Till very recently, Mr Varadaraju, a resident of a gated community in the suburbs of Bengaluru, had to rush to hospitals far off for his family’s health needs -- big or small. But not any more, thanks to a ‘family doctor’ practicing within his residential complex. The ‘in-house’ doctor has a post graduate specialisation in Family Medicine, a clinical specialty which is fast gaining popularity in India.
Historically, family doctors were generalist practitioners who also doubled as health managers, friends, philosophers, and guides. However, over time further specialisation in medical disciplines into sub-specialties diminished the role of general practitioners. Spectacular advances were made by sub-specialists, mostly concentrated in urban hospitals and specialised in treating a single organ, system or disease, thus relegating the general practitioners to the background.
However, this emergence of super-specialist doctors and their presence mostly in big urban hospitals, has now increased the need in the community for an expert physician, who is accessible and approachable. Family Medicine as a clinical specialty addresses this precise gap and therefore is an attractive option for students of medicine. This also kindles the hope for reviving the forgotten traditions of general medicine. The medical advances now demand that today’s general practitioners are better trained than their predecessors.
Family Medicine is a person-centred clinical specialty, which provides comprehensive care through a continuous patient-doctor relationship, oriented towards a family in particular and community in general. “Person centeredness” is the indispensable core principle of Family Medicine, which considers the person as a whole for treatment and seeks to promote a holistic approach to any medical problem.
Family Medicine specialists are highly skilled professionals trained to take care of 80% of the healthcare needs of the community. They orchestrate the management of multiple problems, each at a different point in its natural history. They are trained to recognise, integrate, and prioritise problems related to multiple systems; their critical clinical competence is to synthesise solutions for all age groups, all organs and systems of the human body.
Primary healthcare (PHC) is the backbone of all healthcare systems. Studies too have shown that healthcare systems based on effective primary care with well-trained general physicians practicing in the community, provide a more cost-effective as well as clinically effective care than those with a low primary-care orientation.
Family Medicine came to be recognised as a medical specialty in India only in the late 1980s. As family physicians play an important role in providing affordable and universal healthcare to people, the Government of India is now promoting Family Medicine as a separate discipline. The vision is to bring back the best practices of primary healthcare in India and provide world-class primary healthcare solutions.
The need for capacity building of doctors qualified in Family Medicine has been acknowledged by the Prime Minister’s National Knowledge Commission, the National Rural Health Mission taskforce on human resource development, and the Planning Commission’s Steering Committee on Health in India’s 12th -- and the latest – National Plan.
According to a Planning Commission paper, India needs 15,000 family doctors (Family Medicine specialists) per year by 2030. India has the largest number of medical colleges in the world producing over 90,000 MBBS graduates every year. Ideally, with the right training in Family Medicine, a good number of them should be deployed at the frontline of healthcare, at the community level.
The Covid-19 pandemic has reiterated the importance of a robust primary healthcare delivery system. While people were applauding the tertiary care hospitals for the way they handled critical cases, family physicians were working to prevent complications and significantly reduced the burden on the hospitals. A strong presence of family doctors will also reinstate the sagging credibility of the medical fraternity. There’s a need, and an opportunity, for young medical graduates to come forward and contribute to their communities by choosing Family Medicine as a specialisation.
The Academy of Family Physicians of India (AFPI) is working towards reviving the concept of specialist family doctors and to popularise Family Medicine as a clinical specialty among medical graduates.
Specialist family doctors trained in Family Medicine will fill a critical gap in India’s healthcare system -- that of access to affordable and quality healthcare.
(The writer is national president elect, Academy of Family Physicians of India)
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