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26 August, 2019 00:00 00 AM

Decline and rebirth of family medicine

Prof. Kanu Bala
Decline and rebirth of family medicine

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 1950's 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.