The credibility of medical care is gradually losing its ground and it is being considered to be replaced by the holistic concept, which concentrates on the wellbeing of the body as a whole rather than in piecemeal, part by part. In the 4th century B.C. Socrates warned against treating only one part of the body. He said, “The part can never be well unless the whole is well.” The US Center for Disease Control and Prevention Report states the specific key factors that influence an individual’s state of health. It points out that quality of medical care contributes to only 10%, heredity accounts to 18%, environmental factors to 19% and everyday life style choices to 53%, which will affect our health condition. The decision people make about their life and habits are therefore by far the largest factor in determining their state of wellness or disease condition. Addiction to harmful substances and lack of essential nutrients in the body can result in imperfect functioning of cells unable to do what is required of them to maintain a healthy state. Who can help to take care of the whole body and mind and also advise on life style issues? Simple answer is ‘your family doctor’. He can advise on preventive health as well as treat most of the conditions that you may suffer. He is easily accessible and lives close to your place of residence. Unfortunately the concept of family doctor has been given a goby.
It has been felt that there is a need for rapid revival of the family doctor. According to a planning commission paper India needs to produce minimum of 15000 family doctors per year to take care of its ageing population, children, women and esp. the youth. A relatively young population is India’s dividend, but how is the country going to benefit from it if the same population is crippled with disease, illness, and sickness and burdened with low quality or costly healthcare? It is estimated that by 2030 India is geared to have an additional one million newly qualified medical graduates to the healthcare workforce. However the biggest challenge would be to engage this large number of professionals in proper training in family medicine and make useful for community-based services. There is also a need to sustain the quality of skill and training of this huge health force. A quack or fresh graduate without adequate experience cannot be a family physician.
What is family medicine?
Family medicine (FM) is a clinical medical specialty which is devoted to the comprehensive health care for people of all ages and provides continuing and comprehensive health care for the individual and family across all ages, genders, disease and parts of the body. Family medicine has been developed as a counterculture in response to rapid fragmentation of medical care during post second world war period into specialty and sub specialty care in the much of the developed world. The concept evolved as a concept of medical care to cater to the growing demand of the people for personalized, continued and comprehensive care. Family medicine evolved from the historical tradition of general practice. In much of the developed world and in countries such as USA, UK, Canada, and Australia; family medicine is a distinct academic discipline, knowledge domain and specialty vocational which is imparted through structured residency training. In fact in developed countries, trained family physicians are able to provide care to 90% of the healthcare needs. Diseases such as ‘Diabetes’ and “Hypertension” are considered primary care diseases and managed in community setting unlike India where these clinical conditions are considered specialist domains.
The number of traditional general practitioners is decreasing. During last 50 years much of the medical care has fragmented into organ based specialty domains. In India this trend has become more prominent with arrival of ‘Super specialist” and Super Specialist Hospital” culture. Unlike most of the world, medical education is imparted exclusively at tertiary care hospitals (medical college hospitals) and by specialist doctors only. The role models of medical students are teachers who are by regulations specialist doctors only. Family physicians are not eligible to become medical teachers because of the lack of post graduate qualification and disabling regulations; their practices are not considered teaching locations. Therefore medical students do not have any exposure to this wonderful and viable lucrative career option, considering huge population and morbidity prevalent in the community. As an outcome, the community based family practice space remains vacant and largely has been taken over by quacks and faith healers.
Today there is no one doctor who is responsible for the whole person. People often find it frustrating when their small health related questions are not answered by the treating doctors, as they have to visit multiple health care providers. People want solutions which only family physicians can provide, who are capable of generalist care. Family physicians can provide quality and cost effective healthcare.
Family medicine is a recognized post graduate specialty through both Medical Council of India and National Board of Examinations. There are 200 DNB family medicine seats available through CET. The first MD program in family medicine has started at Calicut Medical College, Kerala. The family medicine specialty has already started taking shape in India. The professional society of family medicine doctors is known as ‘Academy of Family Physicians of India’. Family medicine covers antenatal care to palliative care and end of life situations. Care of elderly is part and parcel of family medicine practice therefore necessary skills should be acquired. It also entails primary prevention as well as timely attention to prevent deterioration of health, so to say ‘a stitch in time saves nine’.
Unlike specialists, FPs’ services are not confined to specific organs of the body and they treat patients with multiple health issues with a wider concept of general knowledge which is not confined to any specific organ. Their role is to detect the diseases early and in suitable cases refer the cases to the concerned specialist.