Basic approaches on family

medicine practice

Prof dr Bagiada SpBiok PKK

Ketua umum PDKI Bali
 INTRODUCTION
Back ground
There are more than 40.000 doctors with

different competency.
General practitioner will be placed in front

line of primary medical services

People need for high quality medical

services.
Competition after AFTA

For above reason we need doctors with

higher quality and competence. Family

physician
 Why FM
Fragmentation of services
Lack of personal relationship with a
physician
Escalating coast
Insufficiently coordination of care
Difficulty knowing which physician to
contact
Having to consult several physician for
common problems
Inadequate access to care especially in
inner cities and rural area.
 History of FM organization
December 20,1981 Study Group of FD/KSDK
24-28 Juni 1990 WONCA (World Organization of
National College and Academic)=World
Organization of Family Doctors Asia Pacific
regional Conference in Bali
October 24, 1990 SGFD Indonesian
College of FD / KDKI
2003 Surabaya ICFD/KDKI
PDKI/Society of FD
 Visi dan Misi organisasi
Vision
Hope that medical practice and medical
education match to people need.

Mision
*Utilization of medical practitioner
through training and education.
*Standardization of med services.
*Education to society.
 Law and regulation
KEPMEN N0: 56/Menkes/SK/I/1996 perihal
DK dan JPKM
PERMENKES N0.
916/Menkes/Per/VII/1997, tentang SIP Dr
dan Drg.
KIPDI III(Kurikulum Berbasis kompetensi
untuk pendidikan Kedokteran dasar.
(2004)
Dari 7 area kompetensi, area 3 adalah
penerapan dasar ilmu biomedik, klinik,
perilaku,dan epidemiologi dlm praktek
kedokteran keluarga.
 Grading of medical services
Ideally there are 3 grade health
services need by the community.
But its not fully understood because
of lack in continuing information to
the community.
1. Primary care services.
2. Secondary care services.
3. Tertiary care services.
 What is FD?
FD are doctors who give health
services on primary health services
holistically, need by all member of the
family.
(The American Board of FP, 1969)
FD are doctors who give pro-active and
holistically health services, Oriented to
community , and centralized to the
familly.(IDI, 1982)
 What is FD ?
FD are doctors who give personally
service, in primary HS, continuously
and holistically to the patients in the
family, community and its environment.
(Singapore College of GP, 1987)
FD : are trained doctors who have an
authority in giving health services at
the front-line of primary care. (IKK
FKUI, 1996)
 What is the role of FD ?
Is to improve medical
services in primary health
care, with high quality,
efficient, and as discreet goal
keeper in regulating the
utility of the clinic, not over
or under used by the family.
 What s the Family Medicine
science ?
FMS : science and art of provision of
primary care (front line), personal care
(care of individual), comprehensive
care (age natural, history, disciplines)
and continuing care (chronic medical
condition).
FMS : Provision of care in context of
- Individual
- Family
- Community
 Primary care
This is first contact care.
In primary care the patient may present
with one or more of the following reasons:
pain or other symptom
accident and emergency
preventive health care
administration requirement
Seeking assurance
problem of living
legitimatization of of sick role
 Characterisic of the FD services
FD perform primary health care
service which is:
1. Comprehensive care.
2. Continuing care
3. Care more about prevention.
4. Coordinative care
5. Focus to the family
6. Considering the community
 Comprehensive care
Comprehension mean completely.
Used medical science and technology
development for the shake of the
patient.
For all gender and age.
Give services more than the patient
complain.
More attention to who is the
patient than what is the disease.
 Generally comprehensive care have 3
meaning:
1. Comprehensive in that it cares for all age
group
2. Comprehensive in that its spans
promotive, preventive, curative,
rehabilitative, and palliative care
3. Comprehensive in that it deals not only
with the physical but also social and
psichological problem
 Continuing care
Continuing care is care of a chronic
medical problem which require
regular monitoring and also care
about complication that may arise.
The basic requirement is the
presence of a care plan for the
problem (hypertension, DM,
hyperlipidemia)
 Continuing care
From conception to the die/From the
cradle to the grave
Need complete medical record.
Better group practice than solo practice.
Efficient Communication.
Medical history included when the patient
move to other place.
Proactive in caring the patient. Not only
waiting them
comp
Prevention better than therapy
Promotive and Preventive:
vaccination, pre and post natal care,
counseling, FP program, health
education to the community.
Early diagnostic and therapy, rational
and standardized.
 Coordinative
Referral system and consultation are well
coordinated.
Professional mutualistic understanding for
the shake of the patient.
Complete information to the patient and
his/her family.
Utilization of the family role.
Sure that patient will believed to the
doctors order.
 Focused to the family
Start from the patient complain
Considered the influence of the
disease to the family and vice versa.
Consider the capability and capacity
of family in treating the patient.
 Consider the community
Environment of the living house.
Working environment
Kind of work.
may be influence or there are
connection to the cause of the
disease, and can be influence the
healing.
 Problems on FD practise.
Not well communicated to the
community.
Health insurance not believable.
Poverty and low income.
Crowded of alumni with difference
competency.
 WHO-WONCA
Profile of FP : it is the desirable
profile for health care professional in
a system that is based on responding
to peoples needs.
 Profile of FD (The five stars
doctors)
The role of the five stars doctors
Care provider

Decision maker

Communicator

Community leader

Manager

Its can be realized if the principle of

FD can be done
 Care provider
Who considers the patient holistically
as an individual and as an integral
part of family and community,
provide high quality, comprehensive,
continuous and personalized care
within long term, trusting
relationship.
Need comphrehensive clinic
 Decision maker
Who makes scientifically sound judgment
about investigations, treatment and use of
technologies that make into account the
patients wishes, ethical value, cost
effectiveness consideration and the best
possible care for the patient
- Require
Science and medical skill and adequate
management
 Communicator
Communicator, who is able to
promote healthy lifestyles by
effective explanation and advocacy,
thereby empowering individuals and
groups to enhance and protect their
health.
- Require : communication capabilities
 Community leader
Community leader, who having won
the trust of the people among whom
he or she works, and reconcile
individual and community health
requirements, advice citizen groups,
and initiate action on behalf of the
community
- Require : Excellent leadership
 Manager
Manager, who can work
harmoniously with individuals and
organization both within and outside
the health system to meet the need
of individual patient and
communities, making appropriate use
of available health data
- Require : managerial capacity
law and ethical capacity
 Tugas
Menapis kebutuhan spesifikasi
Mendiagnosis cepat & mengobati cepat-
cepat
Memberikan pelayan aktif saat sehat dan
sakit
Melayani individu dan keluarganya
Membina dan mengikutsertakan keluarga
dalam upaya penangan penyakit
Menangani penyakit akut dan kronik
 Tugas
Melakukan tindak awal persiapan rujukan
Memantau pasien yang dirujuk
Bertanggung jawab atas pasien yang
dirujuk
Bertindak sebagai mitra,penasihat, dan
konsultan
Mengkoordinasikan pelayanan yang
diperlukan
Menyelenggarakan rekam medis baku
Melakukan penelitian
 Pengamalan Ilmu Kedokteran
Keluarga
Sebagai Ilustrasi apakah yang
dijumpai dilapangan sudah
diperlakukan sesuai dengan esensi
pelayanan ilmu Kedokteran
Keluarga?
Mari kita lihat kasus berikut ini.
 Contoh kasus yang terjadi di lapangan.

Seorang anak umur 12 tahun pada 2 tahun terakhir ini

sering dirawat karena epilepsi berat. Pasien tinggal jauh dari RS.
Pada tiga perawatan terakhir sampai terjadi status epileptikus dan
nyaris membawa maut.Dokter di RS tempat perawatannya tidak
puas dan kecewa karena kepatuhan pasien sangat rendah, padahal
telah disiapkan obat obat mutakhir untuk epilepsinya.

Coba Ts bahas kasus ini dari segi pelayanan yg diberikan oleh

DPU/RS yg merawatnya. Apa yang kurang dan bagaimana
seyogianya pelayanan dilakukan sesuai dgn prinsip pelayanan
DK.
 Yang terjadi dan yg seyogianya
harus dikerjakan
Pelayanan yg terpenggal penggal
* Pasien tinggal jauh dari RS dan tidak
punya DK.
* Dokter yg melayani di RS berganti ganti
dan tak ada rencana Th/ jangka
panjang.
* Rekam medis tak lengkap dan tidak
berkesinambungan
Yang diperlukan : DK dan rekam medis yg
memadai shg tjd kontinuitas pelayanan.
 Yang terjadi dan harus dikerjakan
Pelayanan hanya untuk mengatasi
keluhan sesaat.
* Tak pernah ada data analisis
penyebab kumatnya epilepsi.
* Tak dibuat genogram untuk
keperluan prognosis.
Perlu pelayanan yg holistik dan
komperhensif
 Yang terjadi dan harus dikerjakan
Pelayanan tidak dikoordinasikan dengan
baik.
* Tak ada kontak antara DPU dan
dokter RS.
* DPU tak acuh perihal kekambuhan
penyakit pasiennya
* Tak ada masukan khusus bagi Dr di RS
* Terjadi pengulangan pemeriksaan yg tak
perlu
Diperlukan koordinasi pelayanan.
 Yang terjadi dan harus dikerjakan
Komunitas pasien tidak diperhatikan
* Tidak tercata pekerjaan pasien
* Tidak tercatat kualitas lingkungan
* Tidak tercatat kebiasaan makan
dan kebiasaan pasien pd
kunjungan rumah
Komunitas pasien kurang
dipertimbangkan.
 Yang terjadi dan harus dikerjakan
Tidak ada upaya preventif
* Pasien pulang sudah dibekali obat
* Tidak ada upaya pendidikan bagi
pasien epilepsi.
* Tidak ada upaya pendidikan hidup
sehat
Upaya pencegahan kurang
diperhatikan
 Yang terjadi dan harus dikerjakan
Tidak melibatkan keluarga dalam terapi.
* Tidak ada pertemuan khusus dg
keluarga
* Tidak tampak posisi pasien dalam
keluarga
* Keluarga tidak ada yg tau langkah
pengobatan
Keluarga dilibatkan dan dinilai
pengaruhnya.