August 13, 2017

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General Practitioners Helping Hands to the General Public

May 16 is General Practitioners’ day. General Practioners or Family Physicians are front-line soldiers who combat diseases and assist laying healthy environment. As such, they are clinicians as well as public health personals. Family Medicine is a basic entity, or a specialty for general practitioners.
The basic doctors produced by the Medical Universities are simply not capable of entering into practice as full-fledged Family Physicians. They need to be equipped with the relevant knowledge, skills and attitude to become competent Family Practitioners who are capable of handing health needs of families. Those practitioners, after realizing their discrepancies and shortfalls in their day to day practice, expressed their concerns on updating and or upgrading their competencies. However, there is limited possibility for all general practitioners dispersed throughout the country to attend the post graduate courses offered by the Medical Institutes.
Perhaps it is a necessity to prepare the basic doctors practicing in the community with a systematic training programme specially designed to impart essential knowledge, skills and attitudes defined for a compent general practitioner to be able to provide Comprehensive High Quality care in response to the needs of individual person, families and communities they serve.
Emergence of “Family Medicine” has been haliled as a rediscovery of the human, social and cultural aspects of health and disease, and the recognition of the “family” as a focal point of health care, and the right place for integrating preventive, promotive and curative serves.
As such Department of Family Medicine in Medical College is a necessity. IMACGP – 1989 states.
Family medicine has evolved at different rates in different parts of the world. For many decades the doctor that the people knew was the family doctor. He was the doctor that was around to look after all members of family “from cradle to grave”, whether it was to deliver a baby into the world or to treat an illness or to provide counsel.
The development of medical sicience and the hospital at the turn of the previous century not only led to better understanding of man, disease and ways of dealing with medical problems but also resulted in specialization of medicine, leading to fragmentation of care, high health care cost and an impersonal approach, it is said.
Family Medicine / General Practice has matured in the last 50 years. Family medicine is a discipline concerned with the personal, primary comprehensive and countinuing health care of the individual in relation to his family, community and environment, as defined by College of Family Physicians, Singapore, 2002.
The general practitioner/ family physician cares for the individual in the context of the family, and the family in the context of the community, irrespective of race, culture or social class. He/ she is clinically competent to provide the greater part of their care, taking into account the cultural, socioeconomic and psychological background. In addition, he/ she takes personal responsibility for providing comprehensive and continuing care for his /her patients, Word Organization of Family Medicine states in 1991.
The general practitioner deals with patients presenting with undifferentiated problems and provide continuing, comprehensive, whole-person care to individuals, families and their community, according to Royal Australian Collage of General Practitioners, 1991.
“The General Practitioner provides personal primary and continuing medical care to individuals, families and a practice population irrespective of age, sex and illness. He will attend his patients in his consulting room, in their homes and sometimes in a clinic or hospital. His aim is to make an early diagnosis. He will include and integrate physical, psychological and social factors in his consideration about health and illness. He will undertake continuing management of his patients with chronic, recurrent and terminal illnesses. He will practice in co-operation with other colleagues. He will know how and when to intervene through treatment, prevention and education to promote health of his patients and their families. He will recognize that he also has a professional responsibility to the community. The above mentioned abstract is from General Medical Practice, Walton + Beeson, Oxford University Press 1986.
Family Medicine is neither an amalgam of several disciplines or a unique discipline in itself. It is a discipline that transcends specialties as it integrates into a new whole, Dr. Wayne Watson of College of Family Physicians, Canada, wrote in Repor of the P/G Family Medicine Education 1990.
A family physician provides multiple health care, to general public, including
A. Acute and Emergency care
B.    Behavioral problems care
C.     Chronic and continuing care
D.    Domiciliary care
E.    Elderly (palliative) care
F.    Follow-up care
G.    General care and
P.    Preventive care
As doctors of first contact, GP’s has to be conversant with illnesses that may give rise to emergencies. The anxiety and fear of the patient or close ones that may accompany the situation will require expert management as well.
Generally, patients present to the GP’s ambulatory not in the traditional way of “disease” but as “illness” which may has the following characteristics:
(a)    The patient often presents more than one problem at the same visit.
(b)    The problems are often not pressed in order of priority. The most serious problem may be left until the end of the consultation – or not even mentioned at all.
(c)    The most sensitive problems may be expressed in metaphorical language.
(d)    The problem is not necessarily the same as the disease. Thus some of the problems patients bring to their GP are not related to pathophysioloty but are emotional or social in origin and may have to be defined in “non-diagnostic” terms, e.g. “work stress” or “failure to cope”.
(e)    The problem may not allow precise definition because the symptoms and signs are not conclusive, and expensive and invasive investigations are not warranted. One is not going to do spine X-rays for every patient with backache, or barium meals for every patient with epigastric discomfort. Therefore, the problem is defined in “sub-diagnostic” terms, e.g. “lumbago” or “indigestion”.
As one faces modern life, one is forever finding situations where one want to follow two or more contradicting paths. Desires push in one direction, concepts of what would be wise or ethical to do press in other direction. Coping with the resultant internal clashes may reveal behavioral problems which could be classified in many ways;
Ignorance, denial, repression, defense, escape, withdraw, regression, developing physical ailment etc.
May all GPs be competent and updated enough to provide health-care to the community as front-line first contact doctors.

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