The practicing family physician as a teacher and learner in a family practice residency.
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Education, Medical, Continuing↗
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The general practice (family practice) training in New Zealand.
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Family Practice↗
Intellectual and attitudinal characteristics of medical students selecting family practice.
Family practice residents were compared with residents in internal medicine, surgery, obstetrics-gynecology, and pediatrics in terms of cognitive and non-cognitive characteristics. Family practice residents were in most instances significantly different from the other four groups. On non-cognitive measures they scored higher on affiliation need and lower on aggression and materialism. Their scores on several cognitive measures were among the highest of the five groups. These results were contrary to others from earlier studies. However, if the trend reported here is confirmed on other samples, it is the more intellectually gifted and idealistic physician who is currently being attracted to the practice of family medicine.
Attitude of Health Personnel↗
Toward clarification of objectives for family practice and family medicine.
This paper analyzes the social boundaries derived from an adequate definition of family practice and family medicine and explores the social dynamics between them and other social institutions and disciplines, More precise objectives for family practice and family medicine are delineated using a model which specifies social targets, methods, and purpose of intervention. Implication for further research in family medicine are discussed as well as their future effect on family practice.
Delivery of Health Care↗
The family as the object of care in family practice.
Family practice as a specialty is based upon the continuing and comprehensive care of families. Much emphasis has been placed upon care of the "whole-person" and the family, but actual practice still reflects a predominant focus on the individual, rather than the family, as the object care. There is an important conceptual and practical difference between caring for the individual in the context of the family and caring for the family itself as the patient. Both approaches are required for family medicine to realize its potential in the ongoing care of families. This paper outlines some useful concepts and principles which can help to increase the capability of family physicians to deal with the common problems of individuals and their families.
Behavioral Sciences↗
Comparative prescription practices of family practice, internal medicine, and pediatrics residents.
The purpose of this study was to compare the prescribing practices among family practice, pediatric, and internal medicine third-year residents in an inner city ambulatory care setting. A four-month chart audit was made for the prescriptions provided for asthma, osteoarthritis, congestive heart failure, and upper respiratory infection patients by these residents. In general, family physicians prescribed medications that were not different from those used by internists and pediatricians. However, there were significant (p less than 0.01) differences in the number of visits and prescriptions among the specialties. The prescribing practices of the study group differed from a national survey of private practitioners in several drug categories.
Drug Prescriptions↗
The content of family practice: a family medicine resident's 2 1/2-year experience with the E-book.
The purpose of this paper is to present the content of office family practice problems seen over a 2 1/2-year residency period and to afford comparison with the well-known Virginia Study. It illustrates the usefulness of the diagnostic E-Book, with which all the data were collected and preserved. Over a 2 1/2-year period, the author cared for 592 patients in the family practice office. The ratio of one physician to 592 patients compares to the Virginia Study's one physician to approximately 745 patients. A total of 1,640 problems were coded in the E-Book. In this study 55 problems/physician/month were seen, whereas in the Virginia Study approximately 177 problems/physician/month were noted. Respiratory illnesses were the most common diagnostic category in both studies. Among specific problems, obesity ranked first at Hershey, with afebrile colds second, hypertension and Beta streptococcal pharyngitis third, and smoking fourth. Obesity and smoking were ranked considerably lower in the Virginia Study, whereas "health maintenance examinations" were ranked number one. Finally, for age-sex practice profiles, the present data revealed two peak age groups for both sexes, whereas the Virginia work noted only one peak age range.
Acute Disease↗
Assessing functional status in family practice.
Family physicians need functional assessment skills to care effectively for elderly patients. Self-assessment instruments, such as the COOP charts, offer promise. Educators must give priority to functional assessment and develop specific materials for residency training.
Activities of Daily Living↗
Demonstrating the characteristics of family practice through the family medicine clinic located at a college hospital.
During its development, family practice in Taiwan has been housed at the university/college hospitals, and different settings have served as the main bases for service and teaching. To demonstrate the progress made in the family medicine clinic at the Chung Shan Medical College Hospital and to evaluate the appropriateness of this kind of family practice setting, our patient population of 616 was investigated. There were 5177 patient encounters during the period from September 1987 to August 1989. Of 616 patients, 52.3% were male, the average age was 38.5 years, 85.1% lived in Taichung, where the hospital is located, and 60.1% were insured. A total of 117 families, containing 310 members, made up 50.3% of the patient population. Most patients (64.0%) visited us after introductions by their relatives or friends. There was an average of 4.2 visits per patient per year, and only 6.3% of patients were lost to follow-up after their first visits. The three leading causes for visits to the Family Medicine Clinic were general medical examination (14.5%), acute upper respiratory tract infection (13.6%), and peptic ulcer diseases (8.0%): these comprised 36.1% of all patients' problems. The average referral rate among the 5177 patient encounters was 2.9%. Patient education about treatment of disease, immunization against hepatitis B, and screening for liver cirrhosis/hepatoma in hepatitis B antigen carriers were the most common preventative encounters in our clinic. In conclusion, university/college hospitals are certainly not the best site for service and teaching of family practice, since they are not based on ambulatory care.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Quantitative assessment of the quality of medical care provided in five family practices before and after attachment of a family practice nurse.
The standards of patient care were maintained in five urban medical practices after the introduction of family practice nurses. Evaluations were achieved before and after their appointment by the indicator condition method. Minimal explicit criteria for the management of patients with 12 indicator conditions and by the use of 14 drugs were approved by an ad hoc peer group of community physicians. These cirteria were applied to the five practices by the use of a single-blind design and the abstraction of unaltered medical records. A standardized score for each practic e permitted comparison of scores for the management of indicator conditions and for the clinical use of drugs before and after attachment of the family practice nurses. For each of the indicator conditions and the drugs assessed in the five practices similar levels of adequacy were observed in the two study periods. These explicit (objective) audit resutls agreed with the implicit (subjective) assessments of the family practice nurses by their physician colleagues.
Drug Therapy↗
Selecting a community for medical practice: a study of factors, characteristics, and preferences among practicing physicians, family practice residents and medical students.
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Attitude of Health Personnel↗
Continuity of care in family practice. Part 4: implementing continuity in a family practice residency program.
Although continuity of care is an important goal of family practice residency programs, there are many factors which inevitably prevent its full achievement by individual residents in any program. Each resident is frequently faced with conflicting responsibilities involving the Family Practice Center, inpatient clinical services, and other parts of the residency training program. This paper explores this dilemma and suggests a variety of positive approaches to resolve the issue. All family practice residents must necessarily be intimately involved in providing continuity of patient care and develop the requisite skills and attitudes. However, full continuity of care must ultimately be provided on a program and group level, not exclusively by the individual resident.
Comprehensive Health Care↗
Organizational complexity in family practice: a sociological model of a family practice group.
The growth of a family practice goup is presented as a case study. Enlarging size and increasing functions require organizational change--from solo to collegial to bureaucratic to political systems. Organizational theory distinguishes between the characteristics and functions of individual, collegial, bureaucratic, and political organizations. Different styles and strategies are appropriate at different stages.
Decision Making↗
Colposcopy practice and training in family practice residency programs.
BACKGROUND: The potential growth of colposcopy as a family medicine procedural skill is directly related to the training currently offered to family practice residents. To define whether these skills are being adequately offered to physicians who want to perform this procedure for their patients, a study was designed to investigate the current status of colposcopy practice and training in family practice residency programs. METHODS: A 16-item survey sent to 356 family practice residency directors in the United States included items concerning colposcopy practice, training, educational programs and strategies, colposcopy coordinator educational background, and colposcopic resource materials and equipment. RESULTS: Surveys were returned from 204 (57 percent) family practice residencies. Colposcopy was performed at 45 percent of the residencies that responded. Ninety-six percent of the respondents who did not perform colposcopy believed colposcopy is a procedure that should be performed by family physicians. Clinical teaching and supervision was the most common method of resident training (74 percent). Colposcopy training coordinators were usually family physicians (72 percent), primarily trained by gynecologists. Assistance with implementing a colposcopy training program was requested by 85 percent of those programs presently not performing colposcopy. CONCLUSIONS: This study indicates that there are opportunities for further development of colposcopy practice and training in family practice residencies.
Attitude of Health Personnel↗
A method for projecting ambulatory visits to a family practice center.
Family practice model centers serve multiple teaching, research, and patient care roles. Accurate projection of patient care demand should promote a center's efficiency. Clinic visit forecasts were performed for a university based family practice center using an exponential time series analytic model. The model provided reliable clinic projections for a one-year time horizon. The projections proved useful for administrative, educational, and academic governance purposes. Time series analysis is a useful and relatively easily implemented tool which can facilitate family practice center administration and support.
Ambulatory Care Facilities↗
Association between clinical experiences in family practice or in primary care and the percentage of graduates entering family practice residencies.
In 1990 the authors surveyed all U.S. medical schools in order to solicit information about students' clinical experiences in family practice and in primary care. Of 126 schools, 104 (82.5%) responded. Survey data were correlated with each school's quartile ranking based on the average percentage of graduates who entered family practice residencies. A significant association (p = .0013) was found between required family practice clerkships or preceptorships and institutions ranked in the highest quartile (i.e., having more than 17% of their graduates enter family practice). A similarly significant association (p = .0056) was found for those 12 institutions that had more than 30% of their students select family practice options in required primary care clerkships or preceptorships. The authors suggest that active recruiting of students to take such options may increase the number of graduates who enter family practice.
Career Choice↗
The Adlerian approach: a practical psychology for family practice.
A systematic approach to understanding the patient's personality and helping him cope with common life problems is found in Adlerian Psychology. It is uniquely appropriate to family practice because it stresses the interpersonal purposes of behavior and symptoms and the influence of family constellation on the development of the individual life-style. By obtaining a small amount of data about the patient's present life situation and his family of origin, the physician can gain a basis for understanding how the patient developed his unique way of acting and reacting to the physical and social stresses of life. Interpretation of two or three early recollections reveals what the patient expects of himself, others, and life. The insight thus gained is used as the basis for a holistic assessment of the problem; a directive, supportive, action-oriented plan for treatment; and an ongoing doctor-patient relationship of mutual respect.
Adolescent↗
Toward the evaluation of family practice: development of a family utilization index.
This paper describes a research project that establishes criteria for utilization patterns of a family practice that could be used to develop evaluation techniques for family practice as a method of delivering primary medical care. The criteria are summarized in a Family Utilization Index, which measures the utilization patterns of a family unit. Changes in the Utilization Index are compared over a five-year period. Changes in attitudes and opinions about family practice in general and the specific Family Medicine Clinic are also compared over time and related to changes in the Family Utilization Index. Utilization patterns have significantly shifted over a five-year period, with more total visits to the clinic due to an increase in the number of family members per family unit using the clinic. Both the utilization patterns and attitudes toward the role of the family physician have shifted, indicating an increased acceptance of family practice.
Adolescent↗