The American Academy of Family Physicians (AAFP) in 1993 has defined Family Medicine which may be considered as one of the best definitions.Decline and rebirth of family medicine
Prof. Kanu Bala
About sixty years back, at the small and big towns, doctors qualified from medical college or medical schools, established their independent practices. Families from those thickly populated areas and adjacent areas relied fully on those practitioners for their health needs. Those doctors consulted their patient at their chambers, they attended house calls, did small surgeries, delivered babies, attended their patients at death beds. These doctors even are consulted for social problems like marriage, education, or family conflicts. These doctors were the most honourable person of the locality. In true sense these doctors are Family Physicians. Family physicians do their works from heart.
What is family medicine?
Family Medicine is that branch of medical discipline, which provides continuing and comprehensive primary care in the set up of family.
The American Academy of Family Physicians (AAFP) in 1993 has defined Family Medicine which may be considered as one of the best definitions.
Family Medicine is the medical specialty that provides continuing and comprehensive health care for the individual and the family. It is the specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family practice encompasses all ages, both sexes, each organ system and disease entity.
Family practice provides person centred, continuing, comprehensive and coordinated whole person health care to individuals and families in their communities.
Family Medicine is not the summation of specialists practiced at a superficial level. It is a specialty like cardiology, nephrology, or hepatology. Family Physicians do not just treat patients; they care for people.
In 2003 National Prof. N. Islam, Founder and Vice Chancellor of the University of Science and Technology Chittagong, defined Family Physicians as: Family Physician is the member of the family with knowledge and skill in medical science.
Family Physician is like the captain of a ship. A ship has engine operators, wireless operator, navigators, doctors, etc. All of them are specialists in their receptive areas.
But to coordinate all those specialists, a ship needs a captain. Family Physician is the captain of health care system.
Decline of general practice
General practice is the oldest medical activity, predating the formation of any specialty. After the advent of man-midwifery in the seventeenth and eighteenth centuries and the conceptual melding of surgery and medicine in the early nineteenth, there followed a century during which most doctors were general practitioners. Only professors and researchers could claim to be specialists.
The average medical practice of the late nineteenth and early twentieth centuries was challenging and diverse.
Most patients were seen on house calls, although doctors also kept offices in their homes. Doctors were also called to deliveries, often using forceps at the request of women attendants. They performed small operations, such as extracting teeth, lancing abscesses, suturing wounds, and reducing fractures and dislocations.
On rare occasions, they undertook major operations, including amputations, mastectomies, and repair of congenital abnormalities such as club foot and hare lip. Despite rarely having time off work and, even less often enjoying full payment, rural doctors usually managed to live quite comfortably and with the respect of their communities.
At the end of the nineteenth century, specialists were increasingly numerous in urban areas. General practice became the equivalent of rural practice and was characterized by culture-based assumptions about the modern doctor and the backward doctor.
The trend toward specialization gained momentum through the 1950s and fewer physicians entered general practice. In the early 1960s, leaders in the field of general practice began advocating a seemingly paradoxical solution to reverse the trend and correct the scarcity of general practitioners-the creation of still another specialty. These physicians envisioned a specialty that embodies the knowledge, skill, and ideals they knew as primary care.
Rebirth of family medicine
The whole subject of medicine was segmented in numerous specialties. An individual specialty was dealing with on the basis of organs or diseases. Specialists were not responsible for the wellbeing of the whole patient, rather a part of him. Patients had to go to different specialists. Still they were not satisfied; nobody was guiding them for what to do, where to go. Naturally the people became frustrated, they felt the necessity of a doctor who would take total responsibility of the health problems of his family. Thus old concept of general practice was revived. In fact it returned to a greater sphere.
Professional organigations
Throughout the whole world, the family physicians organized themselves in the form of professional organizations. The newly formed professional associations immediately went to work on several fronts. They organized workshops for the training and continuing education of their colleagues, and they demanded the right to certify their own trainees. They also sought recognition within hospitals and medical schools.
The American Academy of Family Physicians (AAFP) was founded in 1947 to promote the science and art of Family Medicine. It is one of the largest medical organizations in the United States, with over 100,000 members. The AAFP was instrumental in establishing family medicine as a recognized medical specialty; a certifying board was approved by the Americans Board of Medical Specialties in 1969.
The Royal College of General Practitioners (RCGP) is the professional body for general practitioners (GPs) in the United Kingdom. The RCGP represents and supports GPs on key issues including licensing, education, training, research and clinical standards. It is the largest of the medical royal colleges,1 with over 42,000 members. The RCGP was founded in November 1952 in London, England and is a registered charity.
The College of Family Physicians of Canada (CFPC) is a professional association and the legal certifying body for Family Medicine in Canada.
This national organization of Family Physicians was founded in 1954 and currently over 25,000 members.
In modern Australia, General Practice is listed by the AMC as a medical specialty and the RACGP as the specialist college responsible for assessment.
Education in family medicine
Family Physician is a physician who is educated and trained in the discipline of Family Medicine. Family Practice is an important site for the education and training of medical students. It offers a large number of training opportunities in which medical knowledge can be applied and basic clinical skills acquired.
Membership of the Royal College of General Practitioners (MRCGP) is the main education facilities for the general practitioners of UK. The standard training required for applying is a minimum of 3 years, which must include: a) 1 year as a hospital senior house officer in listed specialties, b) 1 year as general practice registrar, and c) 1 year either in listed hospital or general practice registrar posts.
Family physicians in the United States may hold either an MD or DO degree. Physicians who specialize in family medicine must successfully complete an accredited three-year medicine residency in the United Sates in addition to their medical degree. They are then eligible to sit for a board certification examination now required by most hospitals and health plans.
Family Medicine came to be recognized as a medical specialty in India only in the late 1990s. According to the National Health Policy-2002, there is an acute shortage of specialists in Family Medicine. As family physicians play very important role in providing affordable and universal health care to people, the Government of India is now prompting Family Medicine.
College of General Practitioners of Sri Lanka was established in 1972 and one of the oldest colleges in the world. The college offers Fellowship of the College of General Practitioners (FCGP). Besides, Colombo University runs a one-year long Diploma in Family Medicine (DFM) course for the practitioners.
In collaboration with the University of Calgary, Canada, the Tribhuvan University of Nepal has established a three-year long MD in General Practice. It is now one of the most popular postgraduate medical educations in Nepal. The Government of Nepal is very much keen to utilize the MD-GP passed doctors in remote isolated areas of Nepal.
The University of Science Technology Chittagong is running a One-year long Family Medicine Diploma (FMD) Course at its constituted institute- Bangladesh Institute of Family Medicine Resource (BIFMR). Students from all over Bangladesh are availing the opportunity. The University is planning to start the three year long MD is Family Medicine course at its Dhaka Postgraduate Campus.
Bangladesh College of General Practitioners was established in 1985. In 1990 the college started its FCGP course. It is a one-year long compact course leading to an examination. Now, the college is planning to extend the course to two years term. Bangladesh College of Physicians and Surgeons also is running Fellowship (FCPS) and Membership (MCPS) programms.
Conclusion
The rewards in Family Medicine come largely from knowing patients intimately over time and sharing their trust, respect, and friendship. The thrill is the close bond (friendship) that develops with patients. This bond is strengthened with each physical or emotional crisis in a persons life, when he or she turns to the Family Physicians for help. It is a pleasure going to the office every day and a privilege to work closely with human beings who value and respect our efforts. (Reprint)
The author is a Professor of Family Medicine, Bangladesh Institute of Family Medicine Research, The University of Science Technology
