FAMILY MEDICINE

Kedokteran Keluarga :
Suatu disiplin ilmu yang menitikberatkan pada upaya pelayanan kesehatan
yang bersifat primer, komprehensif, dan berkesinambungan, yang tidak hanya
melihat satu individu itu saja, tetapi juga melihat korelasinya dengan keluarga,
komunitas, dan lingkungannya.

Dokter Keluarga :
Dokter yang kompeten, yang menyediakan pelayanan kesehatan secara
personal, primer, komprehensif, dan kontinu pada pasiennya dan juga
memikirkan adanya korelasi dengan keluarga, komunitas, dan lingkungannya.
Pelayanan bisa dilakukan di tempat praktek, rumah pasien, atau terkadang di RS
Dokter tidak hanya menatalaksana tanda dan gejala saja, tetapi harus
memandang pasien tersebut secara holistic. Ini mencakup pemberian edukasi
dan konseling pada pasien

Personal care :
Mengenai hubungan yang dekat antara dokter pasien. Pasien tak hanya
mencari dokter saat sakit saja, tetapi juga mencari saat membutuhkan konseling
& sebagai mentor/teman

Primary care :
Adalah first contact care. Lebih mengutamakan acute & preventive care.

Continuing care:
Care terhadap masalah medis yang kronis yang memerlukan monitoring teratur
& care terhadap komplikasi yang mungkin terjadi. Ex: pada DM, HT,
dislipidemia

Comprehensive care :
(a) comprehensive in that it cares for all age groups;
(b) comprehensive in that it spans promotive, preventive, curative, rehabilitative
and palliative care; and
(c) comprehensive in that it deals not only with the physical but also social and
psychological problems

(that is, whole person medicine).

CENTRAL VALUE :
The first three are attitudes that we would want to infect all doctors with:
Patient centred care and attention to the doctor-patient relationship.
Holistic approach to the patient and his problems
Emphasis on preventive medicine because this has greater long term
impact on health
status than curative medicine.
The next three central values define the family doctors work:
The family doctor looks after health problems that may be initially
unclear in terms of seriousness the ability to deal with initially uncertain
symptoms is important in the makeup of the family physician.
The family doctor looks after people across the whole spectrum of age
groups he is
a specialist in breadth, unlike the hospital specialist who is a specialist in
depth.
The family doctor is willing to look after the patient not only in the
consulting room
but also in the home and other settings as well.

Specifically, we need to work on the following SEVEN AREAS in our

integrating efforts in health care delivery. We can remember them as 4 plus 3:
The first 4 are processes of care :
(1) Good preventive care
(2) Good acute care how to do things right the first time. It is not always easy
and takes a lifetime to perfect. And good acute care is very, very important
in the elderly, particularly, in the very old because the window of
opportunity is small and we must act fast or they will never be the same
again.
(3) Good chronic disease care management reduce the burden of disease on
the sufferers.
(4) Good step-down care this is increasingly important with the rising cost of
acute hospital care and the increasing numbers of the elderly who take a
longer time to recover from their medical illnesses.

The next three concerns those where it is more care than cure
(5) Good elderly care
(6) Good domiciliary care
(7) Good palliative care able to slow down the destructiveness of cancers and
give the sufferers more life and longer life.

There are five LEVELS OF PHYSICIAN INVOLVEMENT IN THE

FAMILY (Doherty & Baird, 1986):

Level 1. Minimal emphasis on the family.

The interaction is limited to the patient only

Level 2. Providing medical information and advice.

This consists of teaching at least one family member about the patient's illness
either as a once-off or an ongoing series of educational sessions.

Level 3. Providing feelings and support.

Family support is enhanced by convening the family members and encouraging
them to discuss their concerns. The family physician must be able to ask
questions that elicit family members' expressions of concerns and feeling related
to the patient's condition and its effect on the family. He also needs to be
able to listen emphatically to their concerns and to normalise them where
appropriate, encouraging family members in their efforts to cope as a family and
identifying family dysfunction.

Level 4. Systematic assessment and planned intervention.

At this level the family physician engages the family members, including the
reluctant ones in a planned family conference or a series of conferences. He is
also able to help the family generate alternative, mutually acceptable ways to
cope with their difficulty and he is able to help the family balance their coping
efforts by calibrating their various roles in a way that allows support without
sacrificing anyone's autonomy.

Level 5. Family therapy.

At this level, the family physician has the ability to handle intense emotions in
families and self and to maintain neutrality in the face of strong pressure from
family members or other professionals.