PHPM

[Babynephro]

Hi , I was wondering , is PHPM so different from family medicine ? What is the advantage?

[GH0ST]

Oh baby I have been summoned! My chance to talk about PHPM! @Babynephro I hope this helps. 

I think one of the main misconceptions in PHPM that even clinical professionals misunderstand is that there is a difference between clinical public health and public health and preventive medicine/community medicine. The scope and scale are vastly different and you need to take some time to think about how much you want to do PHPM vs clinical public health. 

Clinical public health could be something like a travel clinic, sexual health clinic, addictions medicine, vaccination clinics, and so on. This has some overlap, but not the same as the primary + secondary prevention that happens typically in a family medicine clinic (ex. obesity, HTN, DM, cancer screening, etc). 

PHPM is a medical speciality where the focus is on health of a population. We utilize public health (and to some extent the medical knowledge we attain from medical school + residency) to maintain or improve the health of our community. In essence, our population becomes our "patient." Our interventions become public health programming, case and contact management for diseases of public health significance, or policy advocacy/ generation as a player or leader within the political process. Unlike speaking with an individual patient, a public health physician would be expected to engage with large volumes of stakeholders in various contexts to best manage the health of the community. 

Unlike clinical public health, there's greater emphasis on other topics among the pillars of public health such as health policy, environmental and occupational health, epidemiology and biostatistics, health promotion, chronic disease and injury prevention, while combining other skills such as risk communication/media engagement, business/organizational management, emergency operations/management, etc. We work closely with many medical specialties including FM, EM, infectious disease, occupational medicine,  med microbio, etc. 

For example, an OSCE type question could be how you handle the steps in an influenza outbreak in a nursing home -

establish parameters to confirm the presence of an outbreak,

establishing your outbreak team and engage stakeholder partners (nursing home, +/- provincial PH, HCPs/first responders, etc),

establishing a case definition based on descriptive epidemiology from a line list generation,

implement immediate infection prevention and control measures (hand hygiene, quarantine vs self monitoring, PPE procurement, immediate case and contact management including medications, vaccinations, etc...)

implement medium/long term management response with regular meetings with stakeholders to update those on the changing situation and adapt control measures as necessary (cohorting, PPE, visitor restrictions, stopping communal activities, +/- worker isolation, etc), look into potential new cases in the community

depending on the amount of cases over time, knowing when to declare the outbreak over (typically 2 incubation periods) 

review outbreak management to discuss quality improvement, review previous policies - worker policies, visitor policy, resident policy, vaccination policy, critical staffing shortage policy, etc 

+/- publication into outbreak report 

As you can see, although this example is probably something most clinicians can relate to (there are other types of scenarios that seem out of left field), this does require a somewhat different skillset. I have to trust and support the doctors on the ground to manage their individual patient while I look at the wider scope. 

I'd be happy to answer any other questions you may have. I recommend this resource to learn more about the residency program from the PHPC (Public Health Physicians of Canada) https://www.phpc-mspc.ca/What-is-PHPM

Take care, 

- G