NEED FOR A FAMILY PHYSICIAN
“You plant a seed, water it, weed the ground….
but, you don’t grow the seed. All you can do is create perfect conditions for the universe to grow the seed for you.”
Family Medicine is a vast subject, like an ocean, many, many fathoms deep and shallow at the Centre. Most of us contemporaries, are standing only on its shore, while the constantly shifting sands of its beaches and redefinition of the shoreline, never fail to remind us that time continues to change reality.
Over the years, the discipline of family medicine has become complex and challenging. There is also an allegation that the practice of modern medicine has become dehumanized and technology-oriented, which on the one hand ignores the patient as an individual and on the other makes medical care more expensive. With the ever burgeoning phenomenon of specialization in medicine, wherein, “ ‘specialism’, now a necessity, has fragmented the specialists themselves, in a way, that makes the outlook hazardous…the workers lose all sense of proportion in a maze of minutiae“ (1), the need for a competent, caring generalist is more important than even before.
Although the ability to make a competent family physician can only be mastered by practice, its basics are best learnt in medical schools. Unfortunately, the present dearth of teaching of family medicine in many countries makes this ideal difficult to achieve in practice. Many students and even recent graduates may acquire only a sketchy knowledge of the overwhelming, undifferentiated problems and illnesses with an overlap of organic and psychological aspects that form the bulk of family practice. There is also a constant challenge to make an early diagnosis of “masquerading” life-threatening illness.
The situation in a developing country like India , the pattern of general practice is at variance with those in developed countries. The ethnic, cultural, social, economic, educational and a host of other related political factors including quackery, regulate the system of general practice. To overcome these difficulties, the physician has to considerably modify his approach and balance available health resources to the optimum.
Although it’s over four decades since family medicine has been recognized as a distinct medical specialty, the question that is being consistently discussed in almost all medical forums is that, in the present days of rapidly changing health care delivery system and technologically advanced world, what sort of family doctor.
do we need for the new millennium. There is no doubt that in the years to come the world will be technologically different; but what is unchanging is the human need to be loved, to be cared for and to love. In illness, in emotional distress, in sorrow, families and individuals seek someone who they can trust, confide in, seek advice and direction. We need this special kind of person to become a family doctor. What can we do to produce family doctors and create an environment in which they can function effectively and efficiently?
To enhance the status of Family Medicine, affiliated academic organizations in their Project Committee reports, such as the ‘Future of The Family Medicine Report’ (2) , as well as the recently concluded South-East Asia Regional Scientific Working Group Meeting on Core Curriculum in Family Medicine, at Colombo, Sri Lanka, in June 2003, under the auspices of WHO (3) , have recommended specific protocol for promotion of family medicine programmes. It is heartening to learn that, the speciality of Family Medicine, which in the forefront in many advanced countries, has now gained momentum in India as well. The ‘Preamble’ of The National Board of Examinations , Ministry of Health and Family Welfare, Govt. of India (4) , states -
“The present undergraduate medical curriculum and the internship are inadequate to turn out well trained and competent medical professionals to serve the community needs. Preventive, promotive and rehabilitation aspects, which form an integral part of healthy living, have lost focus with most of the medical practitioners. More than 80% of our population comprises of either the rural or urban poor. They are unable to get access to adequate medical care facilities from the exiting hospitals. Moreover, to practice holistic medicine, the treating physician should also understand the social, cultural and economic conditions of the family. Family physicians need to make the optimal use of the resources and judiciously select the investigations for diagnosis. They can form the backbone of health care delivery system and can play a vital role in fulfilling the Rural Health Mission announced by the Government of India”
It must be emphasized that, it is not the question of completing the course, but it is the question of developing the concept of family medicine in the young minds. It is in this context that a sincere effort has been made in the book for family physicians towards the solution of the above problems in the teaching-learning process of the subject.
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References:–
1. Sir Willam Oslar – 1910, 16 th May – address to Classical Association at Oxford .
2. Future of Family Medicine - Project Leadership Committee. The Future of Family Medicine: a collaborative project of the family medicine community. Ann Fam Med 2004; 2 ; S3 – S32
3.WHO Project Report no. ICP OCD 002.
4.DNB in Family Medicine (New regulations), June 2005.
