Management in Family Management in Family practice practice

Dr. JAWAHER AL-AHMADIDr. JAWAHER AL-AHMADIMB. ABFM. SBFM. MDMB. ABFM. SBFM. MD

ProgrammeProgramme Management option 40 MINManagement option 40 MIN Problem solving 60 MINProblem solving 60 MIN Compliance 10 MINCompliance 10 MIN

Some early truths to rememberSome early truths to remember

The patient is as frightened as you areThe patient is as frightened as you are

The patient think is more serious than The patient think is more serious than youyou

Illness is frightening but understanding Illness is frightening but understanding what is going on helpswhat is going on helps

Diagnostic processDiagnostic processCues

Clinical,behvioral

Hypothesis

Hypothesis testing

managment

Outcome evaluation

Unexpectedcuesrevise

Diagnosis

Management option (CRAPRIOP)Management option (CRAPRIOP)

CClarificationslarifications RReassuranceeassurance AAdvicedvice PPrescribingrescribing RReferraleferral IInvestigationnvestigation OObservationsbservations PPreventionrevention

Involve pt. in managementInvolve pt. in management

Choosing optionsChoosing options Self–help & complianceSelf–help & compliance

ClarificationsClarifications (CRAPRIOP) (CRAPRIOP)

Good listingGood listing FeedbackFeedback FlexibleFlexible Respect Respect Right wayRight way Personal Personal

experienceexperience Using patient cuesUsing patient cues

Reassurance (CRAPRIOP)Reassurance (CRAPRIOP)

Active listeningActive listening Objective discussionObjective discussion Physical examinationPhysical examination The diagnosis most probably is ----The diagnosis most probably is ---- It is common disease (prevalence is It is common disease (prevalence is

----%----% The treatment is (----------) safety & The treatment is (----------) safety &

effectivnss effectivnss The prognosis is ------The prognosis is ------

Advice (CRAPRIOP) Advice (CRAPRIOP)

Explanation about the disease and the Explanation about the disease and the important of the managementimportant of the management

Short accurate informationShort accurate information OrganizationOrganization Use the right way & practical methodUse the right way & practical method Response to patient cues Response to patient cues Feed back & encouragement Feed back & encouragement How to help himselfHow to help himself

PrescribingPrescribing (CRAPRIOP) (CRAPRIOP)

prescriptionprescription

A prescription is a physician's written A prescription is a physician's written instruction to a pharmacist to dispense instruction to a pharmacist to dispense medication for a patient. medication for a patient.

It includes directions to the pharmacist It includes directions to the pharmacist regarding the preparation and to the regarding the preparation and to the patient regarding use of the medication.patient regarding use of the medication.

However, a prescription represents much However, a prescription represents much more than these directions. A prescription more than these directions. A prescription focuses on one slip of paper the focuses on one slip of paper the diagnostic and therapeutic proficiency of diagnostic and therapeutic proficiency of the physician.the physician.

Drug information must be provided to the Drug information must be provided to the patient in an understandable mannerpatient in an understandable manner

Communication can be both verbal and Communication can be both verbal and written. written.

Comprehensive written patient information Comprehensive written patient information should be a supplement to face-to-face should be a supplement to face-to-face discussion between the physician and the discussion between the physician and the patient.patient.

Pharmacist colleagues also contribute to Pharmacist colleagues also contribute to patient education effortspatient education efforts

Adverse drug reactionsAdverse drug reactions

Adverse drug reactions have been said to Adverse drug reactions have been said to be the inevitable price paid for the be the inevitable price paid for the benefits of modern drug therapy.benefits of modern drug therapy.

The reported incidence of adverse drug The reported incidence of adverse drug reactions ranges from 1 to 28 percent.reactions ranges from 1 to 28 percent.

Drug-induced hospitalizations account for Drug-induced hospitalizations account for approximately 5 percent of all admissions.approximately 5 percent of all admissions.

Between 5 and 30 percent of hospitalized Between 5 and 30 percent of hospitalized patients experience adverse drug patients experience adverse drug reactionsreactions

Referral (CRAPRIOP) Referral (CRAPRIOP)

To whom ?To whom ? What for ?What for ?

diagnosisdiagnosis

treatmenttreatment

shared careshared care When ?When ? How ?How ?

patient opinionpatient opinion

explanationexplanation

referral letter referral letter

InvestigationInvestigation (CRAPRIOP) (CRAPRIOP)

Why ?Why ? How ?How ? MisuseMisuse

Why Why

For Diagnosis For Diagnosis For follow upFor follow up For reassuranceFor reassurance For screeneeningFor screeneening

How ?How ?

ExplanationExplanation Be gradual Be gradual Non invasiveNon invasive

misusemisuse

As routineAs routine Unable to deal with itUnable to deal with it

Observation (CRAPRIOP)Observation (CRAPRIOP)

Follow up appointmentFollow up appointment To do whatTo do what

Prevention (CRAPRIOP)Prevention (CRAPRIOP)

Anticipatory careAnticipatory care Opportunistic Opportunistic

health promotionhealth promotion Modification of help Modification of help

sickening behaviorsickening behavior

Case 1Case 1

Salwa is 40 yrs house wife presented with Salwa is 40 yrs house wife presented with headache. She had headache for years.headache. She had headache for years.

She was seen by several doctors She was seen by several doctors ( ENT,allergist, neurologist)( ENT,allergist, neurologist)

CT scan normalCT scan normal Her pain improved by paracetamol Her pain improved by paracetamol

temporally. temporally. By history she has (tension + migraine )By history she has (tension + migraine ) Family history of DMFamily history of DM O/E: normalO/E: normal

Case 2Case 2

Huda 32 yrs mother of two boys, Huda 32 yrs mother of two boys, complain from diarrhea 2 days mild complain from diarrhea 2 days mild pain and nausea. No fever or bloody pain and nausea. No fever or bloody stools. She has 6-8 stools motion per stools. She has 6-8 stools motion per day.day.

O/E: normalO/E: normal

Case 3Case 3

Sara 33 yrs with 6 day nasal congestion Sara 33 yrs with 6 day nasal congestion and rhinorrhea. For 2 days her nasal and rhinorrhea. For 2 days her nasal discharge became greenish. She has discharge became greenish. She has headache and pain on bending. headache and pain on bending.

No history of asthma on the familyNo history of asthma on the family O/E: O/E:

nose: swollen erythematous turbinatesnose: swollen erythematous turbinates

sinuses: tender maxillary sinuses: tender maxillary

Case 4Case 4

Sami 5 yrs boy is smaller than other Sami 5 yrs boy is smaller than other boysboys

His past medical Hx is fineHis past medical Hx is fine O/E : Ht below 3O/E : Ht below 3rdrd centile centile

other is normalother is normal

Case 5Case 5

Sameera, a 40-year old house wife,is Sameera, a 40-year old house wife,is diabetic. She was diagnosed 5 year diabetic. She was diagnosed 5 year ago and always had blood sugars of ago and always had blood sugars of 12-15 mmole/liter. She tells you that 12-15 mmole/liter. She tells you that she has stopped taking her 5 mg she has stopped taking her 5 mg glibenclamide and start taking herbal glibenclamide and start taking herbal medicinemedicine

poor compliance poor compliance

DiseaseDisease

Psychiatric disordersPsychiatric disorders Chronic illness (especially if Chronic illness (especially if

asymptomatic)asymptomatic) Minimal disabilityMinimal disability Asymptomatic or decreased Asymptomatic or decreased

symptomssymptoms

Therapeutic regimenTherapeutic regimen

Multiple drug therapyMultiple drug therapy Higher frequency of Higher frequency of

administrationadministration Longer duration of therapyLonger duration of therapy Adverse effectsAdverse effects Higher cost of medicationHigher cost of medication Administration of medicationAdministration of medication Poor taste of medicationPoor taste of medication Slow onset of therapeutic Slow onset of therapeutic

effecteffect

Physician-patient interactionPhysician-patient interaction

Poor physician-patient Poor physician-patient relationshiprelationship

Inadequate follow-up or Inadequate follow-up or contact with physiciancontact with physician

Poor understanding of Poor understanding of instructionsinstructions

Importance that physician Importance that physician places on adherenceplaces on adherence