And so now we're going to be discussing the principles
and philosophy of my specialty family medicine.
And in particularly how that applies to United States Medical
Licensing Examination.
Because I think it is important to understand
some of the background.
It will influence the types of answers that you see
on the exam.
And I believe the answers that you get right.
So I'm going to start with a quote
and I'm going to read it.
And then we are going to come back to some key points.
In the increasingly fragmented world of health care,
one thing remains constant: Family physicians are dedicated
to treating the whole person.
Family medicine's cornerstone is an on going personal patient
physician relationship, focusing on integrated care.
Now that comes from our Academy of Family Physicians.
I just want to focus on a few of the key elements
in that statement.
First of all family medicine is highly personal.
We follow patients overtime.
And the specialties really based on good communication principles
and empathy.
We order fewer tests.
We order fewer expensive procedures.
Stakeholders in medicine really love us.
And I'm talking about governments.
I'm talking about insurance companies.
Because we provide quality care.
We improve morbidity.
We also improve mortality substantially and we do
so at a low cost.
Why? Because it starts with the patient.
The patient is at the center of what we do.
And so good communication skills with the patient in bringing out
all the history and treating the patient in the context
of their values and what's available to them is very
important to us.
So in that same vain we embrace the biopsychosocial model
of health care.
So let's break down that word.
Bio-psycho-social.
So the bio.
The patient has diabetes and heart failure and general
anxiety disorder.
That's these different disease case.
This psychological.
So they have anxiety.
May be that's related to the fact that their kid isn't
doing so well in school.
And they are having trouble at their job.
And may be they have been drinking a little bit more
than they normally would with alcohol.
So that's the psychological.
And then the social, it mentioned how the impact
of their child's educational status may be hurting
their health in terms of their mental health.
May be it's also leading to some poor control of diabetes.
Particularly if they are drinking more alcohol.
And see how it all ties together.
Every patient ties these different domains.
They are all highly interrelated and you can't really, I think
fully understand one domain without understanding the others.
And that's an important principle of our entire specialty.
And we put the patient in the context of their relationships.
So I mentioned this fictitious patient and her son.
So may be I'm seeing not just the patient but I'm also seeing
her son and her husband and her aunt.
And that allows me to get more complete picture about
what's going on within this family unit.
And I'm also thinking about where she lives.
What kind of options for health habits she has.
Does she live in food desert?
Is there any green space next to her?
And so it's pretty the patient in context though.
Their human relationships also the relationships to society
at a larger level.
We are holistic.
We do cradle to grave care and it's complete.
We treat acute illness, and we do chronic illness
and we do preventive care too.
And we see examples of that throughout these discussions
I'm going today.
And then finally we do focus on preventive care.
So it's not just about treating disease.
It's about promoting wellness.
So that's what I think in particularly when it comes to
preventive care family medicine really owns that subject.
Of course with our patients with these many disease states as I
mentioned there are going to see different specialists.
They are going to see different health care providers
such as say physical therapy.
They may be going through alternative care resources.
Our job is to act as a central station when we are organizing
that care and putting the patient at the center
of a team of health care providers.
But we have to be the ones to coordinate back there.
Uncoordinate care is always wasteful, inefficient
and can be actually quite dangerous too.
And so when I say to the patient at the center, it's their values
and their practices and their believes
what they are desiring to do.
What they absolutely won't accept that dictates
what we do as providers.
And as I mentioned we are cheap.
We are driven mostly by history and physical examination.
And we do take ownership of the whole patient.
I really feel like I provide a certain paternalistic style
of care.
It's hard for me not to.
Which I really cheer on the patient successes
when they lose 5 kilograms.
When they get their A1C under control.
When those tension headaches finally go away.
When they get a promotion at their job.
And I definitely mourn when they have difficulties.
When they lose their home.
When their heart failure is getting out of control.
We can't do much about it.
When they are diagnosed with cancer.
I really own all of those conditions.
But they also own to a larger standard.
I think some of the emotional component of those moments
with my patient.
And I think that what makes medicine that much more real
and worthwhile.