General Practice as an essential part of a socially responsible health care system - PowerPoint PPT Presentation

Loading...

PPT – General Practice as an essential part of a socially responsible health care system PowerPoint presentation | free to download - id: 43e08d-YWM0Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

General Practice as an essential part of a socially responsible health care system

Description:

Effective Clinical Practice ... So specialists can have no understanding of the importance of holding ... That seems a good basis for a secure future for general ... – PowerPoint PPT presentation

Number of Views:148
Avg rating:3.0/5.0
Slides: 40
Provided by: ionah9
Learn more at: http://hcrp.nhso.go.th
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: General Practice as an essential part of a socially responsible health care system


1
General Practice as an essential part of a
socially responsible health care system
  • Iona Heath
  • Primary Care and Family Medicine Practical
    Implementation Challenges
  • 8th June 2009
  • Holiday Inn, Silom, Bangkok

2
gift of history
  • specialist/generalist divide

3
Apothecaries Act 1815 Medical Act 1858
4
The physician and surgeon retained the hospital
but the general practitioner retained the
patient.
  • Stevens R.
  • Medical Practice in Modern England.
  • Yale University Press, 1966

5
In hospitals, the diseases stay and the people
come and go in general practice, the people stay
and the diseases come and go.
6
(No Transcript)
7
(No Transcript)
8
Power of scientific medicine for both good and
harm
9
  • A human being is both a subject and an object
  • Illness is different from disease
  • Demand is different from need.

10
  • A human being is both a subject and an object
  • Illness is different from disease
  • Demand is different from need.

11
- the prevailing commitment to accurate diagnosis
of disease - which is the hallmark of the modern
physician - turns on the notion that there is a
pure disease state which is, ideally, distinct
from the patient. Thus, the patient is seen as a
kind of translucent screen on which the disease
is projected. In consequence, ... the patient's
subjective experiencing of illness is ignored in
favor of an objective, quantitative account of a
disease state.
  • S. Kay Toombs
  • The meaning of illness a phenomenological
    account of the different perspectives of
    physician and patient., 1993

12
- individual and closely intimate recognition is
required on both a physical and psychological
level.
  • John Berger
  • A Fortunate Man, 1967

13
- the mystery of the individual is precisely what
must be put into the facts to make them
meaningful.
  • Boris Pasternak
  • Dr Zhivago, 1958

14
The body as object gaze of biomedical science
what this patient has in common with other
patients (normative monological)
Object
Doctor
Patient
Subject
The body as subject what is unique for this
person life context, story and meaning systems
(dialogical)
15
(No Transcript)
16
Theory grows out of particular circumstances
and, however abstract, is validated by its power
to order them in their full particularity, not by
stripping that particularity away.
  • Clifford Geertz
  • Available Light - Anthropological reflections on
    philosophical topics, 2000

17
uncertainty
18
None of us - generalists all, working in an open
system of human interaction can afford the luxury
of certainty, or even near certainty.
  • Stevens J.
  • Brief encounter.
  • J Roy Coll Gen Pract 1974 24 5-22.

19
  • A human being is both a subject and an object
  • Illness is different from disease
  • Demand is different from need.

20
Stressful life experience
Disease requiring hospital treatment
Illness
Disease
21
(No Transcript)
22
Power of scientific medicine for both good and
harm
23
The strength of a country's primary care system
was negatively associated with (a) all-cause
mortality, (b) all-cause premature mortality, and
(c) cause-specific premature mortality from
asthma and bronchitis, emphysema and pneumonia,
cardiovascular disease, and heart disease.
  • Macinko J, Starfield B, Shi L.
  • Health Services Research 2003 38 831-865.

24
  • A human being is both a subject and an object
  • Illness is different from disease
  • Demand is different from need.

25
social solidarity
26
fear
27
Schwartz LM, Woloshin S. Changing disease
definitions implications for disease prevalence
analysis of the Third National Health and
Nutrition Examination Survey, 19881994.
Effective Clinical Practice 199927685.
28
32 million more patients Three quarters of the
total adult population
29
need
30
needs of the individual
needs of the population
GP
31
  • caution
  • doubt
  • frugality

32
Contemporaneous and time-lagged primary care
physician-to-population ratios were significantly
associated with lower all-cause mortality,
whereas specialty care measures were associated
with higher mortality.
  • Shi L, Macinko J, Starfield B, et al.
  • The relationship between primary care, income
    inequality, and mortality in US States,
    1980-1995.
  • J Am Board Fam Pract 200316412-22.

33
illness
disease
34
(No Transcript)
35
Sustaining generalism
  • College
  • Teamwork

36
College
  • identity and self-confidence
  • equivalent status
  • mutual respect
  • training, education, standards
  • examination set and assessed by generalists

37
Teamwork
  • a seamed service
  • interprofessionalism

38
Primary Care Team
  • general practitioners
  • nurses
  • practice
  • home
  • older people
  • children and babies
  • midwife
  • pharmacist
  • interpreters
  • social worker
  • money, benefit, employment adviser
  • administrator
  • reception and clerical staff
  • secretaries
  • trainee professionals

39
- the most fascinating and absorbing and
rewarding job in the world.
  • S Taylor
  • Good general practice
  • 1954
About PowerShow.com