General Practice
Code
11209
Academic unit
NOVA Medical School|Faculdade de Ciências Médicas
Department
SP
Credits
12
Teacher in charge
Profª Doutora Maria Isabel Santos
Teaching language
Portuguese
Objectives
General practice / family medicine is a clinical area with its own particular methods and contents. It is practiced in primary health care. Established in Portugal over 30 years ago, it has been recognized as a specialty and has been taught at the pre-graduate level for almost over a decade at FCM.
The general aims for this course are to:
- Encourage students to adopt a systemic approach based on the patient.
- Enable the provision of health care to different population groups in a non-hospital setting.
- Familiarize students with patterns of complaints and symptoms, and the presentation of health problems in the context of family medicine / general practice.
- Teach skills of prevention, diagnosis, and treatment suitable to the practice of family medicine / general practice.
- Increase knowledge and experience in the recognition of interactions between somatic, psychological, and social factors, and the influence of interactions between members of a family on illness, including both how they affect and are affected by the illness.
Prerequisites
Subject matter
The practice of family medicine / general practice:
- The principles of family medicine / general practice. The importance of primary care in population health
- The features of family medicine in the context of the National Health Service. The specificity of this discipline in relation to others.
- Reasons for encounter and their determinants. The clinical iceberg.
- Types of decisions and phases of clinical processes.
The patient-centered clinical method. Clinical interviews
- Patient-centered visits, the visits contents and process
- Doctor and patient roles
- Definition of the patient-centered clinical method (PCCM). Its role in health promotion and prevention.
- Diagnostic of representations frames and integrated diagnostic
- Disease, ilness and sikness.
- The individual and the family
- Finding common ground (grounding)
- The concepts of importance and self-efficacy
- Building the doctor patient relationship
- Doctor-patient conflicts
- Defining communication, communication models and their importance in the doctor-patient relationship
- Communication components: verbal, non-verbal and para-verbal languages..
- Communicative qualities in a clinician.
- Classification and types of clinical interviews.
- Stages and tasks in the clinical encounter.
- The main techniques of clinical interviews.
Family, health, and illness
- Notion of family
- Modalities of familial organization
- Family life-cycle.
- Development tasks in different types of families.
- Impact of illness in the family.
- Family evaluation tools.
- Characterizing families by functionality criteria.
- Circumstances in which familial evaluation is mandatory.
Making patient-centered decisions based on available evidence
- Evidence-based medicine. Levels of evidence.
- Clinical thinking.
- Dealing with uncertainty.
- Types of studies.
- Sources and bibliographic research.
Evidence based prevention and counseling
- Prevention as a core competency of the family doctor.
- Effectiveness and efficiency of preventive activities.
- Levels of intervention in preventive activities.
- The fundamental principles of screening.
- Periodic health examination.
Quality management in common health problems
- Quality as a governing tool capable of improving individual and institutional practices.
- Definition and examples of dimensions of quality.
- Quality improvement programs in common health problems diabetes mellitus, arterial hypertension.
Steps in a patient visit and clinical records
- Clinical records objectives and specific features in family medicine: deontological, legal and ethical problems.
- Recording methods: the patient oriented medical record (POMR).
- Steps in an a patient visit and how to record them.
- Health problems: classification and codification. ICPC.
- Electronic health records.
- Family record the genogram.
Primary Health Care (PHC), family planning and maternal health
Health vigilance of children and the elderly
- PHC-succinct description of its functional organization.
- Groups with special health needs.
- Reproductive health.
- Family planning objectives, activities, basic principles of advising; Contraceptive methods; Infertility; Preconceptional care; Sexually Transmitted Infections; Opportunistic screening
- Maternal health care organization of follow-up; diagnostic procedures; information/anticipatory care; frequent symptoms; symptoms and warning signs; post-partum visit.
- Infant and child health organizing care visit objectives at different key-ages; growth and development (height, weight, and psychomotor development); anticipatory care.
- Health of the elderly care objectives; health promotion; disease prevention.
Bibliography
A consulta em 7 passos [ PDF, 4,5Mb ]
(Edição da APMCG). www.apmcg.pt/index.php?section=publications&action=details&id=23
A definição Europeia de Medicina Geral e Familiar [ PDF, 288Kb ]
Documento da WONCA Europa com a definição de Medicina Geral e Família
(edição APMCG). www.apmcg.pt/ficheiros/Definicao_MGF-EURACT_2005.pdf
Direcção-Geral da Saúde. Normas de Orientação Clínica.
http://www.dgs.pt.
www.acss.min-saude.pt/Portals/0/ICPC_Resumo.pdf
McWhinney IR. A Textbook of Family Medicine. 3rd edition. New
York: Oxford University Press; 2009.
Nunes J. A comunicação em contexto clínico. Edição da Bayer
Healthcare, Março de 2007. Disponível em
Pocket Guide to Clinical Preventive Services 2014.
Teaching method
The course is organized in two components theory and practice. The pedagogical techniques to be used in the theoretical component are expositive/narrative method, individual and group work, practical exercises to apply familial evaluation instruments, discussion of clinical cases, video recording with a simulated or real patient, discussion and analysis of video recording, training of communication techniques with role-playing among students. The practical component will include one on one tutorials to occur at health centers, in the context of clinical practice, and performing patient interviews with the dual objective of training and evaluation.
Evaluation method
Students have to be present in 2/3 of class time to have access to final evaluation.
The evaluation will be the result of two tests:
1 - Individual written test
The written test is composed of 32 multiple choice questions, steming from a clinical vignette, each marked up of 0.5 points.
2 - Family report
A family interview will take place in practical classes at a health center. A guide for the interview is available in Moodle. It must be sent by e-mail to
For students to have a positive evaluation requires a positive evaluation from their tutor in three categories: punctuality, interest, and relations with patients and members of the health team. They also need to meet the proposed workload (15 hours, 5 hours per day).
The final grade is given on a scale of 0 to 20 and is the result of the grade obtained on the individual written test (0 to 16 marks) plus the grade obtained on the evaluation of the family report (0 to 4 marks).