Date: 26-11-14  Time: 20:56 PM

Author Topic: Family Medicine or Specialized General Practice (GP) Situation in Pakistan  (Read 1608 times)

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Family Medicine   

Family Medicine is a specialty with expertise in treating common health related problems of all the members of a family.


Objective : " To ensure a dedicated specialized medical care for public expert in dealing with common health issues" 

Evolution of The Concept of Specializations.

Before the advent of specialization and super specialization a single   doctor used to take care of all the different categories of diseases. As   the medical knowledge gradually increased, it became difficult for a single doctor to be competent in all the fields of medicine and thus various specialties were born. The first division resulted in birth of Surgeons and physicians as two broad cadres. With further growth of knowledge more and more specialties and sub specialties got included in the list. There were definite benefits of this trend as a specialist who deals with a single specialty  has to sharpen  his skills in a single field instead of trying to master all the fields. Patients encouraged this situation as they found competent doctors dealing with their illnesses and doctors became happy as they had to focus on their own particular fields. With this trend the Specialists and specializations gained popularity and monetary benefits started hovering around specialist cadre.


Who is my doctor? But the goodness had its own evils and curse. The rising popularity   and trend of specialization discouraged  doctors to stay in the role of   general physician and most of the doctors entered into a struggle to   become specialist. With this development patients encountered a new   problem. They found that their family physicians gradually started   disappearing from scene. Either there were no GPs or only those adhoc   GPs were found who were not at all interested in the field and were   planning to enter into a specialty at the first opportunity.
The main problem which patients faced was that  no single doctor    competent enough to look after their different common illnesses of all   the members of a family remained available, whom a family could consult   in case of their common problems. People started asking question like:

"who is my doctor?"

"who is our Family Doctor"

This situation called for the revival of institution of good old Family Doctor.

The Era of super specialization undermined the vital institution of Family Physician.   Every specialist has an expertise in his own specialty but whenever the case falls beyond his domain he is often helpless due to least experience in other fields. This often leads to patient mismanagement and frustration.
There is no substitute for a dedicated family physician.   

Birth of Family Medicine. 

It was therefore decided to introduce the specialty of Family Medicine   or GP Specialization as it is variously termed in different countries.   This Specialty was meant to be properly tackle common problems of all   the members of a family. These problems usually constitute about 80% of   the health problems faced by people. The training of Family medicine   Specialists was so planned that they should be competent to   independently tackle most of these common health issues and for the   remainder uncommon issues they could arrange referrals to the concerned   specialists. This system offered a close bond between a single doctor   and families dependent upon him for their health services. The Family   Physician is thus well aware of the health status, diseases prevalent,   inherited and family disorders, as well as social circumstances of a   family. He keeps the medical record of a family so he is always in a   better position to treat any member of that family as he is likely to   know the root cause of the illness better than any other specialist who   is not fully acquainted with the family.
 
Family Medicine vs Primary health care.

Family Medicine is the heart of primary health care. You cannot separate one from another without damaging the very concept of a systematic quality health care. Family medicine is a specials designed for and destined to deliver specialized quality health care at the Primary health care level. In some countries this specialty is know as GP or General Practice. Whatever the name may be the core concept is to develop an expertise in care giving at the primary level, the first door a patient knocks whenever he is in need of medical attention.


Family Medicine Comes to Pakistan  

Although Fellowship training in the field of Family Medicine was started in early nineties in Pakistan but the pace of evolution and its incorporation into our health system is still not at par with what should be desirable.

Status and prospects for Family Medicine in Pakistan. 

In Pakistan, Specialty of Family Medicine was introduced in late eighties. The number of trained family medicine specialists is still alarmingly low in our society. The role of family physician is still mostly being played by adhoc GPs who are neither well trained in the field nor they are committed to the job. At the same end their is a lack of understanding in majority of our population regarding the existence   as well as importance of the specialty of Family Medicine.
It appears that there is still a long way ahead to the destiny of   evolution of a dedicated primary health care system monitored by   dedicated Family Medicine specialists for most if not for all of our   population.


Historical Background of Family Medicine in Pakistan. 

The College of Family Medicine Pakistan (Karachi) was established in   1972 by a resolution from PMA Karachi in view of the needs of family   doctors to improve the health care system and health of the Pakistani   people.  During that same year, the College became a member of the newly   established World Organization of National Colleges, Academies and   Academic Associations of General Practitioners/Family Physicians, known   as WONCA or,  the World Organization of Family Doctors.

The College as well as Pakistan Society of Family Physicians Lahore sought to educate and train general practitioners  through continuing   medical education programs and succeeded in  convincing the College of   Physicians and Surgeons Pakistan to establish  Departments of Family   Medicine and to allow family doctors to become members  (MCPS) and   fellows (FCPS)   of the College of Physician and    Surgeons in discipline of family medicine in 1992.

Institutionalization of Family Medicine in Pakistan  

There have been some efforts in Pakistan to Institutionalize the specialty of Family Medicine. Training and Research promotion and monitoring cannot be done without institutionalization. Institutions having Family Medicine Departments in Pakistan.  Following Institutions have proper Family Medicine departments and   are running proper postgraduate training programs in the faculty of   Family Medicine.
 
  • Agha Khan Medical University Karachi
  • King Edward University Medical College Lahore
  • Ziauddin University in Karachi
  • Liaquat University of Medical Sciences at Hyderabad
CPSP Training Program for Family Medicine in Pakistan.   

College of Physicians & Surgeons Pakistan introduced training   programme for membership as well as fellowship in the field of family   medicine in late eighties. So far several batches of doctors have   received training in the field and qualified CPSP examinations but   considering our large population and the need of correspondingly large   number of Family Medicine specialists the quantity is alarmingly   insufficient.
 
Pakistan Academy of Family Physicians  Pakistan Academy of Family Physicians has been actively involved in organizing the structure and functioning of General practice / Family Medicine in Pakistan for several years.
 
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