INTRODUCTION TO FAMILY MEDICINE

PRINCIPLES, CONCEPTS AND PRACTICE

ZAQUEO G. FAJARDO, RN MD
Chief Resident for Internal Affairs, Department of Family and Community Medicine, Ospital ng Makati
President, Philippine Academy of Family Physicians’ Residents Organization
 “Type a quote here.”
“If you cannot work with love but only with distaste, it is
better that you should leave your work and sit at the gate of
the temple and take alms from those who work with joy.”
–KAHLIL GIBRAN (1883-1931)
–Johnny Appleseed
 GOAL OF THE SESSION

• By the end of the academic session, the FM resident should

be able to:
•

• Define important concepts and terminologies related to the

practice of Family Medicine
• Discuss the brief history of Family Medicine local and
abroad
• Describe Family as a unit of care
• Review the Family Life Cycle, Impact of Illness on the
Family and Family Assessment Tools
• Discuss the Level of Physician Involvement with Families
ROAD MAP

• Definition of Terms
• Brief History of Family Medicine
• Family as a Unit of Care
• Family Life Cycle
• Impact of Illness on the Family
• Family Assessment Tools
 FAMILY MEDICINE

• Medical specialty that provides continuing and comprehensive health care

for the individual and the family

• Specialty that integrates biologic, clinical and behavioral sciences

• General Practice (GP)

 FAMILY PHYSICIAN

• a physician who is educated and trained in

the discipline of family medicine

• possess distinct attitudes, skills and

knowledge that qualify them to provide
continuing and comprehensive medical
care, health maintenance and preventive
services

• Specialist that are best qualified to serve as

each patient’s advocate in all health related
matters
 PRIMARY CARE

• health care that is accessible, comprehensive,

coordinated and continuing

• WONCA: the provision of integrated, accessible

health care services by clinicians who are
accountable for addressing a large majority of
personal health care needs, developing a sustained
partnership with patients, and practicing in the
context of family and community.

• Backbone of the health care system

PRIMARY CARE

• Functions:
•

A. First contact care

B. Continuity of care

C. Comprehensive care

D. Coordinative function

E. Continuing responsibility

F. Personalised
PRIMARY CARE PHYSICIAN

• generalist physician who provides definitive

care to the undifferentiated patient at the point
of first contact and takes continuing
responsibility for providing the patient’s care.

• COGME & AAMC: completed 3-year training

program in family medicine, internal medicine
or pediatrics and who do not subspecialize
QUIZ ON FAMILY ASSESSMENT TOOLS AND
PEDIA COVID-19 GUIDELINES

Zaqueo Guterrez Fajardo, RN MD

Chief Resident for Internal Affairs, Department of Family and Community Medicine, Ospital ng Makati
President, Philippine Academy of Family Physicians’ Residents Organization
SHORT QUIZ ON FAMILY ASSESSMENT
TOOLS
1. What is the Standard Genogram symbol for the following:
_____a. Child in utero
_____b. Spontaneous abortion
_____c. Identical twins
_____d. Adopted son
_____e. Patient ECQ, 85 year old, male, cause of death: COVID-19
2-4. In clinical practice, the Genogram is a compulsory part of patient’s chart because
it provides the following information?
5. What Family assessment tool is considered the symbol for FM type of care?
SHORT QUIZ ON FAMILY ASSESSMENT
TOOLS
MATCHING TYPE
A. Genogram
B. APGAR
C. SCREEM
_____6. Family relationships
D. Family Map
_____7. Family functioning
E. Family Circle
_____8. Family resources
F. Family Life Cycle
_____9. Vital in obtaining therapeutic ally
G. Family Lifeline
_____10. Based on most significant event
H. DRAFT
_____11. Predictable sequence of event
I. SCREEM-RES
_____12. Significant psychological issues
SHORT QUIZ ON PPS PIDSP INTERIM GUIDELINES
PEDIATRIC PATIENTS WITH COVID-19
1. What specific type of genera belongs SARS-COV-2?
2. How does COVID-19 spread?
3. Who are considered as close contacts? Give 5 situations as defined by WHO.
4. Risk of transmission (very high, high, low, very low)

a. Fecal-oral
b. Asymptomatic infant
c. Breastfeeding mother to infant
d. Performing bronchoscopy
5. Give feeding alternatives that may be given to mothers who are not able to
breastfeed or express breastmilk. (4 possible answers)
SHORT QUIZ ON PPS PIDSP INTERIM GUIDELINES
PEDIATRIC PATIENTS WITH COVID-19
6. Criteria for Severe symptoms that warrants admission of an 11 month
old infant?
7. Preferred specimen for the diagnosis of COVID-19 among pediatrics?
8. What is the role of antibody tests in the diagnosis of COVID-19?
9. Viability of SARS-COV-2 virus on plastic and stainless surfaces?
10. Duration of treatment if given with HCQ?

11. Dosing regimen for Zinc sulfate for 5 years and older?
12. IVIG can be used in severe cases of COVID-19 when indicated as
immunomodulator. What is the recommended dose?
13. Criteria for discharge?
14. Classify the patient: 15 year old asymptomatic with IgM (+)?
BONUS QUESTION

• Prevention is better than cure. As a FM resident,

how will you prevent the next pandemic?
REFERENCES

• Leopando et al. Textbook of Family Medicine Volume 1 (Principles,

Concepts, Practice and Context)

• Rakel’s Textbook in Family Medicine, 9th edition

• Family-Oriented Medical Care, 2nd edition by Susan H. McDaniel

FIRST YEAR DFCM RESIDENTS

A. Portfolio. Contents of portfolio can be limited to residents’

a. reflections of significant experiences during training
b. mentoring sessions
c. case census and procedural logs
However, trainees can still built-up their portfolio to include others
indicated in the previously issued guidelines. Will send a schedule of
checking for your batch. Tentative Date: July 04, 2020 (Saturday)

B. Examinations
•

• PAFP 1st Quarter Exam Part 2 (June 27, Sat) -Pedia COVID
Guidelines
• Pop Short Quizzes Coverage: Family Assessment Tools, Brief
History of Family Medicine, Family as a Unit of Care, Family Life
Cycle, Impact of Illness on the Family, Family Assessment Tools,
Levels of Physician Involvement with Families
•

•
PRIMARY CARE PROVIDER

• RA 11223: UHC Law

• Refers to a health care worker, with defined

competencies, who has received certification
in primary care, as determined by DOH or
any health institution that is licensed and
certified by the DOH
FAMILY MEDICINE AROUND THE WORLD

World Organization of National Colleges, Academies and Academic Associations of

General Practitioners/Family Physicians [WONCA]
• international body which represents GPs and FPs.
• 118 Member Organizations in 131 countries and territories
• 500,000 family doctors
• The Philippines is part of WONCA Asia-Pacific region
• President: Dr Donald Li, Hong Kong China
•

Reference: https://www.globalfamilydoctor.com/
FAMILY MEDICINE HISTORY: THE
PHILIPPINES
1960s Birthing pains Building the Foundation

1970s Recognition as a specialty

1980s Medical education and standards for training and

accreditation; Focus on the member’s welfare

1990s Professionalization of primary care and its being

a specialty organization

2000s Enhancing access and equity to quality primary

care

2010s FP as champions of family health: the key to

universal health care

2020s Role of FM in Universal Health Care Law and

during Pandemic
FAMILY MEDICINE HISTORY: THE
PHILIPPINES

• one of largest medical

specialty organization of
the PMA.
• primary care physicians
dedicated to providing
holistic, accessible,
continuous,
comprehensive, family
centered, coordinated,
compassionate and
culturally effective health
 CORE FOUNDATION COURSES
FOUNDATION
COURSES 1. FM Principles and Family Practice
1. CLINICAL 2. Primary and Secondary Care
2. FAMILY MEDICINE 3. Acute Care
PRINCIPLES 4. Preventive Care and Wellness
5. Communication and Relational Skills
3. COPC 6. Community Oriented Primary Care
4. EBM 7. Evidence Based Medicine
8. Quality Assurance
5. RESEARCH/QA 9. Research
10. Information Technology
6. COMMUNICATION
SKILLS 11. Medical Ethics and Professionalism
12. Health Legislation, Issues and Advocacies
13. Practice Management and Health Administration
14. Occupational Safety and Health
15. Hospice and Palliative Medicine
FAMILY MEDICINE EDUCATION
FAMILY MEDICINE EDUCATION
FAMILY AS A UNIT OF CARE

DEFINITION
• a group of persons united by ties of marriage, blood or adoption
(Burgees and Locke)

• Primary social unit consisting of parents and children.

• Small social system (Berman)

• Semi-closed system of actors occupying inter-related positions defined

by society. (Rogers)
FAMILY AS A UNIT OF CARE

SIX ESSENTIAL FUNCTIONS

1. Physical maintenance and care of family members.

2. Addition of new members through procreation and adoption

3. Socialization of children for adult roles.

4. Social control of members

5. Maintenance of family morale and motivation

6. Production and consumption of goods and services

TYPES OF FAMILIES

1. Nuclear or Small -married couple with unmarried children or of a married couple

without children

2. Extended - pertain to number of nuclear families linked together by virtue of

kinship bond between parents and children or siblings

3. Lineal - two or more generations with each generation composed of one married
couple (or a divorced person, widow, widower)

4. Joint - two or more married couples (or divorced persons, widows or widowers) of
the same generation

5. Blended -one or both of parents have had a previous marriage, and possibly
children from that marriage
FAMILY ASSESSMENT TOOLS

• Family Genogram
• Family Map
• APGAR • Family Lifeline

• SCREEM • Family Life Cycle

• DRAFT
• The Family Circle
 FAMILY GENOGRAM

• Family Anatomy
• essential tool for busy practitioners to recall information
about family member’s names, relationships, and overall
structure
• extends the geneticists’ pedigree to indicate the quality of
those relationships.
• Compulsory part of patient's chart because it provides:
•

a. Quick overview of family members and relationships

b. Way to visually overlay biomedical and psychosocial info
FAMILY GENOGRAM
 FAMILY APGAR

• tool that qualitatively measures

family functioning
• 10-15 minute paper and pencil
technique that elicits the patient’s
perception and level of satisfaction
• Interpretation:
0-3 severely dysfunctional
4-7 moderately dysfunctional
8-10 highly functional
FAMILY MAP

• reflect family relationships and interaction patterns.

• obtaining a therapeutic ally for the delivery of care

• provides a schematic description on whom to ask for

assistance in making decisions for the patient.
 SCREEM

• represents family resources

• tool where the family physician helps the family members identify
and assess the resources to meet a crisis.

• Commonly used when the need for care is long or lasts a lifetime
such as in the case of chronically-ill, terminally-ill and hospice care
patients
• Interpretation:
•

0-6 severely inadequate

7-12 moderately inadequate
FAMILY LIFELINE

• family’s significant experiences over a period of time in a

chronologically sequenced manner

• Includes how the family has coped with these stressful life
events

• Useful when anticipating a long term illness, the presence of

difficult caregiving, non adherence to treatment strategies
OTHER TOOLS

• DRAFT (Draw a Family Test) • The Family Circle

•
•

• asked to draw members of his/her • draws a large circle on a piece of paper

family that represents the family
• provides clues on the significant • asked to draw variable-sized circles
psychological issues within the family within or outside the big circle
system
• explain the diagram that he/she made
FAMILY LIFE CYCLE

• Essential concept in understanding the health and illness

responses of patients and their families

• Key element: Adaptation -one family member moves through

the different stages over a period of time

• Set of predictable steps or patterns and developmental tasks

families undergo within a given time frame.

Examples: Duvall’s Nine Stage Cycle, Carr’s Eight-stage,

Goldenberg’s Six-stage cycle -most widely used, Five stage
cycle
 STAGES OF FAMILY LIFE CYCLE
1. Leaving home: Single Accepting emotional and
young adults financial responsibility for self
Accepting parent-offspring
separation
2. The joining of families Commitment to new system
through marriage: The
new couple
3. Families with young Accepting new members into the
children system
3. Families with Increasing flexibility of family
adolescents boundaries to include children’s
independence and grandparents’
frailties
5. Launching children Accepting a multitude of exits
and moving on from and entries into the family
system
6. Families in later life Accepting the shifting of
generational roles
• Differentiation of self
• Development of intimate peer relationships
• Establishment of self in work and financial independence
• Formation of marital system
• Realignment of relationships with extended families and friends to include
spouse
• Adjusting marital system to make space for child(ren)
• Joining in childrearing, financial, and household tasks
• Realignment of relationships to include parenting and grandparenting roles
Shifting of parent child relationships to permit adolescent to move in and out
•
• Refocus on midlife marital and career issues
• Beginning shift toward joint caring for older
•
•
Renegotiation of marital system as a dyad
Development of adult to adult relationships
• Realignment of relationships to include in-laws and grandchildren
• Dealing with disabilities and death of parents (grandparents)
Maintaining own and/or couple functioning and interests in face of physiological
•
decline; exploration of new familial and social role options
• Support for a more central role of middle generation.
• Making room in the system for the wisdom and experience of the elderly, supporting
the older generation without overfunctioning for them
• Dealing with loss of spouse, siblings, and other peers and preparation for own death.
• Life review and integration
IMPACT OF ILLNESS ON THE
FAMILY
• Physiological • Encompasses the person’s
abnormalities taking place perceptions, emotions, and
in a patient’s body experiences of the disease
Effect: manifest • Not only affects patient’s
•

emotional, mental and

• Disrupts normal family
immediately on patient’s
social well being, but also relations (Flanagan, 2003)
physical body
• influence the functioning
•
of his/her family. • Social functioning -domain
affected
• Burden of financial stress
• Psycho-emotional impact:
depression, anxiety, sleeping
problems
IMPACT OF ILLNESS ON THE
FAMILY
1 Onset of • Covers the period from the time
patient demonstrates physical
symptom/illness symptoms

Intrafamilial factors • Family resources

• Family life cycle stage
• Degree of family 2 Impact Phase • Reaction to the diagnosis stage
• Initial contact established
functionality

3 Major • period of great mobilization when

External factors • Typology of illness Therapeutic family pursues avenues for treatment
• Stigma associated with or palliation
Efforts • Task: offer family options and view
the disease family as therapeutic ally

4 Recovery Phase • Disappearance of symptoms

Readjustment of roles
Adjustment to
•

• Prepare the family for the potential

Outcome outcomes of disease
LEVELS OF PHYSICIAN INVOLVEMENT

1 Minimal emphasis on the family • Biomedical problem

• For practical and medico-legal reasons

2 Providing ongoing medical information • Respectful listening is the key skill

and advise • Skills in identifying gross family dysfunction

3 Eliciting feelings and providing • Understanding of normal family development and responses to
emotional support stress
• Support, encouragement and assessment of functionality of
family

4 Systematic family assessment and • Background knowledge of Family Systems Theory

planned intervention • Assess family functions

5 Family Therapy • Extensive training and supervision

REFERENCES

• Leopando et al. Textbook of Family Medicine Volume 1 (Principles,

Concepts, Practice and Context)

• Rakel’s Textbook in Family Medicine, 9th edition

• Family-Oriented Medical Care, 2nd edition by Susan H. McDaniel

• The Filipino Physician Today: a practical guide to holistic medicine/

Eva Irene Yu-Maglonzo, M.D. -2nd ed. - Manila : UST Publishing
House, c2008