全科医学： 第7讲 A Profile of Family Practice 20140331

1、A Profile of Family Practice,Contents,Notice about the final exam Paper test in Apr. 24 (14:00-16:) in rooms 103-4 of the eastern teaching area Student should go through by yourself the every item in Family Medicine Question Bank Exam forms are in FM course page 80% of questions are from the teacher

2、s lectures 100% are in the FM course page Lecture,Step 1, 用户名(User Name)和密码(Password): Students Number,Into the personal portal /,Step 2,Click Family Medicine,Step 3,Into the user interface,Step 4,Into FM interface,Step 5,Into FM course interface,Step 6,Into the Exam Form,Step 7,Question Bank,Step 8

3、,Example for Family Medicine Paper Test(Nov. 7),一. Best Choice（Score 1 for each, totally 40） （）1. Who are in an best position for helping patients to improve their health? APhysiciansBGynecologists CPaediatriciansDGPs 二. Multiple Choices（Score 2 for each, totally 40） （ ）1. Which can be list as the m

4、inor problems? ACough for two days BBack pain for two days CHigh fever for two days DTired feeling for two days ERed urine for two days 三. Translation（Score 10-15 for each, totally 20）,What is the true picture of the content of family practice?,To record the diagnosis made at each doctor-patient enc

5、ounter diseases (well-defined ) symptom or complaint Many illness episodes seen by family physicians, however, are much more difficult to define and label,case 8.1,An elderly woman complained of a suffocating feeling in the chest, occurring in the early hours of the morning, which was relieved to so

6、me extent by sitting by an open window. She first came in the middle of a busy office session when time was short. Given the above cues, the doctor formed a first hypothesis of nocturnal cardiac asthma, and after a physical examination revealed no signs to support the diagnosis, sent the patient for

7、 a chest x-ray. When this too was normal, he asked the patient to come in for a longer interview.,On this occasion the GP obtained the following history. Her main complaint was of very active peristalsis and abdominal discomfort occurring at night and keeping her awake. After lying awake for hours s

8、he would get more and more tense, get a suffocating feeling, and have to get up and go to the window. The abdominal symptoms had been present for twenty years, but the insomnia was of more recent origin. Many years previously she had had a cholecystectomy, which failed to relieve her symptoms, and a

9、 mastectomy for carcinoma. She had a fear of surgery and on direct questioning admitted to an anxiety that her abdominal symptoms might be due to cancer. She had been widowed several years and lived in an apartment by herself. Recently her landlord had raised her rent without giving her any notice.

10、Her two children were both married and living away. Recently, her daughter had moved near to her after living away for some years. During the interview, she expressed hostility toward her landlord, who, she felt, had been very unfair to her.,How to define and label the case 8.1?,diseases ? anxiety s

11、tate or insomnia Insomnia is characterized by persistent difficulty falling asleep or staying asleep despite the opportunity. It is typically followed by functional impairment while awake. symptom insomnia or gastrointestinal symptoms Whichever route we take, we provide only a partial picture,The re

12、sult,Whichever route we take, we provide only a partial picture equivalent to taking a two-dimensional slice through a three-dimensional object. No assurance that any two physicians will classify the same illness in the same way appear in the statistics under the rubric of mental illness appear unde

13、r the rubric gastrointestinal diseases Given these difficulties of nomenclature and standardization, it is small wonder that there are wide variations in such estimates as the amount of psychiatric illness in family practice.,Standardized coding systems for primary care,ICPC United States, Britain,

14、the Netherlands, Australia, Norway, West Germany, Austria, and Barbados Use Make comparisons between practices or countries Relate process of care to outcome Follow trends in illness over time Learn from our experience by retrospectively reviewing our cases in different disease categories.,ICPC VS I

15、CD,ICPC,Classifying three elements of an encounter between patient and doctor the reason for encounter (RFE) the diagnosis or problem the process of care. Rather than being organized around end points of illness (definitive diagnoses or causes of death), the ICPC is based on episodes of care defined

16、 as “a problem or illness in a patient over the entire period of time from its onset to its resolution”,Structure of ICPC,Biaxial structure 17 chapters on the horizontal axis body systems take precedence over etiology 7 components on the vertical dealing with symptoms and complaints (comp. 1), diagn

17、ostic, screening and preventive procedures (comp. 2), medication, treatment and procedures (comp. 3), test results (comp. 4), administrative (comp. 5), referrals and other reasons for encounter (comp. 6) and diseases (comp. 7).,Case 8.1 in ICPC,Be recorded as follows the reasons for encounter, recor

18、ded under the relevant chapter heading, are shortness of breath (R02), insomnia (P06) fear of abdominal cancer (D26). the chest x-ray result is recorded under component 4. Two diagnostic codes are entered: irritable bowel syndrome (D93) and anxiety disorder (P74).,Note about ICPC,As in all classific

19、ation systems, the accuracy of ICPC depends on the skill of the recording physician. The RFE is not necessarily the same as the presenting complaint, and underlying reasons may not emerge at the first encounter. Much depends on the physicians knowledge of the patient and consulting skills. Consisten

20、cy in assigning diagnostic labels is difficult to attain in the many illnesses that cannot be differentiated to more than low levels of abstraction. All classification systems are simplifications of complex processes. We cannot expect them to fully represent the complexity of family practice.,Sympto

21、ms,What are the twenty-five most common reasons What are the ten most common presenting,The ten most common presentingin males,The ten most common presenting in females,Diagnoses,Diagnostic categories from the ICD and ICHPPC are grouped into clusters that bring together discrete conditions that are

22、clinically related. 367 rubrics of ICHPPC-2 are condensed into a smaller number of clusters suitable for comparative analysis.,Other Features of General Practice,Women consult family physicians more often than males, even after allowing for attendances during pregnancy. The reasons for this difference are not known. Between 70 percent and 80 percent of members of a practice consult at least once a year. The average number of visits per member is between three and five.,Sources of Variation in Family Practice,The age of the physician The gender of the physician. Female p