Preface

PREFACE

Historically, family medicine was not always recognized as a separate specialty. In

the last several decades, however, there has been a push to define family

medicine as a specialty in its own right. This course covers the main issues that

are uniquely dealt with by the family physician. Family practice medicine is about

the care of chronic diseases, the care of acute illness in the outpatient setting, the

care of families as a whole, and the involvement of psychosocial issues in the care

of patients of all ages.

The purpose of chapter one in the course is to talk about the various aspects of

preventative healthcare. This involves the care of the patient who clinically has

no disease but is at risk for illnesses and diseases that can be prevented through

preventative healthcare. The wellness examination, immunizations, and cancer

screening are all part of providing this type of care to the adult patient and will be

covered as part of this chapter.

The focus of chapter two in the course is the history and physical examination of

the adult patient. Primarily, this involves performing the examination of the well

patient for a routine physical examination, focusing on a head-to-toe examination

of all body areas. There are not necessarily any routine blood tests

recommended; however, in patients at risk for heart disease, a lipid profile can be

done. Screening tests known to be beneficial as part of the examination of the

adult include the Pap test, testicular examination, mammography, and

colonoscopy.

Complementary and alternative care are the topics of chapter three in the course.

These practices can be defined as any medical therapy that falls beyond the

traditional scope of modern Western Medicine and involves those therapies that

can be used alongside modern medical techniques in treating illnesses. Examples

of complementary medical practices include Traditional Chinese Medicine (TCM),

osteopathy, and homeopathy. These are discussed as part of the chapter.

The fourth chapter of the course focuses on the psychological and social

influences on heath and illness. Family doctors often deal with patients that don’t have a purely physical problem but have underlying psychological factors that

play into the development of diseases and patients that have purely psychological

reasons for their complaints. Stress plays a large role in the severity of many

physical illnesses and must be considered as a factor in treating the patient’s problem.

The topic of chapter five in the course is obstetrical care. A large proportion of

family doctors will care for the obstetric patient from the pre-pregnancy state

through the postpartum period. Obstetrical care can begin before the woman

gets pregnant and follows the woman through the pregnancy. Family doctors will

often do the vaginal delivery and will care for both the infant and the mother

after delivery a part of total-family healthcare.

Chapter six in the course focuses on newborn care. The care of the newborn

begins with the initial evaluation after the child is born by assessing the Apgar

scores at 1 minute and 5 minutes after birth. After the mother has been

stabilized and the infant has been cleaned off and placed to the mother’s breast,

a complete examination can take place. The infant is screened for certain genetic

diseases and some male infants undergo a circumcision. Infants are generally

discharged from the hospital one to two days after birth unless there are birth

complications.

The study and practice of pediatrics is the topic of chapter seven in this course.

Family doctors care for the well child and follow well child development from

birth through adolescence. They also manage many of the typical diseases

common to children, including cardiovascular diseases, allergies, lung diseases,

gastrointestinal diseases, and others. In this chapter, the various issues and

disorders commonly seen in children are a part of the discussion as family doctors

will deal with both well children and sick children.

The focus of chapter eight in the course is on the nutritional recommendations for

healthy living in patients of all ages. Good nutrition starts in infancy and

progresses through older adulthood. The recommendations a family practice

physician needs to make vary according to age and the presence of special needs

or other issues and these are part of this chapter. The problem of obesity is the

biggest nutritional issue facing adults and children so this is included in the

discussion in the chapter.

Family practice physicians care for a number of acute illnesses in their practice,

which is the focus of chapter nine in the course. Typical acute illnesses a family

doctor treats include the various respiratory diseases, influenza, back pain, and

strep throat. These are things that can be seen in the absence of chronic diseases

in people who normally healthy. This chapter will discuss the different acute

diseases the provider will come in contact with on a daily basis.

Primary care physicians are often a valuable resource for adult patients with

chronic diseases, which will be the main topic of chapter ten in the course. In

caring for these patients, the family doctor acts as internist, caring for patients

with a wide variety of chronic diseases, including hypertension, cardiovascular

disease, diabetes mellitus, COPD, and hyperlipidemia. These are lifelong

conditions that need ongoing management by the primary doctor.

Caring for the elderly person and their chronic diseases is something the family

practitioner does as part of caring for patients of all ages. This is the main focus of

chapter eleven of the course. Older people have problems with Alzheimer’s disease, stroke, and depression, with a high suicide rate among people who are

older and have depression. They also suffer from poor mobility secondary to

osteoarthritis and some will have an increased fracture risk from falls in the face

of osteoporosis.

Dying patients have special needs unique to the dying process, which are the

focus of twelfth and final chapter. These patients no longer need heroic curative

measures and need care related to comfort measures, such as pain control and

special feeding needs. The family is often in close proximity to the dying patient

and, in keeping with caring for the whole patient, these individuals need attention

as well.