FAMILY MEDICINE – NEW SPECIALIZATION – MOST NEED FOR DEVELOPING COUNTRIES

Dr.S.ABBAS ALI
MD, DFM, DNB(FAM.MED)
MNAMS (Family Medicine)
FCGP, MCCP (Cardiology)
PGDHSc(Ultrasonography)
PGDHSc(Echocardiogram

Family medicine is defined as a field of specialization which provide comprehensive and holistic health care services centered on the family as the unit – from first contact to the ongoing care of chronic problems including promotive, preventive, curative and rehabilitative health care services. Family medicine is different from Community medicine. Community medicine specialists deals with populations and try to measure the needs of populations both sick and well and engaged in services to meet those needs. They do not provide comprehensive health services to individuals or Family. Family medicine is horizontal speciality like internal medicine and pediatrics, shares of large areas of content with other clinical disciplines. Family medicine is different from Internal medicine. The specialty of internal medicine is comprised of physicians trained in adult medicine who provide the majority of health care to adults in the hospital or clinic. The internist do not trained in maternity and child care and they do not treat children and neonates. In short, Family medicine specilist is specialist in internal medicine, paediatrics, Obs&gynae, surgery and community medicine. single specialization for all the problems of family and needed for developing nations.
Medicine has moved from organism to organ, from organ to cell and from cell to molecular properties. The vast increase of medical knowledge during the 20th century has contributed to increasing complexity of specialization with in the medical profession. There are at present 20 recognized specialties and many more subspecialties. Some specialties have emerged based on clearly defined skills such as surgery, radiology, and anesthesia, some based on parts of the body such as ENT ophthalmology, cardiology and gynecology and some based on particular age group such as pediatrics, geriatrics and obstetrics. Again in each speciality, there has been a growth of subspecialties as for example, neonatology, perinatology, pediatric cardiology, pediatric neurology, and pediatric surgery – all in pediatrics. A super specialist or sub specialist is one who learns more about less and less. He is concerned with particular organ or part of the body. The specialization and micro specialization contributed the mushrooming growth of large luxurious super speciality hospital. No doubt, specialization raised the standards of medical care but it favors high cost, low coverage, and elite oriented health services.
Despite spectacular advances in medical advances and massive expenditure, the death rates and life expectancy in the developed countries have remained unchanged. So the developed and developing countries needed a specialization which focuses on organism or specialization in general practice which give comprehensive and personalized health care. In 1966 two reports namely Mills commission report, Willard committee reporting United States made similar recommendations. In 1971 the American academy of general practice which began in 1947 changed its name to American academy of Family physicians. The emergence of new speciality family medicine has been hailed as a rediscovery of the human, social and cultural aspects of health and disease.
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. It is a specialty in breadth that integrates the biological, clinical and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity.” Family medicine aims to provide initial, continuing and comprehensive care, while centering this process on the patient-physician relationship in the context of the family. These physicians emphasize disease prevention and health promotion, and when referral is indicated, the physician remains the coordinator of patient care.
In Family medicine referral system is not just sending patients to super speciality hospital or sub specialists but they consider it as two way exchange of information by referring to particular sub specialist and follow-up care of those who referred in consultation with sub specialist. It will ensure continuity of care and inspire confidence of the patients. The family doctor serves as a patient advocate in dealings with sub-specialists, third-party payers, employers and others. Ideally, this leads to decreased disintegration of patient care in inpatient settings, higher patient satisfaction, and increased cost-effectiveness.
National board of examinations, New Delhi requirements of family medicine specialization include after passing primary, 3 year mandatory training in the recognized centers of NBE, acceptance of thesis, pass in final examination. The training programmes address a large breadth of topics; general medicine, surgery, 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