In many developed countries, primary care health services are provided by family physicians/general practitioners (FP/GP). For this reason, the primary care delivery methods in these countries are referred to as the Family Medicine System. Family medicine is not the name of a system but the name of a medical discipline and a philosophy of care delivery. Family medicine is the medical discipline of family medicine specialists trained to provide a modern health service.
WONCA – Europe, the European branch of WONCA, the World Association of Family Physicians, defined family medicine and its characteristics in 2002. This definition was subsequently updated in 2005 and 2011.
According to WONCA – Europe’s definition, family medicine is an academic and scientific discipline and a primary care-oriented clinical specialty with its own unique educational content, research, evidence base and clinical practice. It has 12 core characteristics defined in six core competencies: These core competencies and core characteristics are as follows:
Management of a primary health care center
It constitutes the first point of medical contact with the health system; provides an open and unrestricted access to those seeking services; deals with all health problems regardless of age, gender or any other characteristic of the individual.
It ensures the effective and efficient use of health resources. It does this by coordinating the care provided to individuals, working with other health professionals in primary care, and managing contact with services provided by other specialists, advocating on behalf of the patient when necessary.
Person-centered care
It develops a person-centered approach towards the individual, family and society. It has a unique patient interview process. This process enables the establishment of a relationship between the physician and the patient that develops over time through effective communication. Empower patients to take responsibility for their own health and manage their health problems. Responsible for ensuring the continuity of health services as determined by the needs of the patient.
Specific problem solving skills
It has a unique decision-making process in which the prevalence and incidence of disorders in the community is decisive.
Manages patients’ acute and chronic health problems simultaneously.
Comprehensive care
Manage conditions that present in an undifferentiated form at an early stage of development and may require urgent intervention.
Promote health and well-being through appropriate and effective interventions.
Community orientation
Assumes special responsibility for the health of the community
Holistic approach
It addresses health problems in their physical, spiritual, social, cultural and existential dimensions.
In the context of these core competencies and essential characteristics, WONCA defines family physicians as “personal physicians responsible for providing comprehensive and continuous care to every individual seeking medical care, regardless of age, gender or condition, in the context of their family, community and culture”. He emphasized that family physicians “always respect the autonomy of their patients and have a professional responsibility to the community”.
In WONCA’s definition, family physicians “use the knowledge and trust built up through repeated contact to discuss the management of their conditions with their patients and to assess physical, psychological, social, cultural and existential factors together; they fulfill their professional duties by promoting health, preventing disease, providing treatment, care or alleviation of conditions. They carry out these tasks according to the health needs and the available resources of the community they serve and, when necessary, by assisting patients in accessing these services, either directly by themselves or through the services of other professionals.
When evaluated within the scope of WONCA’s definition, it is seen that family medicine is a specialty branch based on six basic principles. These principles are continuity in service, comprehensive service, coordination in health services, community health, preventive medicine and family integrity. The essence of successful service in family medicine is that all of these principles are taken into account together in the health services provided to individuals. A comprehensive and well-coordinated health service should include continuity and integrity on the basis of family and community.
The most important principle of family medicine is continuity of service. Continuity of service means that the same physician sees the individual at least at certain intervals and assists in solving health problems in all health processes and periodic healthy person examinations encountered during the process of individuals or family members continuing to receive services from the same person, institution or organization. Such a patient-physician relationship will naturally be based on mutual trust and respect and is a powerful therapeutic element.
Another important feature that should be emphasized in family medicine is that the patient, not the disease, is the priority. Unlike other specialties, patients do not need to have problems with a certain organ or organ system, be in a certain age group or be of a certain gender to consult family physicians. Patients can consult family physicians even if they do not currently have a disease.
Family physicians try to find solutions to problems with unique decision-making processes, taking into account the incidence and prevalence of diseases in the community. For this purpose, an appropriate management plan is made in cooperation with the patient by interpreting the information obtained from history, physical examination and investigations. History taking in family medicine is different from other specialties. Through the interview process in which unique interview skills are used, both the patient and the disease are tried to be recognized and the patient-physician relationship is strengthened.
During history taking, personal, familial and social aspects of the patient’s problem are investigated. With the awareness that the complaints that patients bring to their family physicians may not always be their real problems, “hidden agendas”, if any, are tried to be revealed. It is kept in mind that sometimes the real client of the physician may not be the patient, but the family or friends who are concerned about the patient’s health. For this reason, with a family-oriented approach, the patient and his/her family are evaluated and the person or persons who are important to the patient are utilized as sources of support for the solution of the problem.
With a holistic approach, the biological, psychological and social aspects of patients’ problems are taken into account and the role of these factors in the solution is evaluated. Working principles such as effective use of time and research are adopted. When faced with uncertain situations, the situation is tried to be clarified with appropriate research. Emergency interventions are made when necessary. Early interventions are planned with appropriate studies for the management of patients admitted in the early and undifferentiated stages of diseases. Management plan, diagnostic and therapeutic interventions are planned effectively and efficiently in cooperation with the patient according to the latest guidelines.
Family physicians deal with all physical, mental and social conditions of the patient within the scope of holistic care. They manage both acute and chronic problems of their patients.
They address all existing health problems as they consider the person as a whole in the management of the health problems of the people they are responsible for. They consider each encounter with the patient as an opportunity to promote health and prevent disease and to promote health and well-being.
Family physicians evaluate people’s health problems in a life cycle approach. It is kept in mind that people may have different problems at certain periods of their life span. As a result of an assessment that takes into account the needs of the patient at all stages of life, they conduct periodic health examinations, conduct evidence-based screening tests according to age and gender for the prevention, early detection and treatment of diseases and well-being, and provide counseling for a healthy lifestyle. They provide comprehensive services to their patients for the protection and promotion of health. Therefore, the family physician will have a confidential communication with his/her patient throughout his/her life.
The causes of diseases and health-related conditions have roots in the individual’s behavior, family and society. Society affects the health of the individual in many ways. Family physicians take social connections into account when assessing individuals’ health problems. This characteristic, called community orientation, requires being aware of the health needs, health beliefs and behaviors of the community. Community-oriented family physicians try to reveal the social patterns of the individual’s disease causes and try to solve this health problem within the community. They use community resources for this purpose.
Family physicians compare the social characteristics and practice of health and illness as part of the community assessment process. They collect information on health problems in the community. This social data improves community assessment. Learning the perspectives of community members is important for understanding and solving specific problems. Community members are aware of their resources and are empowered to mobilize them. Community-oriented family physicians plan the necessary interventions to protect the health of the community in the light of the information they collect about the diseases and risk factors seen in the community, cooperate with other sectors if necessary and try to implement them.
The family physician is in the best position to ensure continuity of care as he/she is familiar with the patient’s past life, problems, previous illnesses, medications used in the past and currently, the patient’s lifestyle, and is ready to cooperate with secondary and tertiary health institutions if requested.