Critical Appraisal Essay

This exclusive practical session revolves around students fastening to family doctor or frequent practiti one(a)r. Beforehand, a sound pull ining and trenchant comparison between these two specialty is needful to perform this bunking class efficiently. Family medicate is a aesculapian exam exam specialty that erects continuing and comprehensive wellness c be for the individual and family across all ages, genders, infirmitys, and all parts of the organic structure. It is ground on knowledge of the affected role in the background of the family and community, emphasizing dis liberalization pr reddention and wellness promotion.According to the World Organization of Family Doctors, the aim of family medicine is to provide personal, comprehensive and continuing treat for the individual in the context of the family and community. On the separate hand, general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive c are an d health education to patients. The genuine general practitioners will treat patients both as people and as a population. In some health take schemes general practitioners work in prime care healthcare centers where they play a central consumption in the healthcare team.Nevertheless, in some models of care general practitioners work as single-handed practitioners. In conjunction with this block, I visited a local puskesmas to understand much somewhat role of a general practitioner and family medico. Physical Access , Convenience and Facilities The clinic I was designated to is Puskesmas Danurejan I. The puskesmas is located in Bausasran, Danurejan in Yogyakarta. After being renovated and improvised since December 2011, Puskesmas Danurejan possesses new carnal organize and more sophisticated facilities.Now, the puskesmas has a new building, whereas the ground floor serves as an infectious and non-infectious area. The puskesmas is almost 656 meter squared in size with gener al consultation rooms, dental consultation rooms, emergency room, pharmacy and laboratory fitted in the ground floor. On the other hand, the first floor serves as the accompaniment facility . This floor contains the office, hygiene and sanitation department and prayer room. This health center is located in the midst of housing estates, and at that placefore in truth accessible to those living within close proximity.The housing area is as well as densely populated, with numerous shops, public amenities which makes it a rather nonsuch and conducive stay. The puskesmas is open daily on weekdays and Saturdays from 7. 30am to 3. 00pm. The puskesmas similarly has a landline which makes it reachable for any prior information beforehand the peoples visit. champion obvious setback of the setting is that of, the signboard was unclear and hidden in corner branches. The removeion guiding the visitors are vague and non specified. This may be inconvenient for anyone who is ab prohibi ted to make their very first visit without conspicuously knowing the location.Furthermore, there were not enough parking lots pricey the puskesmas. The Waiting Room The time lag room is spacious, sufficient to fit active 20 patients at an instance with countenance number of chairs provided. The cleanliness and tidiness of the time lag room is also well maintained . There were garbage bins provided. The airing of the room is also well considered as there are aim windows for healthy air movement. Huge healthcare pamphlets and banners are also seen in the waiting room, aimed educate and enlighten patients.A staff was bserved in the waiting area as she is assigned to take vital signs of the patients and direct them to the doctor as their turn comes. As we were walking pass the waiting room, I noticed surreptitious gazes from the patients who were rather clueless of our enthusiastic presence with lily-white coats. I managed to start a conversation with a few patients even befor e tending to the consultation room for observation. Patient Load and mental testing Room The patients who visit this puskesmas are mostly from the community living within close proximity to the center.Apparently, the densely populated housing estate are attracted to the recently renovated health center. The health center receives a generous bonny of 40 patients daily, most probably collectible to the satisfactory health care received and affordable charges. The examination room is rather small further sufficient to carry out basic corporal examination, equipped with racks, tabularise for physician and an examination bed. During my observation period, the physician received 5 patients. in which 3 of them were regular patients under controlled musics (hypertension and diabetes mellitus patients), with the other 2 having ordinary feverishness and viral flu.According to the doctor, most of his patients are barbarianren with acute illnesses and venerable patients liner chronic diseases. However, any serious medical complication which cannot be diagnosed or treated by the doctor is referred to the possible hospital. Physician-Patient Communication Based on my observation, the physician seemed to have mastered all crucial skills in smart set to provide the outflank for the patient. Firstly, I would like to discuss about the primary care management of the physician towards the patient.The doctor successfully connects with the patient via good communication and interpersonal skills, and subsequently put the patient at ease to express his complaints and condition. Therefore, the physician is able do deal competently with the problems presented to her. steady though the physician I observed has just completed internship, she has an painful person centered care towards each of her patient. She understands and relates her patients as individuals and developed the capacity to work in partnership.The physician encountered various different cases involving dif ferent ranging from a myriad of genders, age group and illness. However, she applies specific problem-solving skills about the context-specific aspects of general place and successfully dealt with undifferentiated illness and skills. The duration of consultancy was about 10 proceedings per patient for chronic diseases like hypertension and diabetes mellitus and the interaction process took about 5 minutes. Shortly after my observation, I managed to have a give-and-take with the physician.She explained to me that the key to a good family physician is the comprehensive approach. It is about how one as a physician must be able to set up care of acute illness, chronic illness, health promotion and disease legal community in the general practice setting. Not to forget, to respect and honor the patients for an faultless physician-patient communication. Besides she emphasized the importance to keep patients informed about their condition, see and respect their views about their healt h and respond to their question.Documentation and Medical Records The medical records are stored very systematically in the center. There is an allocated room with particular accessibility to keep all of the documents safely in order to invalidate breach of confidentiality of the documents. Only the brass section personnel are permitted to enter. As we were informed, the documents of the medical record has been computerized using a programme called MedCis System. However, the manual means are still practiced in the physicians desk.The information is then transferred by the administration personnel. The medical record on the hysicians desk is a piece of white-colored paper with patient identity particulars such as name, age, gender, registration number, and consultation date at the top. The remainder of the page is filled up by writing by the doctor himself, which are anamnesis, medical register, drug allergies, vital sign results, physical examination results, diagnosis, sermon and prescription. By the implementation of the computerized system, loss of data due to natural disaster is prevented. Besides, the patients privacy and confidentially is recognised as the system is well secured, in the sense no changes of previous medical history is made possible.The system can only when be viewed by physicians for follow-ups and patient himself upon request. Clinical Care Processes The overall process of treatment is very structured indeed. It begins with registration and recording of vital signs. Later, the patients are directed accordingly to the appropriate departments namely psychology, nutrition, general consultation and dental consultation. After receiving their treatment, they were to settle payments before collecting their prescription from the pharmacy. As per clinical care specifically, the physician has performed necessary procedures to diagnose and treat the patient.The physician accomplishes her role as a family physician very successfully. Her ana mnesis was very detailed and intricate. She thoroughly skims the past medical history, medication history, and latest prescription before she proceeds further. Concerning chronic diseases of the elderly like hypertension, she initiated by asking the patient how did they feel lately and if there were any relieve or aggravation from their condition. As the temperature, height, weight, blood pressure, respiratory rate and pulse rate has been obtained earlier from the registration personnel, she proceeds with treatment and prescription.The physician prescribes simple generic medicine for the patient which was available in the pharmacy. As for the child, she performed basic physical examination as he complained of body ache. I also observed that treating an elderly person and a child requires different approach altogether. Obviously, they had to be nurtured with care and respect. The physician was seen to have attached importance to personal safety by the usage of gloves, masks, and han d sanitizer. This is an unarguably important step to prevent nosocomial infections in the health center.One setback that I observed was in terms of educating the patients. The physician only provided the patients with very minimal input and education. Payment There are some(prenominal) paying methods made feasible by the puskesmas to facilitate the patients, namely restitution coverage and direct payment. For instance, Jaminan Kesihatan Masyarakat, Jaminan Kesihatan Daerah, Jaminan Kesihatan Social, Jaminan Kesihatan Persendirian and Jaminana Kesihatan AKS. Patients who owns insurance coverage as mentioned need not make any payment, whereas those without pays an amount as low as RP5000. 00.However, the medications has to be purchased by the patients at their own expense. For the most part of my observation, the patients receives prescription of their medication to be purchased themselves in the pharmacies, unless generic medicines which are provided in the puskesmas. I could wit hhold that the charges are very affordable compared to that of private practices. Therefore, quality medical care is made accessible to everyone regardless of their economic background. This is indeed extremely sociable in reaching out to the necessarily of the people in an actively developing region.Discussion In the context of satisfactory health care, patients rapture is substantial. This explains why health care providers should make extraordinary efforts in providing the best achievable standards of health care. In the context of Indonesia, family medicine is developing slowly, until now a clear structure and guideline for patients has not been constructed. On the other hand, due to limited number of specialist available, most specialists carry out private general practice outside their work hours. This may ignore the efficiency of the physicians due to stress and overwork.Moreover, the general practitioners training programme is not welcomed and well supported by the spec ialist because they are held in direct competitions with the general practitioners. Pertaining the clinical attachment, the physician tried their level best to provide appropriate health care to her patients despite the limited resources. However, there is also abundant room for improvement in terms of educating the patient about prevention of diseases and the effects of medication prescribed. Besides, the physician should have given more enlightenment when concerning lifestyle related iseases, because at all times, prevention is weaken than care.On the whole, the entire health care team should work on the regulations concerning controlled medication to avoid abuse and overuse. Another most crucial luff in family medicine is the community orientation. Community orientation is about the physical environment of your practice population, the need to understand the interrelationship between health and social care, and the tensions that may exist between individual wants and needs and the needs of the wider community.As a conclusion, holistic approach is about your ability to understand and respect your patients values, culture, family beliefs and structure, and understand the ways in which these will affect the cognise and management of illness and health. I am very contented to be granted an opportunity for this clinical attachment. This would, in time, help me in my emerging endeavors as a doctor.