Principles of family medicine and general practice – defining the five core values of the specialty
M. Jawad HashimDepartment of Family Medicine, College of Medicine and Health Sciences United Arab Emirates University, UAE
Correspondence to: M. Jawad Hashim, Department of Family Medicine, United Arab Emirates University, PO Box 17666, Al Ain, United Arab Emirates. Email: physicianthinker@gmail.com
Journal of Primary Health Care 8(4) 283-287 https://doi.org/10.1071/HC16006
Published: 21 December 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
The principles of general practice and family medicine are the defining characteristics of the speciality. The five principles are: compassionate care – a caring attitude towards patients and their families shown as kindness and a desire to help; generalist approach – a perspective on the whole person and the context of illness including family, culture and society; continuity of relationship – the interpersonal bond of trust and respect between family physicians, patients, and their families that develops over the life course; reflective mindfulness – doctors’ awareness of their thoughts and emotions manifested as a sense of presence and attentiveness towards self and others; and lifelong learning – a commitment to personal and professional development by participating in learning activities and practice-based research that leads to better patient outcomes. Concepts such as care coordination, preventive care, access to care, professional competence, resource management and community-based care, are part of the principles above. The term ‘comprehensive care’ is should be avoided as it misinterprets the scope of family medicine.
The principles of general practice and family medicine characterise the speciality’s core values. These guidelines form the basis of clinical practice as well as the identity of family medicine as a discipline. Aiming to extract the principles from current literature, I searched MEDLINE and Google Scholar for the term ‘principles of family medicine’ with results sorted by relevance, and without limits on language or date of publication. Major textbooks of family medicine and general practice were consulted as well.1–6 As supported by academic literature, the terms ‘general practice’ and ‘family medicine’ are used synonymously.7
References
[1] Rakel D, Rakel RE. Textbook of Family Medicine. 9th ed. Elsevier Health Sciences; 2015. 1447 p.[2] Sloane PD. Essentials of Family Medicine. Lippincott Williams & Wilkins; 2008. 838 p.
[3] Taylor R. Family Medicine: Principles and Practice. Springer Science & Business Media; 2013. 1219 p.
[4] Lipsky MS, King MS. Blueprints Family Medicine. Lippincott Williams & Wilkins; 2010. 352 p.
[5] Saultz JW. Textbook of Family Medicine: Companion Handbook. McGraw-Hill; 2000. 676 p.
[6] McWhinney IR, Freeman T. Textbook of Family Medicine. 3 edition. Oxford; New York: Oxford University Press; 2009. 472 p.
[7] Lewis M, Smith S, Paudel R, Bhattarai M. General practice (family medicine): meeting the health care needs of Nepal and enriching the medical education of undergraduates. Kathmandu Univ Med J 2005; 3 194–8.
| 1:STN:280:DC%2BD28%2FislCjug%3D%3D&md5=c572eb9cfa53c9d84aac40591af68731CAS |
[8] Starfield B. Reinventing primary care: Lessons from Canada for the United States. Health Aff 2010; 29 1030–6.
| Reinventing primary care: Lessons from Canada for the United States.Crossref | GoogleScholarGoogle Scholar |
[9] Kelly L. Four principles of family medicine. Do they serve us well? Can Fam Physician 1997; 43 1902–12.
| 1:STN:280:DyaK1c%2FkvVWitg%3D%3D&md5=c75f2e948b4ebbbaf66b14c62e1da0a5CAS |
[10] McWhinney IR. Teaching the principles of family medicine. Can Fam Physician 1981; 27 801–4.
| 1:STN:280:DC%2BC3M7msVykug%3D%3D&md5=3a5860877fcf0657aa294f2505963806CAS |
[11] National curricular guidelines for third-year family medicine clerkships. The Society of Teachers of Family Medicine (STFM) Working Committee to Develop Curricular Guidelines for a Third-Year Family Medicine Clerkship. Acad Med 1991; 66 534–9.
[12] Qureshi R. Principles of family medicine. J Pak Med Assoc 1998; 48 152–4.
| 1:STN:280:DyaK1M%2FjtFGhtg%3D%3D&md5=3afacf0d84f0a500c5b81851a3e07c99CAS |
[13] Visagie S, Schneider M. Implementation of the principles of primary health care in a rural area of South Africa. Afr J Prim Health Care Fam Med 2014; 6 562
| Implementation of the principles of primary health care in a rural area of South Africa.Crossref | GoogleScholarGoogle Scholar |
[14] The Royal New Zealand College of General Practitioners. Curriculum for General Practice [Internet]. Wellington; 2014. Available from: www.rnzcgp.org.nz
[15] European Academy of Teachers in General Practice. The European definition of General Practice / Family Medicine [Internet]. WONCA Europe; 2005. Available from: www.woncaeurope.org/
[16] Royal Australian College of General Practitioners. What is General Practice? [Internet]. East Melbourne; Available from: www.racgp.org.au/becomingagp/what-is-a-gp/what-is-general-practice/
[17] Rakel RE. Compassion and the art of family medicine: From Osler to Oprah. J Am Board Fam Pract 2000; 13 440–8.
| Compassion and the art of family medicine: From Osler to Oprah.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7htl2msg%3D%3D&md5=737be36a24fcae1ab90ef12f567fbddbCAS |
[18] Rabow MW, Wrubel J, Remen RN. Promise of professionalism: Personal mission statements among a national cohort of medical students. Ann Fam Med 2009; 7 336–42.
| Promise of professionalism: Personal mission statements among a national cohort of medical students.Crossref | GoogleScholarGoogle Scholar |
[19] Pettitt GA. The compassion meter: An important diagnostic instrument? N Z Fam Physician 2004; 31 418–20.
[20] Loxterkamp D. What do you expect from a doctor? Six habits for healthier patient encounters. Ann Fam Med 2013; 11 574–6.
| What do you expect from a doctor? Six habits for healthier patient encounters.Crossref | GoogleScholarGoogle Scholar |
[21] Wilson H, Cunningham W. Being a Doctor: Understanding Medical Practice. Royal College of General Practitioners. University of Otago Press; 2014. 277 p.
[22] Stange KC. The generalist approach. Ann Fam Med 2009; 7 198–203.
| The generalist approach.Crossref | GoogleScholarGoogle Scholar |
[23] Brucker PC. A chance for the generalist? J Am Board Fam Pract. 3 15S–27S.
[24] Cohen D, Coco A. Do physicians address other medical problems during preventive gynecologic visits? J Am Board Fam Med 2014; 27 13–8.
| Do physicians address other medical problems during preventive gynecologic visits?Crossref | GoogleScholarGoogle Scholar |
[25] Xierali IM, Tong ST, Petterson SM, et al. Family physicians are essential for mental health care delivery. J Am Board Fam Med 2013; 26 114–5.
| Family physicians are essential for mental health care delivery.Crossref | GoogleScholarGoogle Scholar |
[26] Murdoch C. New horizons, old values: Remaking the reputation of generalism in a changed world. N Z Fam Physician 2005; 32 157–60.
[27] Green LA, Graham R, Bagley B, et al. Task Force 1. Report of the Task Force on patient expectations, core values, reintegration, and the new model of family medicine. Ann Fam Med 2004; 2 S33–50.
| Task Force 1. Report of the Task Force on patient expectations, core values, reintegration, and the new model of family medicine.Crossref | GoogleScholarGoogle Scholar |
[28] Brummel-Smith K. Family physician geriatricians do mostly geriatric care: Is this a problem for our specialty? J Am Board Fam Med 2015; 28 311–3.
| Family physician geriatricians do mostly geriatric care: Is this a problem for our specialty?Crossref | GoogleScholarGoogle Scholar |
[29] Schultz K, Delva D, Kerr J. Emotional effects of continuity of care on family physicians and the therapeutic relationship. Can Fam Physician 2012; 58 178–85.
[30] Higgins D, Manhire K, Marshall B. Prevalence of intimate partner violence disclosed during routine screening in a large general practice. J Prim Health Care 2015; 7 102–8.
[31] Green LA. The research domain of family medicine. Ann Fam Med 2004; 2 S23–9.
| The research domain of family medicine.Crossref | GoogleScholarGoogle Scholar |
[32] Epstein RM. Mindful practice. JAMA 1999; 282 833–9.
| Mindful practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MvgsFOqtg%3D%3D&md5=9d057b307bcc6ae9ee0381401b74b37eCAS |
[33] Beach MC, Roter D, Korthuis PT, et al. A multicenter study of physician mindfulness and health care quality. Ann Fam Med 2013; 11 421–8.
| A multicenter study of physician mindfulness and health care quality.Crossref | GoogleScholarGoogle Scholar |
[34] Beckman HB, Wendland M, Mooney C, et al. The impact of a program in mindful communication on primary care physicians. Acad Med 2012; 87 815–19.
| The impact of a program in mindful communication on primary care physicians.Crossref | GoogleScholarGoogle Scholar |
[35] Pullon S. Where are we going in the next fifteen years? N Z Fam Physician 2006; 33 368–74.
[36] Kiessling A, Lewitt M, Henriksson P. Case-based training of evidence-based clinical practice in primary care and decreased mortality in patients with coronary heart disease. Ann Fam Med 2011; 9 211–8.
| Case-based training of evidence-based clinical practice in primary care and decreased mortality in patients with coronary heart disease.Crossref | GoogleScholarGoogle Scholar |
[37] Tierney WM, Oppenheimer CC, Hudson BL, et al. A national survey of primary care practice-based research networks. Ann Fam Med 2007; 5 242–50.
| A national survey of primary care practice-based research networks.Crossref | GoogleScholarGoogle Scholar |
[38] Cunningham WK, Dovey SM. Educating vocationally trained family physicians: a survey of graduates from a postgraduate medical education programme. J Prim Health Care 2016; 8 115–21.
| Educating vocationally trained family physicians: a survey of graduates from a postgraduate medical education programme.Crossref | GoogleScholarGoogle Scholar |
