Byung Wook Doh | 2 Articles |
Background
: The role and future of family physician are not yet clearly determined even when 20 years lapsed since its introduction to korea. This study was conducted to establish identity of family physician, to develop pragmatic. curriculum of training, and to sort out frame of certification exam by analysing the job of family physicians who were practicing in community. Methods : We analysed the job of practicing family physician by using DACUM(Development of Curriculum) method from March 11, 2000 through March 12. Job analysis team was composed of five practitioners, four professors, one facilitator, and one scriber. Six sessions of 2 hours were mainly devoted to brain storming of the idea related to family physician. Results : Job analysis results are as follows. Family physician was defined as "primary care physician who provides primary medical service continuously and comprehensively by offering individual patient and/or family health promotion, disease prevention, and treatment of common illness". Family physician had seven duties and 129 tasks. The duty of physical exam had 18 tasks, duty of test, 21 tasks, duty of treatment, 40 tasks, duty of health promotion and disease prevention, 15 tasks, duty of patient/client, management, 12 tasks, duty of clinic management, 15 tasks, and self-development, 8 tasks respectively. Number of tasks whose impotance was classified as 'A'(very important) were 43 as total, 3 in physical exam, 7 in test, 9 in treatment, 11 in health promotion and disease prevention, 2 in patient/client management, 9 in clinic management, and 2 in self-development respectively. Number of tasks whose difficulty was classified as 'A'(very dif-ficult) were 19 as total. 2 in physical exam, 7 in test, 7 in treatment, 1 in clinic management, and 2 in self-development respectively. Number of tasks whose frequency was classified as 'A'(very frequent) were 22 as total, 6 in physical exam, 1 in test 8 in treatment, 3 in health promotion and disease prevention, 3 in patient/client management, and 1 in clinic management respectively. Number of tasks which were required for entry level were 74 as total, 18 in physical exam, 14 in test, 29 in treatment, 9 in health promotion and disease prevention, 3 in patient/client management, and 1 in clinic management respectively. Conclusion : Family physicians in Korea perform 7 duties and 129 tasks. Seventy four tasks are required to enter into the job.
Background
: Depression appears by major disease entity itself but also by physical symptoms frequently and often accompanies with many other diseases. Therefore patients who tend to ignore emotional factors visit to primary care only with additional symptoms. Primary physicians recommend to investigate for somatic diseases but the results are not significant because depression os missed. Identification of depression which appears as physical symptoms is a major role for primary physicians, because they can provide adequate medical care and can relieve the additional symptoms. The purposes of this study are measurement of frequency of depression in primary care and investigation of symp-toms this study are measurement of frequency of depression in primary care and investigation of symp-toms and diseases that are correlated with depression. Methods : Study subjects were all of first-visit patients to Department of Family Medicine, Seoul National University Hospital from May 8th to June 10th, 1995. We investigated depression by Beck Depression Inventory and also demographic characteristics(sex, age, education, marital status, occupa-tion) was collected. Medical charts of responders was audited to collect all registered symptoms and diseases, and we investigated correlations with BDI scores. Adjusted correlations of symptoms and diseases with BMI scores were calculated by ANCOVA, Cut-off value of BMI scores was adopted with 16 points which was reported that false negative rate was minimal in clinical setting. Results : The response rate was 77.8%(207/266) and patients who had BDI score 16 or over were 14.4% of men and 38.5% of women. The prevalence of all depressive tendency was 28.0%. Symptoms which had significant demographic characteristics-adjusted correlations with BDI scores were total number of symptoms, anxiety, fatigue, chest discomfort, weight loss, peripheral tingling sense, general weakness, indigestion, skin lesion, multiple pain. Diseases correlated with BDI scores were anxiety disorder, adjustment disorder, tension headache, panic disorder, anxiety/depression, depression, FGID, hypertension and total number of diagnoses. Conclusion : The results of the study were that the rate of diagnosis of depression was relatively low(6.8%) than the higher frequency of depressive tendency and total number of symptoms was significantly correlated with depression(p=0.0001). Theses symptoms and diseases and used as predictors for depression in primary care.
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