Principles and Application to USMLE

00:01 And so now we're gonna be discussing the principles and philosophy of my specialty, Family Medicine.

00:07 And particularly how that applies to United States Medical Licensing Examination.

00:13 Because I think it is important to understand some of the background.

00:16 It will influence the types of answers that you see on the exam.

00:22 And I believe the answers you get right.

00:24 So I'm gonna start with a quote. I'm gonna read it.

00:28 Then we're gonna come back to some key points.

00:30 "In the increasingly fragmented world of health care, one thing remains constant: Family physicians are dedicated to treating the whole person.

00:37 Family medicine's cornerstone is an ongoing personal patient-physician relationship focusing on integrated care." Now that comes from our Academy of Family Physicians.

00:48 I just wanna focus on a few of the key elements in that statement.

00:53 First of all, family medicine is highly personal.

00:56 We follow patients? overtime.

00:58 And our specialty is really based on good communication principles and empathy.

01:03 We order a fewer tests. We order a fewer expensive procedures.

01:08 Stakeholders in medicine really love us.

01:12 And I'm talking about governments.

01:13 I'm talking about insurance companies, because we provide quality care, we improve morbidity, we also improve mortality substantially and we do so at a low cost.

01:24 Why? Because it starts with the patient.

01:26 The patient is at the center of what we do.

01:28 And so good communication skills with the patient and bringing out all their history, and treating the patient in the context of their values and what's available to them is very important to us.

01:41 So in that same vein, we embrace the biopsychosocial model of health care.

01:46 So let's break down that word.

01:48 Bio-psycho-social. So the bio.

01:50 The patient has diabetes and heart failure, and generalized anxiety disorder.

01:55 That's these different disease states.

01:57 The psychological. So they have anxiety.

02:01 And maybe that's related to the fact that their kid isn't doing so well in school.

02:06 And they're having trouble at their job.

02:07 And may be they've been drinking a little bit more than they normally would with alcohol.

02:12 So that's the psychological, and then the social.

02:15 I mentioned how the impact of their child's educational status maybe hurting their health in terms of their mental health.

02:24 Maybe it's also leading to some poor control of diabetes, particularly if they are drinking more alcohol.

02:29 And see how it all ties together.

02:32 Every patient ties these different domains.

02:35 They're all highly interrelated and you can't really, I think fully understand one domain without understanding the others.

02:42 And that's an important principle of our entire specialty.

02:45 And we put the patient in the context of their relationships.

02:48 So I mentioned this fictitious patient and her son.

02:53 So maybe, I'm seeing not just the patient, but I'm also seeing her son, and her husband, and her aunt.

03:02 And that allows me to get a more complete picture about what's going on within this family unit.

03:09 And I'm also thinking about where she lives, what kind of options for health habit she has.

03:16 Does she live in a food desert? Is there any green space next to her? And so it's putting the patient in the context of their human relationships and also other relationships to society at a larger level.

03:28 We are holistic.

03:29 We do cradle to grave care and it's complete.

03:33 We treat acute illness, we do chronic illness, and we do preventive care, too.

03:38 And we'll see examples of that throughout these discussions I'm doing today.

03:43 And then finally, we do focus on preventive care.

03:46 So it's not just about treating disease, it's about promoting wellness. So that's what... I think, particularly when it comes to preventive care, family medicine really owns that subject.

03:55 Of course, with our patients, with these many disease states as I mentioned, they're gonna see different specialists, they're gonna see different health care providers such as say, physical therapy, they maybe going to alternative care resources.

04:10 Our job is to act as a central station where we're organizing that care and putting the patient at the center of a team of health care providers.

04:18 But we have to be the ones to coordinate back here.

04:20 Uncoordinated care is always wasteful, inefficient and can be actually quite dangerous, too.

04:26 And so--and when I say, we put the patient at the center, it's their values and their practices, and their beliefs, what they are desiring to do, what they absolutely won't accept, that dictates what we do as providers.

04:41 And as I mentioned, we are cheap.

04:45 We are driven mostly by history and physical examination, and we do take ownership of the whole patient.

04:53 I really feel like I provide a certain paternalistic style of care.

05:00 It's hard for me not to.

05:02 Which I really--I cheer on the patient's successes when they lose 5 kilograms, when they get their A1C under control, when those tension headaches finally go away, when they get a promotion at their job.

05:15 And I definitely mourn when they have difficulties.

05:21 When they lose their home, when their heart failure is getting out of control, and we can't do much about it. When they're diagnosed with cancer.

05:30 I really own all of those conditions. But I also own to a larger stand.

05:36 I think some of the emotional component of those moments with my patient.

05:42 And I think that what makes medicine that much more real and worthwhile.