• Contents page •
• European Definition • GP in Europe • Albania • Australia • Canada • Denmark • Ireland • Italy • Kuwait • Spain • USA •
• Up • Four Principles • FM Residency Programs • CanMeds •
• •

Principles of Family Medicine

An effective family physician incorporates into practice the four principles of family medicine.

Four principles of Family Medicine

The physician is an effective clinician.

Family Medicine is community based.

The family physician is a resource to a defined practice population.

The physician/patient relationship is central to Family Medicine.

Family Medicine Learning Objectives

Four principles of Family Medicine

An effective family physician incorporates into practice the four principles of family medicine. These principles are of equal importance in educational activities and clinical practice. The principles form the basis of specific rotational or learning objectives throughout the Family Medicine Programme at McMaster and the challenge for both residents and preceptors is to integrate all four principles into the ongoing practice of family medicine.

1) The family physician is a skilled clinician.

Family physicians demonstrate competence in the patient-centred clinical method: they integrate a sensitive, skilful and appropriate search for disease. They demonstrate an understanding of patients’ experience of illness (particularly their ideas, feelings and expectations) and of the impact of illness on patients’ lives.

Family physicians use their understanding of human development and family and other social systems to develop a comprehensive approach to the management of disease and illness in patients and their families.

Family physicians are also adept at working with patients to reach common ground on the definition of the problems, goals of treatment and roles of physician and patient in management. They are skilled at providing information to patients in a manner that respects their autonomy and empowers them to "take charge" of their own health care and make decisions in their best interests.

Family physicians have an expert knowledge of the wide range of common problems of patients in the community and of less common but life-threatening and treatable emergencies in patients in all age groups. Their approach to health care is based on the best scientific evidence available.

2) Family medicine is community-based.

Family medicine is based in the community and is significantly influenced by community factors. As a member of the community, the family physician is able to respond to people’s changing needs, to adapt quickly to changing circumstances and to mobilize appropriate resources to address patients’ needs.

Clinical problems presenting to a community-based family physician are not preselected and are commonly encountered at an undifferentiated stage. Family physicians are skilled at dealing with ambiguity and uncertainty. The family physician will see patients with chronic diseases; emotional problems; acute disorders, ranging from those that are minor and self-limiting to those that are life-threatening; and complex biopsychosocial problems. Finally the family physician may provide palliative care to people with terminal diseases. The family physician may care for patients in the office; the hospital, including the emergency department; other health care facilities; or the home. Family physicians see themselves as part of the community network of health care providers and are skilled at collaborating as team members or team leaders. They use referral to specialists and community resources judiciously.

3) The family physician is a resource to a defined practice population

The family physician views his or her practice as a "population at risk," and organizes the practice to ensure that patients’ health is maintained whether or not they are visiting the office. Such organization requires the ability to evaluate new information and its relevance to practice, knowledge and skills to assess the effectiveness of care provided by the practice, the appropriate use of medical records and/or other information systems and the ability to plan and implement policies that will enhance patients’ health.

Family physicians have effective strategies for self-directed, lifelong learning. Family physicians have the responsibility to advocate public policy that promotes their patients’ health. Family physicians accept their responsibility in the health care system for wise stewardship of scarce resources. They consider the needs of both the individual and the community.

4) The doctor-patient relationship is central to the role of the family physician.

Family physicians understand and appreciate the human condition, especially the nature of suffering and patients’ response to sickness. Family physicians are aware of their strengths and limitations and recognize when their own personal issues interfere with effective care.

Family physicians respect the primacy of the person. The relationship has the qualities of a covenant–a promise, by physicians, to be faithful to their commitment to the well-being of patients whether or not patients are able to follow through on their commitments. Family physicians are cognizant of the power imbalance between physicians and patients and of the potential for abuse of this power.

Family physicians provide continuing care to their patients. They use repeated contacts with patients to build on their relationship and to promote the healing power of their interactions. Over time the relationship takes on special importance to patients, their families and the physician. As a result the family physician becomes an advocate for the patient.

In summary, the effective family physician brings a unique set of qualities and skills to a unique practice setting, keeps these up to date and applies them by using the patient-centred clinical method to maintain and promote the health of patients in his or her practice. The four principles are a helpful guide as you participate in both family medicine and specialty rotations.

Adapted by James Goertzen from the College of Family Physicians of Canada Standards for Accreditation of Residency Training Programmes.

Source: Principles of Family Medicine McMaster

See also College of Family Physicians of Canada: Four Principles of Family Medicine

Family Medicine Learning Objectives

The objectives for the two four-month blocks of family medicine experience based in a family medicine teaching unit and for the two month block experience in a community practice will be described as they relate to the four principles of family medicine.

The family physician is an effective clinician

	The resident will learn the special nature of the doctor-patient relationship in family medicine and the many roles of a family physician serving patients: as a listener, advisor, healer, advocate, comforter, technician and educator.
	The resident will provide care in a variety of practice settings, including the family physician's office, hospital wards, the emergency room, the patient's home and institutions for the chronically ill.
	The resident will provide care to patients of both genders and of all ages.
	The resident will demonstrate comprehensive care across a spectrum to include health promotion, disease prevention, curative and rehabilitative care. This includes the ability to deal effectively with a wide variety of common illnesses as well as less common but life-threatening conditions.
	The resident will demonstrate an awareness of human development, family systems and the cultural and social milieu which influence the therapeutic process.
	The resident will demonstrate competence in the patient centred clinical method. This objective includes a demonstration of the understanding of patients' experiences of illness (particularly their ideas, fear and expectations) and of the impact on the lives of patients and their families.
	The resident will demonstrate an understanding of the critical analysis of medical literature and the ability to find and utilize the best scientific information available to guide the diagnosis and management of patients illnesses. This objective includes the ability to present information to patients in ways comprehensible to them in order to empower patients to participate fully in their own health.
	The resident will demonstrate an awareness of his or her own strengths and limitations and the ability to recognize when his or her own personal issues interfere with effective care.
	The resident will learn to balance the diverse professional demands with family and personal needs.

The patient-physician relationship is central to the role of the family physician

	The resident will demonstrate an awareness of the patients responses to illness and of the nature of suffering
	The resident will demonstrate the attributes of warmth, caring, compassion and empathy for patients within the context of a professional interpersonal relationship.
	The resident will demonstrate an awareness of the imbalance of power between physicians and patients and the potential for abuse of that power.
	The resident will demonstrate continuing care of patients. This involves repeated patient-physician interactions over time and a demonstration of the building and strengthening of the relationship.
	The resident will demonstrate adherence to the ethical principles of beneficence and non-maleficence in all interactions with patients.

The family physician is a resource to a defined practice population

	The resident will demonstrate a commitment to viewing her or her practice as a "population at risk", and organizing the practice to promote the maintenance of patients health.
	The resident will demonstrate an awareness of effective strategies for the maintenance of self-directed, lifelong learning.
	The resident will demonstrate the skills required to assess and improve his or her own effectiveness, including a commitment to improve continuously his/her knowledge and skills by such methods as audit and peer assessment.
	The resident will demonstrate knowledge of the efficient management of the business aspects of practice, including such issues as scheduling, office supplies and equipment, personnel, on-call systems and medical records.
	The resident will demonstrate an awareness of the impact of public policy on health and a willingness to advocate for public policy that promotes the health of his or her patients.
	The resident will demonstrate wise stewardship of scarce resources within the health care system and will consider both the needs of the individual and of the community.
	The resident will demonstrate the ability to work collaboratively with other health care providers within the practice environment to enhance the health of patients in his or her practice.

Family Medicine is a community-based discipline

	The resident will demonstrate skill at dealing with ambiguity and uncertainty, including the ability to use time as both a diagnostic and therapeutic tool.
	The resident will demonstrate the ability to see himself or herself as part of a community network of health care providers and will demonstrate the skills of working collaboratively with such providers outside the practice environment.
	The resident will demonstrate the knowledge, skills and attitudes appropriate to a member of a self-governing professional body, including the requirements for obtaining and maintaining licensure in the medical profession and certification in the discipline of family medicine.
	The resident will demonstrate the ability to identify and to respond appropriately to the health needs of communities.
	The resident will demonstrate awareness of the principles of population health including such things as community health assessment, health promotion techniques, social determinants of health, health care planning and public policy making.

Source: Learning Objectives McMaster

• Contents page •
• Up • Four Principles • FM Residency Programs • CanMeds •
• •
Top of page
Get Adobe Acrobat Reader

Copyright statement
Copyright for all the information published on this web remains with the original authors.
Where known, sources are acknowledged.
There is no claim of ownership of any of the material on this web by the web author.
If your copyright has been infringed please inform me and I will
acknowledge you or remove the material.