the physician primarily responsible for providing comprehensive health care to every individual seeking medical care in the context of himself, the family, and the communities, taking into account their cultural, socio-economic, and psychological background (WONCA 1991).

A specialist usually referred to as a primary care physician.

Until the 1950s, their roles were usually performed by any medical graduate, when it became a specialty in its own right with training requirements tailored to each country.

The Family Physician aims at promoting personal, comprehensive, and continuing care for individuals in the context of the family and the community.

• WONCA: World Organization of National Colleges, Academies, Academic Associations of Family Physicians/General Practitioners. An official organ of WHO. Seven regions: Africa, Asia Pacific, East Mediterranean, Europe, Iberoamericana, North America, and South Asia.
• SOFPON: Society of Family Physicians of Nigeria. (AAFP in the USA)

• U.K.: Family Medicine began in 1966.
• U.S.A.: 1970.
• Started in 1970: In National Postgraduate Medical College of Nigeria (NPMCN), but training started in 1981 in Nigeria.
• West African College of Physicians (WACP) (an organ of West African Health Organization (WAHO)): 23rd October, 1976.
• Faculty of General Medical Council (GMC) within WACP: November, 1986, at Anglo-German-Swedish Medical Society (AGSM), Monrovia, Liberia, with 78 foundation fellows.
• First Primary exams: October, 1988.
• First part 1: April 1992.
• In 2002: Nomenclature changed from GMP to Family Medicine.

• Caregiver: Preventive, promotional, acute, chronic, longitudinal, etc.
• Communicator: Every opportunity to interact with the patient is for intervention in terms of promotion of health, disease prevention, etc. Consultation and communication are special skills of FP. Explores FIFE, cues, touches, etc.
• Coordinator: Coordinates healthcare of a patient within the healthcare system and outside the facility. Referrals and collaboration with other health practitioners.
• Researcher: Conducts researches.
• Advocate: Identifies the need of the patient and healthcare services and canvases for them.
• Manager: Time, manpower, materials, and money.

• A group of people living together and functioning as a single household, usually consisting of parents and their children.
• Primary social group.
• A person having kinship with another or others.
• Syndicate: a loose affiliation of people in charge of organized activities.
• An association of people who share common beliefs or activities.
• Two or more people who share goals and values, have long-term commitments to one another, and reside usually in the same dwelling place.
• All the members of a household under one roof.
• A group of persons sharing common ancestry.
• Lineage, especially distinguished lineage.
• A group of people who are related biologically, legally, or by choice from whom an individual can expect some form of support in terms of food, shelter, finance, and emotional nurturing; and share a common past, present, and future. (universally acceptable)

Types of Family

• Nuclear family: Mother, Father, Children
• Variations on this:
  • Blended or Step-parent family, also called reconstituted
  • “Binuclear” divorced with joint custody
  • Nuclear dyad, couple with no kids
  • Single-parent family
  • Single adult living alone
• Extended family:
  • Nuclear family plus other relatives
  • Usually multi-generational
  • May live in the same household or a number of households
  • Usually near each other
• Polygamous families:
  • Practiced in many cultures
  • Most commonly several wives
• Communal families:
  • Groups of people living together
  • Consider themselves as families
  • Share work, responsibilities, and property to varying extents
  • Variable commitment to relationships
• Gay/Lesbian families:
  • Similar to the nuclear family but the couple is of the same sex
• Skip-generation families:
  • Child being raised by grandparents

Basic Functions of Family

• Reproduction, recruitment, and release of family members.
• Placement of members in the larger society.
• Physical maintenance.
• Maintenance of motivation and morale.
• Development of philosophy of life and sense of family.
• Allocation of resources.
• Division of labor.
• Socialization of family members.
• Maintenance of order.

• Developmental:
  1. Evelyn Duvall (1977) - applies to nuclear family
  2. Joanne Stevenson (1977) - Family tasks include maintaining a common household, rearing children, finding satisfying work and leisure, sustaining appropriate health patterns, providing mutual support, and acculturation of family members.
• Interactional:

  Virginia Satir (1972) - 4 concepts: self-worth, communication, rules, and links to society.

• Structural-Functional:

  Marilyn Friedman (1986) -

  • Structure: Organization of the family unit and how members relate in terms of values, power, communication network, and role systems.
  • Function: Outcomes of the interactions of the family with Supra-system and subsystem (system theory).
• Calgary Network: Structure, Function, and Development. All parts are inter-related.

• Family Genogram
• Family Circle
• Family Stage
• Time Line
• Home Visits/House Calls
• Medical Informatics
• Family Conferencing
• Ecomap

Family Care: Central to the practice of family medicine is the understanding of the concept of what the family is, the dynamics of its processes and the components of its care.

Primary Care: Primary medical care and primary healthcare.

Primary medical care is used to refer to all care delivered at the first or primary level in contrast with care delivered in the hospital.

Primary health care in its broadest sense is a philosophy or set of values and principles for organizing the health system as a whole.

Hospital Care: FP provides comprehensive healthcare to patients within the hospital and as a generalist specialist especially in rural areas.

Domains of Care in Family Medicine

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Domains of Care in Family Medicine

The Therapeutic triangle in Family Practice

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The Therapeutic triangle in Family Practice

A ‘model of care’ is a multifaceted concept, which broadly defines the way health services are delivered (Queensland Health 2000).

A model of care outlines best practice patient care delivery through the application of a set of service principles across identified clinical streams and patient flow continuums (Waikato Health Board 2004).

• Biopsychosocial Model
• Patient-Centered Clinical Method
• Holistic Approach
• System Approach
• Family Medicine Model of Care
• Ethno-medical Cultural Model of Care
• Lifespan Perspective
• Biomedical Model of care (The commonest- not ideal)

• Family Medicine is the backbone of medical care globally.
• Family Physician undergoes specific trainings- country specific.
• Family is a social and nurturing unit of the society.
• FP provides all sorts of care to patients and conducts research.
• Several tools are used in clinical practice.
• Biomedical model of care is not ideal.
• We need to do more to achieve more.