FAMILY MEDICINE-MY PERSPECTIVE

FAMILY MEDICINE- MY PERSPECTIVE

I loved practicing in rural areas. After my graduation I worked for 18 months in a rural hospital where there was no electricity, no oxygen supply, no ambulance etc. It was a family practice treating all diseases and attending labour. I left that place when I was selected for postgraduate course. Once in specialty practice in Medical College I have completely ignored my earlier carrier. When I became Dean of the college I was trying to strictly implement referral system in order to reduce the patient burden so that those who deserve tertiary care may get it. But soon I could understand that this could be a distant dream, as every body wanted to consult specialists. Nobody has confidence in primary health centers. This I thought will disintegrate the health care system. This also will lead on to unnecessary investigations and unnecessary medication which in turn will add to the cost of medical care.

What we need in this scenario is a global approach, a family or community approach. I remember fondly my former Principal Secretary to Govt. who asked me to chart a programme to link primary, secondary and tertiary cares. He sent me to CMC Vellore where a good family medicine department is functioning. He also made arrangement for an interaction with Dr Peter Kuling, a family practitioner from Canada. It was indeed an eye opener for me. We need to strengthen the primary care. For this a strong base of family practice and adequate number of primary care physicians are needed. This really motivated me to initiate the first MD course in Family Medicine in the country. I am really proud of that and still believe that this is a humble beginning and in future Calicut Medical College will be remembered for this.

The American Academy of Family Practice (AAFP) defines family medicine as a medical specialty which provides continuing, comprehensive health care for the individual and family. The scope of family medicine encompasses all ages, sexes, organ systems and diseases. Family Medicine ( FM) aims to provide initial, continuing and comprehensive care, while centering this process on the patient-physician relationship in the context of the family. It is not a patient but the family is treated by a family physician. Primary care physician always aims at relationship building, continuity of care, and seeing the impact on a patient’s health. They focus on disease prevention and health promotion, and when referral is needed, Family physician remains the coordinator of patient care. This leads to decreased chances of inpatient care, higher patient satisfaction, and increased cost-effectiveness.

FM training programs address a large breadth of topics: adult medicine, pediatrics, maternity care, gynecology, care of the surgical patient, musculoskeletal and sports medicine, emergency care, mental health, community medicine, skin, diagnostic imaging and nuclear medicine, and management of health systems. Family physicians have greatest flexibility regarding practice of any specialty.

The first purpose is social change. Many diseases, especially chronic ones like diabetes and heart disease, afflict the poor more than any other group. Chronic diseases are the embodiment of the extreme inequality present in this society. They can be improved with conscientious and thorough care on the part of health professionals dedicated to the underserved and prepared to advocate on their behalf. This ethos is promoted by many FM programs, which emphasize the physician’s responsibility to the community and the family as well as the individual patient. Many FM residencies are located in areas of need and specifically aim to produce primary care physicians to improve health care outcomes in these areas.

Philosophically, I believe that FM is the best platform for delivering primary care.  People live in families and communities, and rarely do illnesses affect only one person.  Patients often come to the doctor with family members, and thus building trust by treating the entire family, offering anticipatory guidance to family members when they come as patients as well as caregivers, and better understanding the dynamics at home through multiple visits are powerful assets when delivering primary care as a family physician.  When that primary care for the family is fragmented through multiple physician practices, the benefits of true primary care can be lost.

 
Practically, it is seen that most FM residents spend nearly 50 percent of patient-care time in the outpatient setting.  Meanwhile, most internal medicine primary care residents typically spend 20 to 25 percent of their time in outpatient care. 
 Family physicians in rural India, has a lot to do like moving from the pediatric ward, OB ward, and adult medicine wards with ease each morning, and then see patients of all ages in outpatient clinic in the afternoon. As a primary care doctor, it seems as though the vitality of one’s practice is often proportional to the breadth of one’s practice.

Finally, as we all know, the health care system in this country is broken, especially, when it comes to the coordination of care.  The broad clinical training one receives in family medicine, as well as the strong new emphasis many family medicine residencies are placing on team-based care; there is a unique position for family doctors to help lead the revolution that is stealthily underway in primary care.