Foundational Knowledge for the Practice of Family Medicine in West Africa
By Victor Inem
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About this ebook
The concept of family medicine in West Africa was a paradigm shift from a specialty conception of a conglomeration of independent specialties in general practice to a unique specialty with its own distinct identity with a fundamental principle based on the biopsychosocial model. The specialty draws a distinctive identity from its approach to care by placing emphasis on the contextual setting of the patient, starting with the family and extending to the sociocultural and economic environment.
This composite approach to health care was new and confusing to the uninitiated medical graduate undergoing a residency training taught in the traditional biomedical reductionist model and to other medical specialists who asked what new knowledge we were bringing to the table that other specialists were not already teaching.
As for those teachers of family medicine in the subregion, it was quite clear as to the need for this conceptual framework in family medicine as opposed to the limitation of general practice. This book documents the struggle to position family medicine as a separate specialty of medicine in West Africa.
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Foundational Knowledge for the Practice of Family Medicine in West Africa - Victor Inem
Copyright © 2019 by Victor Inem.
Library of Congress Control Number: 2019906197
ISBN: Hardcover 978-1-7960-3682-4
Softcover 978-1-7960-3681-7
eBook 978-1-7960-3680-0
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.
The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.
Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.
Certain stock imagery © Getty Images.
Rev. date: 06/07/2019
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CONTENTS
Book Review
Acknowledgement
Dedication
Preface
Chapter 1
What Is A Family?
Definition Of A Family
Classification Of Families:
Some Functions Of The Family
Levels Of Interaction With The Family In Family Medicine
Chapter 2
Systems Thinking In Family Medicine
Systems Theory
General Systems Theory (Gst) In Family Medicine
General Systems Theory And The Hierarchy Of System
The Person And The Family In General Systems Theory
Family Systems
How Family System Operates
Characteristics Of The Family System
Tasks For The Family Physician In Applying Family Systems To Practice
Chapter 3
General Models
Basic Needs
Safety
Self Fulfilment Need
Self-Actualization
Self-Transcendence
Johari Window
Chapter 4
Family Models
DUVALL’S FAMILY DEVELOPMENTAL MODEL
Satir’s Interactional Family Model
Friedman’s Structural-Functional Family Model
Chapter 5
Biopsychosocial Concepts
George Engel’s Legacy
Three Causes Of De-Humanizing Care In Medicine
Dualism-The Separation Of Body And Mind
Reductionism
The Detached Observer
Systems Thinking In The Biopyschosocial Method
The Biopsychosocial Model And Relationship-Centered Care
Calibrating The Physician: Self-Calibration As A Way To Reduce Bias
Chapter 6
Social Support And Family Functioning
Forms Of Social Support:
Biological Pathways Of Social Support And Health:
Measures Of Social Support:
Family And Family Function:
Family Influence On Health
Family Functioning
Determining Family Function:
Definition Of Family APGAR Components:
Family APGAR And Clinical Practice:
Chapter 7
The Uncertainty Of Illness
How To Use Model:
The Beginning Of The Illness Event:
Two Factors Influence The Stimuli Frame:
Mishel Uncertainty In Illness Scale (Community) Sample
Mishel Uncertainty In Illness Scale(Adult) Sample
Mishel Uncertainty In Illness Scale(Parent/Child) Sample
Chapter 8
Assessment Models And Tools In Family Medicine
GENOGRAM: Family Diagram
Ecomap
Family Circle And Sociogram
Family Map
Family APGAR
SCREEM Tool
Chapter 9
The Practice Of Family Medicine
Family Practice Model: Reason For Encounter
Components Of The Encounter In An Episode Of Illness.
Primary Medical Care
Primary Health Care (PHC)
Family Dynamics And Family Care
Hospital And Clinic Care
Chapter 10
The Family Physician
Implications Of The Principles
Cumulative Knowledge Of Patients
Conceptual Issues
Contextual Issues
Principles Underpinning The Practice Of Family Medicine
Essential Attributes Of Family Physicians
Communication In Practice Bad News
A Framework For Breaking Bad News
Chapter 11
Research In Practice Why Family Practice Research Is Important
How Do Family Practitioners Acquire Research Skills?
What Do We Research In Family Practice? The Subjects Of Research
For Further Reading
BOOK REVIEW
T HE PARADIGM SHIFT from the original General medical practice to the current family medicine practice resulted in an obvious wide gap in knowledge and practice. It has been very imperative to write a book for fill this gap especially in the context of medical practice in West-African sub-region.
This book is a product of decades of practice, teaching and research in family medicine in Nigeria and other countries in Africa and beyond. It set out to update the missing link between practitioners of family medicine in the tropics and to provide the foundational basis of family medicine to upcoming practitioners in the field.
The book brings together the basic foundation principles, concepts and theories upon which the practice of family medicine is built.
It addresses the family medicine concept of what a family is, and with special emphasis on the different family models used in the assessment and evaluation of individual and family health status.
It clearly elucidates the basis and concept of systems thinking, biopsycho-social theory and various assessment tools used in family medicine diagnosis and management. The roles and responsibilities of a family physician are clearly highlighted. The challenges of managing the myriads of undifferentiated health conditions and uncertainties of illness in family practice are highlighted.
The role of family functionality and social support in the prevention of disease and promotion / maintenance of health was clearly articulated.
The applications of all these principles and concepts to the practice and training of family physicians in Africa, makes this book a must read for all family physicians practicing in the West African sub-region.
Dr. ShabiOlabode
Chief Consultant Family Physician
Federal Teaching Hospital
Ado-Ekiti
Ekiti State
Senior Lecturer
Afe Babalola University
Ado-Ekiti
Editor,
Nigerian Journal of Family Practice.
ACKNOWLEDGEMENT
M OST IMPORTANTLY FOR me is my gratitude to God Almighty for this dream which has been embryonic for more than 12 years come through.
I also thank my numerous colleagues and friends especially Dr. O. A. Ewedairo who contributed the chapter on Family Support and Dr. T. E. Attoye who took time to edit the entire manuscript. Incidentally both were my residents who went on to receive postgraduate training at the prestigious Harvard University. They believed so much in me and took me on as their mentor. My Personal Assistant Mr. Olawale Oladejo, Ph.D. Medical Physics (in view) who accommodated my idiosyncrasies and Ms Joy Daniels for secretarial assistance and many others who God used to complete this work.
Finally, I appreciate God’s invaluable gift to me, Grace Cobham Inem and my children. TO GOD BE THE GLORY.
DEDICATION
T HIS WORK IS dedicated to my highly cherished parents His Serene Highness Etidung Elder Victor Inem of blessed memory and my mum, the Queen mother, Eka, my family friends the Alonges, Ogundes, Okojies and Akpan families who contributed immensely to my early education and developmental upbringing. Though some are long gone to be with the Lord their efforts were not in vain. Glory to God.
PREFACE
T HIS BOOK IS written for medical students, resident doctors of the National Postgraduate Medical Ccollege and the West African College of Physicians in the faculty of Family medicine as well as those reading for the diploma in family medicine.
The first medical degree MBBS or MBChB is the primordial step or the stem cell to practice. This does not in any way confer the status of General Practitioner to a medical graduate. To practice as a GP even with this first degree requires continuing professional development. For this reason a Doctor needs to be trained in General Practice which is a narrow but essential part that forms the more comprehensive and larger specialty of Family Medicine.
Family Medicine is a distinct discipline with its own science cum art form and not a subspecialty of any other discipline. Family Medicine is firmly entrenched in Primary and Secondary care with subspecialty in the areas of lifestyle medicine, emergency care, geriatric and palliative care among others.
The foundational knowledge
is needed as the baseline on which family medicine practice stands. Once the basics are gotten right, the understanding and application of the concepts are made a lot easier. However, when the very beginning which is the base is weak or faulty, conceptualization and contextualization of necessary principles and processes of the subject becomes difficult and the application wrong. Invariably, this leads to frustration and loss of interest in the specialty.
Two principal reasons motivated the writing of this book. First I met one of my former students, a Diplomate in Family Medicine and Professor of Rural Surgery who had practiced in diverse places like Saudi Arabia, England and rural Nigeria and who felt that the absence of written texts concerning the unique features of the specialty especially in the West African context was like winking in the dark. He also felt that the inadequate focus on the need for doctors to be trained in Family Medicine was a big disservice to both the medical and non-medical West African communities.
Secondly, a colleague in a more familiar specialty once asked me – as many others have since asked, What are you teaching that has not been taught by the other specialists?
I informed him that there is more breadth than depth in family medicine in the synthesis of the generalist context in a specialist mode, an understanding of the oxymoronic nature of the specialty. The basic