FIVE-STAR FAMILY PHYSICIAN " 70RAYDA E. LEOPANDO, MD MARIA TERESA ROSARIO G. MERCADO, MD INTRODUCTION What is a five-star family physician? Just like inany other: profession, there are certain attributes that a Family Medicine practitioner should have for him/her to get a five-star rank or title. During its 51* Anniversary and Annual Convention, the Philippine Academy of Family Physicians (PAFP) issued its official vision and ission. Its vision is as follows: ‘* Toachieve the unifying vision of a Filipino family physician for every Filipino Family; and * To embrace and accept the challenge to become CHAMPION family physicians, ead and innovate to improve the health care of Filipino families, and contribute to the growth of Family Medicine at the local, national, and global levels. Thus, the PAFP is committed to its CHAMPION Thission: to be an organization of family doctors who share common values; moving together to become health policy shapers in an atmosphere of academicexcellence; and effectively manage health care resources as primary gatekeepers practicing cost-effective care without compromising patient safety, PAFP also believes that sound and judicious Use of information technology while continuing to deliver overall/holistic/total patient care will improve the health outcomes for our Filipino ients, families, and communities. All the care ipino family physicians give will be guided improved by new knowledge generated through active research which can also help guide Family Medicine practice not only locally, but internationally as well (PAFP, 2011). With the CHAMPION mission in mind, the five-star physician concept begins to take its shape. BACKGROUND Patients and families are familiar with family doctors, their doctors of choice whom they consult for most problems. These same doctors almost disappeared with the advent of specialization and sub-specialization. Care became fragmented, but eventually, a need for a personal physician, who is an expert on the person and who provides personalized care was resurrected. Indeed, the trained family physician plays an important role in health care. In the 1960s, Dr. Antonio G. Sison, former Dean of the University of the Philippines College of Medicine and former Director of the Philippine General Hospital, was awarded thetitleof Honorary President of the then Philippine Academy of General Practitioners. In one of his messages to the members in 1970, he wrote about the functions of a family doctor as less that of a healer and more of a conservator of health, coordinator, and integrator. He/She harmonizes and evaluates opinions of the various specialists for the good of the patient. His/ Her broad knowledge and psychological insight make him understand the totality of the patient as a person Gison, 1971).HERI r0<1000« oF FAL ME on R. Angeles, the PAEP described the Ith protector for the In the 1970s, Dr Ram founding President of the family physician as a “heal Filipino family.” : ‘1 In 1991, the World Organization of Family Doctors (WONCA) characterized a ie physician as the one primarily responsible providing comprehensive health care to every individual seeking medical care, and arranging for other health professionals to provide services when necessary. This is very evident in countries with strong national health services like the United Kingdom and Cuba where the citizens are registered with their own physicians. The family physician is a “generalist” who accepts everyone seeking care. The patients he/she sees are undifferentiated. They are not bound by age, sex, or disease entities. The family physician cares for the individual in the context of the family and the family in the context of the community, irrespective of race, culture, or social class. Clinical care is provided with competence, taking into consideration the various social, economic, and cultural factors affecting health and disease (oelen, Hunt, Hac, Rivo, & Shahady, 2002). FIVE-STAR DOCTOR: THE EVOLUTION The five-star paradigm started in the early 1990s as a global strategy to address the need to promote the “Health for All” advocacy of the Alma-Ata Declaration, In 1992, Charles Boelen, then Head of the Human Resource Office of the World Health Organization, raised the need to have five-star doctors who perform the role: i 8 of team member, eae and m Manager, communicator, and Secision maker. The roles have been modified in 2000 into the following (Boelen): . Asacare Provider, the family doctor ‘considers the patient holistically as an individual and ae f a family and communi i A unity and provides high quality, comprehensive, gontinuous, and personalized care within % long-term trusting relationship, TIC ‘ICINE, PRINCIPLES, CONCEPTS, PRAC' ie, AND CONTEXT (© ManLuLuSoG *) a [ Healing ing Manager ofGod Urey r Leader Social Mobitzer Organizer Care Provider! Clinician Lifelong Learner (TeacherfRescaigy Source: Ryan Guinaran. AnecDoc's pp. 87-88, Figure 1. Manlulusog and the Five-star Doctor Nay * Asa decision maker, the family doctor makes scientifically sound judgment about investigations, treatments, and us of technologies that take into account the patients’ wishes, ethical values, cost-effective considerations, and the best possible care er the patients. * Asa manager, the family doctor works harmoniously with individuals and organizations both within and outside the health system to meet the needs of individual patients and communities, making appropriate use of available health data. * Asa communicator, the family doc! Promotes a healthy lifestyle by effectit® explanation and advocacy, thereby empowering individuals and groups enhance and protect their health. As a community leader, the family 400 having won the trust of the people a™! whom he/she works, can reconcile individ and community health requirements, aay citizen groups, and initiate action 0” of the community, wef The physician in Filipino language is bert to as “manggagamot” or healer of the Sik Ryan Guinaran has introduced anew transit, whichis being adapted by the network of HFT, Medical students. He refers to a physii®' in “manlulusog” ot doctor for health, tasK° maintaining the health of his/her patien'®/ overriding role here is that of being a gnd socially responsive care provider. ides promotive, preventive, curative, He rehabilitative care. goes of Family Physicians polistic ily physicians are the only generalist jans trained to provide comprehensive health care needs of the people regardless in developed and developing Fal nysic rm ps i of 986 $m provision of cost-effective and quality health care by family physicians at the primary care level strengthens the conviction of defining their competencies according to the five-star paradigm. However, the skills required of family physicians to address the primary health care F eds of patients and the communities they serve ary depending on the location of practice, the diseases prevalent in their region, the resources available to them, and their proximity to other health care services (Haq et al., 1996). Procedures commonly performed are individual preventive services, office diagnostic procedures, office surgical procedures, control of laboratory testing, supervision of other health rs, and preventive services to communities. In Canada, the roles of family physicians are {guided by the principles of Family Medicine based on the handbook, College of Family Physicians of (Canada: Professionalism for Family Medicine Residency. These roles have been identified as (CFPC, 2003; Gutkin, 2004); |. Medical Expert. The family physician is an effective clinician who arranges practice to maximize the ability to provide patient care, ‘meets “on call” responsibilities, assesses and applies guidelines to maximize patient benefits, maintains knowledge of current literature and Practice in the context of best evidence, and actively communicates and collaborates with other health care professionals to ensure a unified approach to patient care. Collaborator, manager. The family physician teeo™unity-based. He/she understands © Physician’s responsibility to his/her Professional organizations, colleagues, and x rvestarramey eHysican other health service organizations. He/ she is familiar with the health needs of the community, alternative models of health care delivery, and the impact of health care reform issues on the profession and patient care. 3. Health advocate, scholar, professional. The family physician acts as a resource toa defined practice population, uses information technology effectively, maintains medical records in keeping with the Canadian Physicians Society of Medicine (CPSM) guidelines, has working knowledge of the statements and pathways that apply to Family Medicine practice, understands and applies the role of the physician as an advocate, is able to apply research findings to clinical practice in a way that benefits the patient and the community, and participates in research that will benefit the populace and the profession. 4, Communicator. Thedoctor-patientrelationship is central to the role of family physicians. Thus, the family physician understands confidentiality and scope of practice and personal limitations. He provides continuity of care and models patient-centeredness. The Filipino Family Physician Filipino family physicians provide care in the clinic, homes, workplace, schools, hospitals, to patients at various stages of life, and families at various stages of the family life cycle (Leopando, 1995). In 1994, the Department of Health and the Association of Philippine Medical Colleges conducted a series of workshops defining the most appropriate roles of a five-star Filipino doctor, namely, as a health care provider, teacher, researcher, leader/manager, and social mobilizer. In 2003, the Commission on Higher Education strengthened the medical curriculum by validating these roles for medical graduates. The roles became the basis for the core curriculum in Family Medicine (CHED, 2006). In 1998, the Department of Family and Community Medicine of the College of Medicine and Philippine General Hospital, University ofHEMI 012006 0F rae meni, PRINCIPLE CON the Philippines Manila reviewed ace a easel have tefolowing roles health care provider, counselor, teacher/educator, researcher/lifelong learner, and leader/managet/ social mobilizer. These are the same roles the PAP adopted when it reviewed the competencies of family physicians. In the 2005 Planning Workshop of the PAFP, Dr. Josefina Isidro suggested a revision on the format of the five-star family physician by being a health care provider central to the family as follows (Leopando & Olazo, 1998; Fernandez & Leopando, 2007; PAFP Committee on Residency, 2012): a Leet | Figure 2. Five-star Family Physician . As health care providers, the family physicians facilitate entry to the health system as primary care/ first contact physicians, They see ‘patients with undifferentiated problems and provide continuing, comprehensive , cost-effective and high quality care. They know their limitations and refer patients appropriately and promptly. They provide a Patient- at centered, family-focused, and co; ity- communit * As counselors, they apply active listen: skills, empathize with patients and fee Provide alternatives, clarify issues, reassue, Patients and families, and Sive support; * As educators, they promote lifestyles through effective explanatinggee advocacies, thereby empowering individwe, and groups to enhance and protect thei, \CEPTS, PRACTICE, AND CONTEXT health, disseminate information, : i and families, and provide Proferctieny knowledge and skills that are con *i0nay and family-centered. As teachers 4g and residents, they act as role most en trainers. They also act as tutorsfaige _ i ircles, involv; in quality assurance circles, involving ys based trainees and family practtiong « As researchers, they document experi and conduct researches in Practice; appa’ and apply research to clinical decision my manage information about patients ang ® community through record keeping With reporting, analyze health statistics ang daty and use an evidence-based approach to cat by adhering to clinical practice guidelines 4 lifelong learners, they maintain continuin professional development by using electron technology, practicing quality assurance updating knowledge and skills through journals, attending conferences, surfing the Internet, and maintaining a practice portfolio, * As community leaders, they establish a trusting relationship with the people they work with, reconcile individual and community health requirements, advise citizen groups, and initiate action on behalf of the community. As manager, they work harmoniously with individuals and organizations both within and outside the health system to meet theit needs and make appropriate use of available health data. * As social mobilizers, they lead and active Participate in health policy-making advocate patients’ rights and safety, mobil communities towards worthy projects whi will improve their quality of life and pro™™ quality health care development and pros! among colleagues, A descriptive study conducted in 2008/2 Maria Teresa Mercado focused on how the star paradigm was implemented in the re! wit Haining program of Family and Comm Medicine in the Philippine General Lat from 1998 to 2008. The five-star roles tur to be feasible for the resident physician aepody in their practice during the cou: et training. However, some roles camer obemore feasible than the others. depending on the jnterest of the individual resident physician nee. some were more inclined tobe clinicians wt educators, rather than being researchers mealth managers. This study showed that "en the proper motivation, the future family Bins ch do all the five-star roles. These Fj become relevant in the community where fhefamily physician is practicing, depending on theneed of the said community (Mercado, 2012). pUuTURE DEVELOPMENT The World Organization of Family Doctors NCA) is a strong proponent of the concept of thefive star doctor. Itrecognizes family physicians who have shown excellent contributions in health care and in improving the health of families and communities. Italso has a high regard for family ysicians who introduce innovations, conduct and publish studies on comprehensive health, and contribute significantly to medical education. ‘Thus, in 2004, the International Award for Health ee _| Care or Five-star Doctor Award was introduced (Rivo, 2007; Ghent University, 2004). Is there really much ado about the five-star Paradigm? Or does the worldwide community truly have a pressing need for five-star family Physicians? Have we not long imbibed the five-star Toles among our Family Medicine resident trainees? Primary care, characterized by continuity of care and an established relationship between the patient and the physician, was once the central grounding of the U.S. health care system. However 60 million Americans, or nearly one in five, lacks adequate access to health care due to a shortage of primary care physicians in their communities, Health reform has placed growing attention on increasing access to and availability of primary care services by increasing coverage and improving reimbursement and the quality of working conditions of primary care professionals. Family physicians have the flexibility to do their best so long as this is acceptable in their location of practice, and they provide services that other specialists are not willing to deliver within that given area. They make appropriate referral to a tertiary institution when warranted.