.Assist.

Prof
Dr. Huda Adnan Habib AL- Mousawie
Family Medicine Consultant

/ Family & Community Medicine Department

AL-Kindy college of medicine

five-star doctor
The term five-star doctor has been
promoted to represent the model
, physician for today's society
who should be able to respond to the
needs of both
individual patients and their
.community

five-star doctor
The Five-Star Doctor is one who improves
the quality of care by responding to the
patients total health needs with
integrated preventive, curative and
rehabilitative services while considering
the patient as an integral part of a family
. and a community

five-star doctor
The Five-Star Doctor makes optimal use
of new but cost-effective technologies,
bearing in mind ethical and financial
considerations and the final benefits as
.well as costs to the patient and society

five-star doctor
The Five-Star Doctor promotes healthy
lifestyles by effectively communicating
with individuals and groups and empowering
them for their own health protection and
.well-being

five-star doctor
The Five-Star Doctor works and functions
efficiently and effectively in teams, both
within and across the health sector and
the socio-economic sectors influencing
.health

In much of the world, both (health care

beneficiaries and those who plan, finance
and provide health care) are increasingly
aware of the need to reform health care
systems but
have very different priorities and
expectations.

For example, consumers primarily want

high-quality health services in adequate
quantity;

health professionals want to expand their

knowledge base and exercise independent
judgment in providing the best possible
care;

health care policy-makers want care for

all citizens that is cost-effective.

For a health care system to make the necessary

changes and run efficiently, however, the main
stakeholders must decide to work together and
must agree on a set of fundamental values:

Relevance,
quality,
cost-effectiveness and
equity

Relevance, quality, cost-effectiveness and

equity are values implicit (understood) in the
goal of health for all, endorsed (authorized) by
all nations and governments, which offers
such a basis.

The stakeholders policy-makers, health system

managers, researchers, care providers, educators
and consumers all alike must consider
readjusting their expectations to ensure that these
values are upheld and peoples health needs are
better met.
It is in this context that the future role of health
professionals, and in particular, the medical
doctor, should be thought of ; (the above values)..

:Relevance
Relevance (synonyms: importance, significance).
Relevance in health care can be defined as the
degree to which the most important problems are
tackled first.

:Relevance
Although priorities may be interpreted in different ways
in different societies or by different groups within the
same society,
primary attention should be given to those who
suffer most, to (diseases) that are most prevalent,
and to conditions that can be addressed with
locally available means.
It is fundamental that health policy reflect these
priorities.

:Relevance
Relevance also implies an organized effort
to constantly update a plan to address
the priority health needs.

:Relevance
Certain aspects of relevance may be
considered universal (general) as
articulated in the Declaration of Alma-Ata,
: these include issues of
universal access,
primary health care services,
essential public health services and
availability of essential drugs.

Quality

:Quality
High-quality health care uses evidencebased data and appropriate technology to
deliver comprehensive health care to
individuals and populations, taking into
account their social, cultural and consumer
.expectations

:Quality
WHOs definition of health as a state of
complete physical, mental and social wellbeing and not merely the absence of
disease or infirmity should be a guiding
light for health care *reformers and
.communities
Reformers: A change for the better; an improvement*

:Quality
The search for high-quality care by consumer
modified to respond to their specific needs
.for well-being
High quality in health care must therefore
encompass (cover) the technical criteria
set by health care providers and the
comfort criteria set by health care
.consumers

:Quality
Primary care provided by physician
specifically trained to care for problems
presenting to personal physicians,(who
know their patients over a span of time) ,
is of higher quality than care provided by
other physicians.
This has been confirmed by a variety of
studies comparing the care given by
physicians in different specialties.

Cost-effectiveness

:Cost-effectiveness
Cost-effective health care systems are those
that have the greatest positive impact on
the health of a society while making the
best use of its resources.
Whatever the level of resources available,
cost-effective care can be provided.

:Cost-effectiveness
The rise in health care costs is due to universally
observed phenomena:
specialization in health care, which implies the
use of costly procedures;
increased access to health services due to
socio-demographic changes;
increased demand from individual consumers
as expectations for a better quality of life result
from wider access to information.

Cost-effectiveness
:(continue)
As these phenomena will persist and even be
amplified in the future in any society, all health
policy-makers and health care providers concerned
with the health system improvement must give
urgent attention to the containment (suppression)
of cost without compromising effectiveness in
health care.

Cost-effectiveness
:(continue)
This issue is extra urgent as in governments under
socioeconomic pressure which offer no increase in
health budgets; in many countries, health budgets
are decreasing even as the health status of the
people is deteriorating.

Cost-effectiveness
:(continue)

Many studies showed that:

Countries with strong primary care have :
Lower overall health care costs,
Improved health outcomes , and
Healthier populations.

Cost-effectiveness
:(continue)

Many studies showed that:

Physicians who is well familiar (up-to dated) with
the patient not only provides more personal and
humane medical care but does so more
economically than does the physician involved
.in only episodic care

Cost-effectiveness
:(continue)

Because of the fact that family doctor-patient

close , ongoing relationship, the family
physician is under less pressure to exclude
diagnostic possibilities by use of expensive
laboratory and radiological procedures than is
the physician who is not familiar with the
,patient

Cost-effectiveness
:(continue)

Many studies showed that:

The greater the number of the primary care
physicians practicing in a country the lower the
. cost of health care

:Equity

:Equity
Equity, which is central to a socially accountable
(responsible) health care system, means motivated
towards making high-quality health care

available to all.
The central goal of the WHO Global Strategy for
Health for All is that all people receive at least
such a level of health that they are capable of
working productively and of participating
actively in the social life of the community in
which they live.

:Equity

To attain such a level of health, every individual

should have access to primary health care and
through it to all levels of a comprehensive health
system.
Consumers expect health services to be
comprehensive, continuous and their seek for
relevance, quality, cost-effectiveness and equity is
universal.
Societies at every level of socioeconomic
development seem to adhere to the same
fundamental principles.

:Equity
Attaining each of these values is indeed a challenge
for health reformers, but even more demanding is
the need to address this challenge in a
balanced way.
But the tensions that exist in a health reform process
that aims of finding technically appropriate and
socially acceptable compromises ( ) among
all values at the same time.

The Emergence of the 5-Star

Doctor
The optimal (best) model of health service
delivery may be one that contributes to the
meeting of different inputs towards the
satisfaction of the values of relevance, quality,
cost-effectiveness and equity in health.

The Emergence of the 5-Star

InDoctor
1994, in the joint WHO and WONCA (World
Organization of Family Doctors) conference,
reference was made to the five-star doctor
particularly when recommendation was made that
the family doctor (general practitioner/family
physician) should have a central role in the
achievement of quality, cost-effectiveness and
equity in health care systems.

The Emergence of the 5-Star

Doctor
To fulfill this responsibility the family doctor must
be highly competent(skilled) in patient care and
must integrate individual and community health
care
In 1995 the World Health Assembly, the principal
governing body of the WHO, adopting
Reorientation of medical education and
medical practice for health for all,
urged WHO and its Member States to undertake
coordinated alteration in health care and in health
professions practice and education.

The Emergence of the 5-Star

Doctor
It also called for a Coordination of worldwide
efforts to reform medical practice and
medical education in line with the principles
of health for all and more relevant to
peoples needs
by cosponsoring consultative meetings to put
forward appropriate policies, strategies and
".guidelines

The Emergence of the 5-Star

Doctor

The WHO global strategy for implementing this

resolution, as articulated in the document Doctors
for health, mentions that
Doctors of tomorrow may not be doctors of the "
, day-after-tomorrow
as societies and health systems start change and
. version (form) to current and expected needs
But certain universally essential skills characterize
".what WHO calls the "five-star doctor

FUTURE TRENDS:
New thinking and courageous attempts must be made
to counteract (work against) the fragmentation of
the health care delivery system, which is
characterized by at least three splits :
the first is the relative isolation of individual care
from population-based care, or in other words, the
split between medicine and public health;
the second is the split between generalists and
specialists and
the third is the split between the health sector and
other sectors with a bearing on health .

In Summary
There is a need for:
alteration of medical practice and medical
education to be more relevant to peoples needs.

health services to be comprehensive,

continuous under the umbrella of values
(relevance, quality, cost-effectiveness and
equity).
Doctors of tomorrow with universally essential
skills.
De -fragmentation of health care delivery
system.

Qualities of the Five-Star

Doctor
The concept of the five-star doctor is planned
as an ideal profile of a doctor that carry out
the range of services that health settings
must deliver to meet the requirements of
values of relevance, quality, costeffectiveness and equity in health.

Qualities of the Five-Star

Doctor

An authoritative WHO publication gives the

following qualities of the Five-Star Doctor:
1) responds to the patients total health needs
2) makes optimal use of new technologies
3) promotes healthy lifestyles
4) balances patients and community expectations
5) works efficiently in teams

Qualities of the Five-Star

Doctor
A doctor with all five might be called a "five star doctor". He would
be expected to fulfill the following functions:

Assess and improve the quality of care by responding to

the patient's total health needs with integrated preventive,
curative and rehabilitative services

Make optimal use of new technologies, bearing in mind

ethical and financial considerations and the ultimate benefit of
the consumer

Promote healthy lifestyles by means of communication skills

and the empowerment of individuals and groups for their own
health protection

Qualities of the Five-Star

Doctor
Reconcile (merge) individual and community
health requirements, striking a balance
between patients' expectations and those of
society at large, both short term and long term.
Work efficiently in teams both within the health
sector and across the health sector and other
socio-economic sectors influencing health .

World Health Organization Attributes of

5 Star Doctors
The 5-Star Doctor should be:
Care Provider
Decision Maker
Communicator
Health Advisor and Community Leader
Manager and Team Member

qualities
1) responds to the
patients total health
needs
2) makes optimal use of
new technologies
3) promotes healthy
lifestyles
4) balances patients and
community expectations
5) works efficiently in
teams

Attributes
Care Provider
Decision Maker
Communicator
Health Advisor

and Community
Leader
Manager and
Team Member

:Care-provider
Besides giving individual treatment five-star
doctors "must:
take into account the total needs of the patient
(physical, mental and social).
They must ensure that a full range of
treatment (curative, preventive or rehabilitative)
This care will be dispensed in ways that are
complementary, integrated and continuous.
And they must ensure that the treatment is of
the highest quality.

:Decision-maker
five-star doctors will have to take decisions that
can be justified in terms of efficacy and cost.
From all the possible ways of treating a given
health condition, the one that seems most
appropriate in the given situation must be
chosen.
As regards expenditure(cost), the limited
resources available for health must be shared
out fairly to the benefit of every individual in
the community.

Communicator:
Lifestyle aspects such as a balanced diet, safety
measures at work, type of relaxation (vacation),
respect for the environment and so on all have a
determining influence on health.
The involvement of the individual in protecting and
restoring his or her own health is therefore vital,
since exposure to a health risk is largely determined
by ones behavior.

Communicator:
The doctors of tomorrow must be excellent
communicators in order to persuade
individuals, families and the communities in
their charge to adopt healthy lifestyles and
become partners in the health effort.

Community leader:
The needs and problems of the whole community in a neighborhood or a district - must not be
forgotten.
By understanding the determinants of health
inherent in the physical and social environment
and by appreciating the breadth of each problem
or health risk five-star doctors will not simply be
treating individuals who seek help but will also take
a positive interest in community health activities
which will benefit large numbers of people.

Manager and Team :

member
To carry out all these functions, it will be
essential for five-star doctors to acquire
managerial skills.
This will enable them to initiate exchanges of
information in order to make better
decisions, and to work within a
multidisciplinary
team
in
close
association with other partners for health
and social development.

Although the five attributes described

above may equally apply to any health
professional, family doctors come close
to fulfilling the concept of the five-star
doctor, and it is fair to say that they are
seen as playing important roles as
primary care providers who can bring
together quality and cost-effectiveness in
care.

What Makes a Good Doctor

Many studies showed that A good doctor should
: have three qualities ( from patient point of view)
knowledge, empathy and philosophy.
First, knowledge:
a good doctor should be knowledgeable and should
keep side by side of developments in his or her
field of expertise.
A good doctor should be a skillful diagnostician.
A good doctor should neither under-prescribe nor
over-prescribe medication to his patients.

What Makes a Good

Doctor
:Second, empathy
a good doctor should have a high Emotional
personality
It was noticed that most of patient chose to go to the
doctor of old age . Probably because he had a
warmer personality, was a better listener and
communicator and was able to inspire his
.patients confidence in him

What Makes a Good

Doctor
:Third, philosophy
. a good doctor should also be a good philosopher
A good doctor should treat his patients in a holistic
way. He should counsel his patients on their diet,
. exercise, and stress management
A good doctor should understand the limits of
efficacy of western medicine and should have an
.open mind to what is called alternative medicine
A good doctor should be wise and humble not strict
. and superior
Thank you

Thank
You

What Makes a Good

Doctor
the qualities of a good doctor can be summed up by the
word ASK.
A is for Attitude
The attitude of a medical practitioner to his work, his
profession, the patients he sees, is of greatest
importance.
a good doctor is one who truly cares for his patients, who
possesses a deep compassion for them and is
committed to alleviating suffering.
He is motivated by the well-being of his patients rather
than material or other gains, such as fame or status.

What Makes a Good

Doctor

He is empathic, placing himself in the positions of

his patients and seeing it from their points of view.
He asks, seeks clarifications and listens actively to
their difficulties, and not assume that he knows
them. He then decides on the diagnosis and
treatment modality.
Since he has had the privilege and benefit of
medical education, he recognizes his obligation to
society. He thus serves not only the individual
patients that he sees, but the wider community in
various ways e.g.. committees, public education
programmes.

What Makes a Good

Doctor
S is for Skill
Another very important quality of a good doctor is
skill. He is skilled and competent in his trade,
able to make accurate diagnoses and treat his
patients appropriately to ensure the best
possible recovery, without having to put them
through a series of unnecessary and/or
expensive tests, resulting in unnecessary
suffering and hardship. This instills confidence
in his patients.

What Makes a Good

Doctor
K is for Knowledge
skills and the right attitude must be undergirded by
sound medical and professional knowledge.
A good doctor should keep himself abreast (side by
side) of latest research findings and developments
that would enhance his professional practice as this
would affect the quality of care that he provides to
his patients.
In addition, he should be adequately informed about
the services that are available in the community.
He could then make appropriate referrals for his
patients e.g.. rehabilitation centers, to enhance their
total well-being.

Wonca Award of Excellence in

"Health Care "The 5-Star Doctor
This is an award to be conferred on
physicians, who in the opinion of the
Council, have made a significant impact on
the health of individual and communities,
through personal contributions to health care
. and the profession

Wonca Award of Excellence in

Health Care "The 5-Star
Doctor
It"is
instituted in an attempt to increase the global
development of Family Medicine, global
. networking and partnership
The award is preferably given to those who are
still active in the field for which they are
. nominated

Wonca Award of Excellence

in Health Care "The 5-Star
"Doctor
The
award will be offered on a Regional (Wonca
Regions are: Africa, America's, Asia-Pacific,
Europe, Middle East South Asia Regions) and
Global basis.
The Regional Awards may be awarded on an
annual basis and the Global Award be awarded
every third year.
The award will take the form of a medal and a
.certificate

Wonca Award of Excellence in

"Health Care "The 5-Star Doctor
The criteria to be considered by the selection
committee/s will include the following.

impact on health care of individuals and community

contribution to regional/global development
community perspective and involvement
networking for the benefit of the community
innovative (advanced) services

Star Family Doctor-5

Star Family Doctor-5

means

Star-5
means
Top Quality
means
means
Adherence to the right standards
Adherence to the right standards
means
means High Level of Excellence
High Level of Excellence
means
means
(*****) Star-5

Top Quality

(*****)Star-5

Wonca Award of Excellence

in Health Care "The 5-Star
"Doctor
development of services in previously underserved /

disadvantaged areas
demonstrated support of colleagues in another
region/country/college
performance of academic work of quality and relevance
including teaching and research the development of
models which could be applied to other regions/areas

best meet the criteria of the "5-Star" health professional

Care provider- Decision maker
- Communicator
- Health Advisor and Community Leader
- Team member

The concept of the "Five Star Doctor", as the ideal

doctor for today's society, sits comfortable with
those who provide health care in community
. settings
Traditionally, the family doctor has exhibited the
attributes of the five star doctor even when
specialization and technology threatened to
. overwhelm medicine
The swing back to the generalist in recent times
makes it essential that these attributes be spelt
out, understood and accepted by all health care
.workers

WONCA, the World Organization of Family Doctors,

has a global objective to improve the health of the
people of the world through education, research
.and health service provision
It sees the family doctor as central to any health
care system which sets out to provide high quality
personal health care at a cost the community can
.afford
So how well do today's family doctors match the
?ideal five star doctor

It is part and parcel of the role of the family doctor to

"assess and improve the quality of care by
responding to the patient's total health care needs
with integrated promotive, preventive, curative and
". rehabilitative services
Whilst most patients still present to their doctors with
complaints for which they seek a cure, family
doctors are alert to seize the opportunity to give
advice and take actions which will prevent disease
. and disability

They do so through primary prevention such as

immunization, through secondary prevention by
the early detection of disease in its
presymptomatic phase, and through tertiary
prevention where the doctors' efforts are directed
towards minimizing the progress of established
. disease
Additionally, it is in the field of promotion of health
and the enrichment of life that the family doctor
.excels

Family doctors have always been conscious of the need to

"promote healthy life-styles by means of communication skills
and the empowerment of individuals and groups for their own
". health protection
They have shown their patients the advantage of a healthy diet,
exercise, relaxation, good family relationships and a congenial
. working environment
They spend much of their time educating individual patients and
in providing health education at a more general level for their
.patient population
Health promotion is the stock in trade of the family doctor who
realizes that most of the major disabling diseases can be
.avoided by healthy living and preventive care

Family doctors have been particularly mindful of the need to

"make optimal use of new technologies, bearing in mind
the ethical and financial considerations and the ultimate
".benefit of the consumer
Diagnostic technologies which have high predictive value in
specialist hospital settings have an entirely different
. predictive value in community settings
Conscious of this, family doctors use those technologies
which through experience are found to be most efficient
and effective in detecting illness in the clinic and in the
patient's home where the prevalence and pattern of
.disease differs sharply from that seen in the hospital

In recent years, with the escalating cost of health care, and

particularly high technology, the family doctor has been
sensitive to the need to"reconcile individual and
community health requirements, striking a balance
'between patients
expectations and those of society at large, both short and
long term". Family doctors have moved from the "spare
no expense" approach to being conscious of the cost to
. the community

They use expensive resources prudently and

recognize that priorities need to be established
to govern how these resources are deployed.
They
recognise that it may be wiser to spend money on
building a facility for elderly people than on high
technology equipment which has limited
.value in community terms

Although family doctors are often seen as individuals

working somewhat in isolation, they often work in
groups, and even the solo doctor has a team of
assistants such as receptionists, nurses and
. dispensers
Family doctors increasingly recognize the need to work
not only within the health sector but also with other
. sectors such as social welfare, urban planning, etc
So the family doctor is already a five star doctor, but like
some modern hotels, which now boast a six star
rating, maybe the family doctor needs to be a six star
.doctor

It is becoming increasingly apparent that if doctors are

to practice in an ideal way, not only do they need to
be properly educated themselves, but society itself
also needs to be educated to know what to expect of
.its health care service and its doctors
It is sometimes the unrealistic expectations of the
public and traditional health beliefs of individual
patients which bring pressure to bear on the doctor
. to behave in a way which is not ideal
.

For example, in some societies, the doctor is under

continual pressure to prescribe more and more
drugs, not just for curative purpose or symptomatic
relief, but for imagined or hear-say belief that the
.drug can do them good
The doctor who attempts to prescribe rationally runs
the risk of his patients leaving him for doctors who
.will meet their unprofessionaldemands

Therefore the family doctor has a

:sixth
role patients and the community to
that
of educating
change their expectations to those that are
consistent with good medical practice as we
understand it today. So perhaps we should be
: adding a sixth star
to educate individual patients and the community at "
large about the nature of health and illness, what
medicine can and cannot do, the dangers of overmedication or self medication and the most costeffective way of utilizing the community's health
".care resources

Thank You