The provision of integrated and accessible health care services by clinicians who are accountable for addressing the majority of personal health care needs by developing a sustained partnership with patients and practicing in the context of family and community. Primary care physicians provide the first contact for a person with an undiagnosed health concern and continuing care of a varied of medical conditions, not limited by cause, organ system or diagnosis. Emphasis is placed on prevention. Care continues when diseases are not reversible.
Care which is palliative is management of diseases which are chronic, serious, or not curable. Palliative care is focused on what can be achieved as opposed to what can be done. By the dictionary palliate means to make the effects of an illness less painful, harmful, or harsh. Provision of palliative care does not require the services of a specialist. The best palliative care plan is coordinated by a primary care physician who has a committed relationship with the patient and has the input of a team.
Geriatrics or geriatric medicine is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. The American Board of Internal Medicine and American Board of Family Medicine issue a Certificate of Added Qualifications to certify the subspeciality of geriatric medicine.
Preventive care is an approach to an individual which focuses on doing something before an adverse health event. Preventive care includes administering recommended vaccinations to prevent infectious illness, and goal-directed health screening physical exams and testing to find a problem when it is curable. For older people especially, preventive care also includes counseling on skin care, oral care, diet and attention to reducing medications . Guidelines for preventative health vary with age and are revised as new medical research is done. Most importantly, preventative health care has to be customized to what can be achieved for an individual. A physical exam may be more important than a CT scan with advanced age and disability.
Primary prevention is an intervention or method used before the person gets the disease. Primary prevention aims to prevent the disease from occurring. For example, vaccination to prevent influenza or use of an appropriate mattress to prevent a pressure ulcer.
Secondary prevention is an intervention or method used after the disease has occurred, but before the person notices that anything is wrong, for instance preventing kidney disease in a person with diabetes. The intervention or methods are intended to prevent long term consequences of the disease.
Tertiary prevention is use after the disease has occurred and after the person has symptoms. Interventions are directed to slow down the disease, prevent additional effects or reduced the impact. Tertiary prevention is focused not on curing the disease, but on helping the person feel and function better.
A test, including a basic physical exam, that is used to detect disease or an abnormality in a person with no symptoms of disease. A physical exam to determine if a woman has or does not have a breast mass is a screening test. A screening test in done in people with apparent good health. The intention of a screening test is to detect and treat an abnormality early and reduce the long-term effects on health. Not all screening tests are recommended in all people. Screening tests can also be painful, stressful and provide false results including false reassurance.
A test done to confirm, determine or help determine the probable cause of a symptom. A colonoscopy done in a person with rectal bleeding is not a screening test because the person has a concerning symptom the cause of which should be determined. A diagnostic test most commonly helps determine the probability of a specific disease. Most diagnostic tests have imperfect accuracy.
A prediction of the probable course and outcome of a disease. The three components of a medical formulation done for a new symptom or illness are diagnose, treat and make a prognosis. Prognosis is the least often used or discussed for many reasons. One reason is that when doctors treat without making a diagnosis, the expected outcome cannot be known. Another reason is because each individual person has unique susceptibility to the effects of disease and response to treatment.
A business relationship where the consumer of the health care services, the patient or their representative, is responsible for paying the health care provider rather than payment coming from a health insurance company. Direct-pay medical care eliminates the significant cost to the physician for billing the insurance company. Direct pay eliminates the interference and restrictions that health care insurance places in the doctor-patient relationship.
Anyone who contributes to the needs of someone who can not care for themselves. The person who pays the bills is a caregiver perhaps as much as the person who changes the diapers. Caregivers also meet needs for social contact, connection to community and serve as advocates in the health care industrial complex.
Goals of Care
Health care is traditionally oriented to the outcome of treatment for a specific disease rather than achieving a health state for an individual who may have many diseases, each with competing treatment options. Determining goals of care for an individual defines which health states are important to the individual and the relative priorities.
A health care place of service which is best suited for evaluation and treatment broken bones, dislocated joints, and massive bleeding. Not the best place location of care for the dying or for those who have a prognosis such that they are unlikely to regain a prior state of health even with treatment of a new medical illness. Going to an emergency room for an old person is a decision best determined by a physician who considers possible outcomes after evaluating prognosis.
A professor or student teaching or studying at a hospital where they are a guest at an institution other than their primary association. The term visiting doctor has no relationship to where the evaluation and treatment of a patient occurs.