What is special about being a family doctor

Are you a Family doctor, General Practitioner, a Primary Care doctor or a specialist and does it matter?

Definitions

PRIMARY CARE The setting within a health care system, usually in the patient’s own community, in which the first contact with a health professional occurs (excluding major trauma).

SPECIALIST A physician from whatever discipline who has undergone a period of higher postgraduate training.

PRIMARY CARE PHYSICIAN . A physician from whatever discipline working in a primary care setting.

SECONDARY CARE PHYSICIAN A physician who has undergone a period of higher postgraduate training in an organ/disease based discipline, and who works predominately in that discipline in a hospital setting.

GENERAL PRACTITIONER AND FAMILY DOCTOR. In Britain these are synonyms, used to describe those doctors who have undergone postgraduate training in general practice. In other parts of the world, generalpractitioner may mean a doctor without any postgraduate specialist training.

GENERAL PRACTICE / FAMILY MEDICINE is an academic and scientific discipline, with its own educational content, research, evidence base and clinical activity, and a clinical specialty orientated to primary care.

What is special about the being a family doctor. There is a special dimension to the way that you understand the patients problems and how to manage those problems. You may understand cause, cure and care better.

Jason was a delightful intelligent young man but cursed with hypomania that usually started when he had a change in his routine like a new job. Once after a long, late night session trying to negotiate with him to comply with my suggestions for treatment when he was high I persuaded him to go to hospital voluntarily. I drove him with his father to the hospital ward. His dad got the bus home but by the time he got home, Jason was already home because he took a taxi from the ward! The background was that his dad had the same problem and it was controlled by his wife who always recognised the early warning signs and with my help restarted his antipsychotics medication. Typically dad was told by his wife to attend for a BP check, and medication restarted. In addition to Jason, his brother Wayne also had the same problem but was more prone to alcohol abuse and truculence with a self destructive tendency fuelled by the alcohol. The 2 boys and the father were managed by the long suffering wife and mother who tried to keep her family madhouse under control. She knew I was there to help her in her role and together we conspired as best we could.

Over 50% encounters are family orientated in some way, and family problems are discussed in about 25% of encounters . There are six main ways family contacts inform and affect the encounter. In many ways you treat the family not just the patient

Knowledge about a family can

• help you understand the patient’s disease, illness and health
• help you identify the source of the patients disease
• focus your attention on the health and illness of other family members
• demonstrate the family concern for your patients health
• involve the family as a care resource and care collaborator
• prompt family members to receive unscheduled care

In hospital the diseases stay the same but the patients and families change, in general practice the patients and families stay the same but their diseases change.

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