General medicine

See also: MG

The general medicine (MG) is the branch of medicine taking charges with them the durable follow-up and the general medical care with a community, without limiting itself to groups of diseases concerned with a body, an age, or a particular sex. The general doctor (one says also doctor Omnipraticien ) is thus the specialist in health ensuring the follow-up, the prevention, the care and the treatment of the patients of its community, in a long term vision of the health and wellbeing of those which consult it. Its surface of assumption of responsibility is horizontal, where the other specialities exert more in verticality of a medical problem.

The interrelationship between fundamental competences, the fields of activity and dimensions specific characterizes the discipline and underlines the Complexité this specialization. It is this complex interrelationship of fundamental competences which must be used as guide and to find itself in the development of the training programs, research and improvement of quality.

Definition of the Speciality of the General medicine - Medicine of family

Here the work of synthesis worked out by the European representatives of the speciality of general medicine - medicine of family at the time of the congress of the WONCA in 2002:

General doctors - family practitioners are specialist physicians trained with the principles of this discipline. They are the attending physician of each patient, charged to exempt total and continuous care with all those which wish it independently of their age, their sex and their disease. They look after the people in their family, Community, cultural context and always in the respect of their autonomy. They agree to have also a responsibility public health professional towards their community. In the negotiation of the methods of assumption of responsibility with their patients, they integrate dimensions physics, psychological, social, cultural and existential, making profitable the knowledge and confidence generated by repeated contacts. Their community activity includes/understands the promotion of health, the prevention of the diseases and the service of care to curative and palliative aiming. They act personally or call upon other professionals according to the needs and the available resources in the community, by facilitating if necessary the access of the patients for these services. They have the responsibility to ensure the development and the maintenance of their professional competences, their personal balance and their values to guarantee the effectiveness and the safety of the care to the patients.

Extract of: WONCA EUROPE (The European Society off General Practice/Family Medicine) (Prepared for), The european definition off general practice/family medicine, WONCA EUROPE, 2002

Characteristics of the discipline of medicine general-medicine of family

General medicine - medicine of family is a scientific and university discipline, with its specific contents of formation, clinical search for practice, and its own scientific bases. It is a clinical speciality directed towards the primary education care.

  • It is usually the first contact with the health-care system, allowing an open access and not limited to the users, take into account all the health issues, independently of the age, sex, or of all other characteristics of the person concerned.

  • It uses in an efficient way the resources of the health system by the coordination of the care, work with the other professionals of primary education care and the management of the recourse to the other specialities, being placed if necessary as a defender of the patient.

  • It develops an approach centered on the person in her individual, family, and Community dimensions.

  • It uses a specific mode of consultation which builds in the duration a relation doctor-patient based on a suitable communication.

  • It with the responsibility to ensure of the continuous and longitudinal care, according to the needs for the patient.

  • It bases its specific decisional step on the prevalence and the incidence of the diseases in primary education care.

  • It manages simultaneously the acute and chronic health issues of each patient.

  • It intervenes at an early and undifferentiated stage of the development of the diseases, which could possibly require an rapid intervention.

  • It supports promotion and education for health by a suitable and effective intervention.

  • It has a specific responsibility for public health in the community.

  • It answers the health issues in their dimensions physics, psychological, social, cultural and existential.

Ibid

Fundamental competences of the General medicine - Medicine of family

The definition of the discipline as of the speciality must highlight fundamental competences of the general doctor - family practitioner. “Fundamental” means essential with the discipline, independently of the health system in which these definitions are applied.

§ 1. the eleven central characteristics which define the discipline report to capacities or skills that each family practitioner specialized must control. They can be gathered in six fundamental competences (in reference to the characteristics):

1. The management of the primary education health care (has, b) 2. The care centered on the person (C, D, E) 3. The aptitude specific to the solution to problem (F, G) 4. The comprehensive approach (H, I) 5. Community guideline (J) 6. Adoption of a model holistic (K)

§ 2. the general practitioner applies these competences in three fields of activity:

a) clinical step, b) communication with the patients, c) management of the doctor's office.

§ 3. Like scientific discipline centered on the person, three specific dimensions must be regarded as fundamental:

a) Contextual: to use the context of the person, the family, the community and the culture b) Behavioral: based on the professional capacities of the doctor, his values and his ethics c) Scientist: to adopt a critical approach based on research and to maintain this approach by an continuing education and an improvement of quality.

Ibid

Modes of exercise

The general doctor can exert within the hospital (consultation of general medicine) or as a liberal (attending physician, doctor of city, country doctor, family practitioner). In France, certain liberal general doctors exert also one or more days per week in a structure other than their cabinet: hospital, old people's home, center family planning, center Maternal protection and infantile…

The first stage of a consultation is the diagnosis, which will make it possible to determine the nature of the affection and to direct the treatment:

  • Anamnèse : it is the most crucial stage of the consultation. The doctor listens to his patient, initially freely there, then by directing it by questions. The anamnèse makes it possible to know the antecedents of the patient, the Symptôme S felt, the seniority of the disease and its evolution, the already followed treatments, waitings of the patient…

  • physical Examination: at the conclusion of the anamnèse, the doctor often has a rather precise idea of the disease; the examination is used for seeking physical signs, and thus bringing evidence to support a diagnosis. It uses for that the inspection, palpation, the sounding, the percussion.

    • Inspection: catch of the vital constants such as temperature, blood Pressure, Pulse; examination of the tympanum S, the throat in the children;
    • Palpation: examination of the ganglia, abdominal, gynaecological, rhumatologic… if it is necessary.
    • Sounding: listen to noises of the Cœur and Poumon S (with a Stéthoscope);
    • percussion: test of the Reflex S: neurological evaluation;

If necessary, it can even practice a certain number of examinations complementary to the cabinet (for example a electrocardiogram) or to prescribe an examination in a laboratory (taking away of fabrics, catch of Blood) or a cabinet of Radiology. Starting from this diagnosis, the doctor can make a Prescription, which can be Médicament euse, the orientation towards a specialist, meetings of Kinésithérapie, care male nurses… He can also carry out itself of the care (injection, Suture, bandage).

When the access at an hospital is difficult, the liberal general doctor deals with more important traumatisms (for example the Luxation S in the winter sports resorts). He can also collaborate in the public helps is spontaneously (obligation of intervention if it is pilot of an accident or a faintness, article 9 of the Code of conduct medical), that is to say on request of the Samu or as a doctor Sapeur-pompier. It must (deontology) take part in the permanence of the care with a system of alternating custody the evenings and weekends; one directs oneself towards the creation of “medical houses” where the care apart from the opening hours will be assured the cabinets. A decree of 2005 institutes voluntariate as regards permanence of the care and a tariff revaloration for the controlled urgencies (centers 15, S.O.S Doctors: in France).

The doctor also has a legal role: he can issue certificates allowing of the sports activities (certificate of noncounter-indication to the practice of a sport), being able to be used as a basis for an legal action (observation of physical damage opening right compensation), being able to lead to a hospitalization without assent (hospitalization at the request of a third, hospitalization of office); he also issues premarital certificates (marriage), of death.

Medical secret

See also the article Professional secrecy.

The doctor should not reveal any element concerning the health of a person, that it is a person whom it would have had in consultation or of a deduction that it would have made apart from his community activity (article 226-13 French penal code, article 4 of the code of conduct medical) and this, even if the patient asks him. However, it can, and must, rising this medical secret in certain cases in particular:

  • when it is pilot maltreatment towards a person without defense, for example child or elderly (article 226-14 penal code, articles 43 and 44 of the code of medical Déontologie);
  • when it required there to carry assistance to a person in danger (article 122-7 of the penal code);
  • when the revelation would make it possible to clear a person shown wrongly (article 434-11 of the penal code);
  • for its own defense when it is marked (article 11 of the French criminal procedure code).

Certain pathologies are excluded from the field of the medical secret:

  • pathologies related to an industrial accident;
  • some infectious illness are with obligatory declaration near the health authorities (Variole, Choléra, coal, hemorrhagic fevers viral, the collective food poisonings…) ;
  • the Death.

To have of information

The doctor has a duty of information towards his patients (article 35 of the code of conduct medical). He must seek their assent before lavishing the care (Article 36 of the same code).

Formation

See also: Studies of medicine

In France, the training of a general doctor rests over 6 years of joint base in a UFR of medicine, followed by three years of boarding school in general medicine allowing obtaining General medicine (stopped of September 22nd, 2004 fixing the list and the regulation of the diplomas of specialized studies of medicine, OJ of the French Republic of October 6th, 2004) Source CNGE

The first 6 years are common to all the future French doctors.

  • the first year is also common to the studies of Odontologie, of Kiné sithérapie, Sage-femme and starting from re-entry 2006 of Infirmier, it is sanctioned by a contest. The row of the candidate determines his orientation in medicine, odontology, or studies of midwife.
  • the two following years (Propaedeutics) are devoted to fundamental sciences: Anatomy, human Physiology, Biochemistry, Bacteriology, Statistical S…
  • Lastly, the 3 following years, traditionally called “externat” are devoted to the training of clinical medicine (program of 345 “questions” covering vast extended from human pathologies, chosen because of their frequency and/or their gravity).
The externat ends in the national classifying tests (which succeed the contest of the boarding school since June 2004) whose result (row of assignment) determines followed specialization; general medicine having become a medical speciality with whole share, following the example Anglo-Saxon family practice .

At the end three years of practical training of 3rd cycle (the boarding school, preliminary track records), a Thèse of exercise is necessary to obtain the right to exert as a doctor of medicine in France. Without doctorate, the student can exert as a substitute after one year and half in 3rd cycle of which a 6 months training course in a general doctor. The thesis of doctorate in medicine relates to research tasks, generally starting from series of patients statistically studied in order to propose an opinion of assumption of responsibility (from an epidemiologic point of view, diagnoses, or therapeutic).

At the conclusion of the university medical formation, the doctors are subjected to an obligation of formation and evaluation of their medical practice.

Summary bibliography

  • Welsh P. and Al , Of the data to decide in general medicine , Paris, Masson, 2001. Compilation of the articles (Bibliomed) of the information center of the UNAFORMEC

  • Galam E and Al , Infinitely doctor ED Differently 1996
  • Gay B, Goaziou MF, Budowski M, Druais PL, Gilberg S Shortened of General medicine Masson 2003
  • Gay B., Pouchain D, Hooted D, Budowski M, Doumenc M: General medicine - bibliography with accompanying notes ED. Scientist 2000
  • Gay B, Pouchain D, Hooted D, Budowski M, Doumenc M: General medicine - bibliography with accompanying notes ED. Scientist 2001
  • Gay B, Pouchain D, Hooted D, Budowski M, Doumenc M: General medicine - bibliography with accompanying notes ED. Scientist 2002
  • Gay B, Pouchain D, Hooted D, Budowski M, Doumenc M: General medicine - bibliography with accompanying notes ED. Scientist 2003
  • Gay B, Pouchain D, Hooted D, Budowski M, General medicine - bibliography with accompanying notes ED. Scientist 2004
  • Gay B., Pouchain D, Hooted D, Budowski M, Druais PL: General medicine - bibliography with accompanying notes ED. Scientist 2005
  • Pouchain D, Attali C, De Butler J, Clement J, Gay B, Molina J, Olombel P, Rouy JL: General medicine - Concepts and practical Masson 1996
  • Perino L., the wisdom of the doctor, the eye nine 2004
  • Rouy JL, Budowski M, Gay B, Chambonet JY: Handy guide of the Master of training course in general medicine Edition LLC 1999
  • Samuelson Mr. (to dir), For a reference frame trade of the general doctor: to renovate the teaching of the general medicine , in Documents of research of the French company of general medicine, n° 48,1998

See too

External bonds

  • WONCA, World Organization off National Colleges, Academies and Academic Associations off General Practitioners/Family Physicians

  • CNGE, National College of the teaching General practitioners, learned society, training company medical continues (France)
  • ISNAR-IMG, Autonomous National Inter-Syndicale Representative of the General House physicians (ISNAR-IMG) representative national union (France)
  • SNJMG, national union of the young general doctors (France)
  • Code of conduct medical (France)
  • SFMG (French company of general medicine)
  • SSMG (Swiss Company of general medicine)
  • a guide of the medical studies
  • Doc. the Maghreb: Gate of the medical students of the Maghreb

  • Sites of formation/medical informations:
    • SFDRMG (French company of documentation and research in general medicine): learned society of the UNAFORMEC
    • SFTG (therapeutic Company of training of the general practitioner): learned society, training company medical continues
    • UNAFORMEC (National union of associations of continuous medical training): training company medical continuous, approved organization for the evaluation of the professional practices
    • Course of medicine in line
    • MedSyn
    • Esculape.com

  • articles

    • Marie Jaisson, " Lost honor of the généraliste" Acts of research in social sciences Year 2002 Volume 143 Number 143 pp. 31-35.
    • Anne Bargès, " Anthropology and sociology associated with the field with the disease and the médecine" in Introduction to the social sciences in medicine, Paris, Ellipses, 2001, p 131-205.

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