My experience sharing (3): Family Medicine in Thailand

  I studied concepts of Family Medicine 15 years ago. I thought it was very important concepts to take care of patient by this way in that time because of high workload of doctors, but it is possible now. But the concepts of Family Medicine still spread in narrow area with Family physicians whom were trained. Fortunately, the health care reform project is interested in this concepts and it made the health facilities apply to use them with nurses and medical officers in health centers. Some health centers were selected to be primary care unit (PCU) with the staffs from both hospital and health center to take care of population in the catchment area. It is very good time to start with Family Medicine concepts.

Community health system is a very complex and diversity. Population health is divided into 3 components as 80 % in popular sector, 10 % in Folk sector and 10 % in professional sector. In professional sector, we have to pay attention to a man as a person that has relationship from the big part to small part as the world, country, society, community, family, couple, individual, organ system, organ, tissue and molecule. So they cannot be separated into each part. These are the main concept that health care worker should keep in mind and facilitate the heath care system to reach the ultimate outcomes with equity, quality, efficiency and social accountability. Family Medicine helps us to reach these.

Family Medicine: A medical specialty which provide continuing  and  comprehensive  health care continuing and comprehensive health care for the individual and the family. It’s the specialty in breadth with integrates the biology, clinical and behavioral. The scope encompasses all age, sex, organ system and every disease. From AAFP, 1997.

Main concepts of Family Medicine have been applied in Thailand, was summarized by Dr. Thanyasopak Kasemsant, who was be the head of Family Medicine department of Medical Faculty in Chiangmai University. There are 6 main concepts as following;

1.     First contact: There are catchment area with defined population, family folders and community folders. Providing primary care to population in all age groups, as a whole person, all diseases or syndromes. Acting as gate keeper (front line care provider) in primary care unit (PCU). They should provide primary care to the population in catchment area since birth to death, pre-illness to post-illness, illness to healthy to make patient’s autonomy and community participation.

2.     Continuity care: providing care for population with continuity care by chronological (timing), geographical (place), interdisciplinary (role of each profession) and interpersonal (good & long relationship between doctors and patient & family). The results from continuity care will be good doctor-patient relationship, patient satisfaction and good health outcomes.

3.     Comprehensive care: It mean that all of types (as promotion, prevention, curative care and rehabilitation), all of aspects (Biological, psychological, social and spiritual), all of levels (individual, family and community), all of methods (cognitive, psychomotor, attitude or KSAB technique)

4.     Integrated care: to integrate team, time resources and manage them for good health at low cost and high patient satisfaction and autonomy.

5.     Accessible care: to reduce the barriers which protect the population to gain health care or no limitations, i.e. finance, distance, timing, acceptance. We called as “Near home, near heart”.

6.     Consult and referral system: there are two ways referral system, professional consult and coaching system between first line health services and other tiers and appropriate documents accompany with patients.

"Superior doctors prevent the disease;

Mediocre doctors treat the disease before evident;

Inferior doctors treat the full blown disease."

Huang Dee: Nai Ching. Chinese Medical Textbook, 2600 B.C.

Phichet Banyati,

ITM HSMP 2007-2008 participant,

November 28, 2007

[kob oop oop]

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good .... เคยไป แม่สอด (จังหวัดตาก)แล้วครับ