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 Table of Contents  
EDITORIAL
Year : 2021  |  Volume : 2  |  Issue : 1  |  Page : 1-3

Need of family medicine at tertiary care institutions: Experience from AIIMS Rishikesh


1 Associate Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
2 Junior Resident, Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission10-Jun-2020
Date of Decision15-Jun-2020
Date of Acceptance18-Nov-2020
Date of Web Publication25-Apr-2021

Correspondence Address:
Dr. Senkadhirdasan Dakshinamurthy
Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_92_20

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How to cite this article:
Kumar S, Dakshinamurthy S. Need of family medicine at tertiary care institutions: Experience from AIIMS Rishikesh. J Med Evid 2021;2:1-3

How to cite this URL:
Kumar S, Dakshinamurthy S. Need of family medicine at tertiary care institutions: Experience from AIIMS Rishikesh. J Med Evid [serial online] 2021 [cited 2022 Aug 12];2:1-3. Available from: http://www.journaljme.org/text.asp?2021/2/1/1/314637


  Introduction Top
The family medicine (FM) speciality has been mandated by the National Health Policy 2017 and the recently passed act of National Medical Commission Act 2019. FM offers comprehensive care regardless of age, gender, illness or organ system. It is patient centred, evidence based, family focused and problem oriented. Family physicians are specialised in providing continuum and coordinated care with keeping in mind the patient context and concerns. India is a country with inherent socio-cultural heritage, which is an essential domain of human life, which eventually affects the health status. Family physicians emphasise health promotion and disease prevention. Their knowledge, skills, attitudes and perception target community practice to improve it further.
  Family Medicine and Primary Care Top
Health is being shaped by multifactorial influencers such as demographic changes, ageing, rapid urbanisation, globalisation and unhealthy lifestyles. Apart from therapeutic care, comprehensive and coordinated care is essentially required to manage this burden of lifestyle diseases. In the last few decades, chronic non-communicable diseases (NCDs) have overtaken communicable diseases, contributing significant morbidity and mortality. Majority of the patients with NCDs land up to the tertiary care hospital due to long-term complications.[1] Preventive approach may be applied at any stage along with the natural history of the disease with the aim of preventing further progression of disease complication.[2] Primary care is deficient in the health system due to the lack of preventive approach. Production and marketing of tobacco, food, beverages and alcohol are becoming the root cause of chronic diseases, which mostly exist in non-health sectors. Health budgets are ridiculously tiny when compared with the marketing and advertising budgets of these industries. This concept of prevention should not only be implemented at primary care level but also be inevitably applied at the tertiary care level. This paradigm shift from disease spectrum might be challenging for organisations and financing and healthcare delivery systems.[3] There is global evidence that primary healthcare is critical to improving health outcomes. Chronic disease like diabetes, hypertension, obesity etc. are taken care by family physicians as the first point of care and manage the cases in the initial state itself by giving health education and health promotion and preventing further morbidity and mortality.[4]
  Need of Family Medicine at Tertiary Care Institutions Top
A significant number of patients visit FM outpatient department (OPD) just for reconfirmation and reassurance about their disease status. It became possible because of our effort and that is how we gain trust of the patient. With the gradually increasing burden of patients over tertiary care, the family physician will reduce the disease burden to the speciality departments. The World Health Organization also endorses the biopsychological model for health, which deals with interaction between health and illness due to biological, psychological and social factors.[5] Doctor–patient relationship is a key element which affects the health outcomes of patients in terms of psychological, physiological and subjective measures. Physician–patient relationship becomes more important for a family physician to improve the patient's health outcome and his/her medical care. To emphasise upon continuum, contextual and personal care is an essential tool in FM practice, which builds a good rapport with patients and also helps to understand their concerns and illness in a better way. Despite the fact that FM is not well established at tertiary care, however patients financial, socio-cultural, family and spiritual health will be considered by Family Medicine specialist, which are extremely essential determinants of wellbeing and helps in prognosis of the disease. FM experts working at tertiary care institutions can support the hospital work in efficient triaging of the patient load so that only the more appropriate patients are seen by the specialists.
  Role of Family Physicians Top
The roles of family physicians in FM practice areas are as follows:[6],[7]
  1. A family physician sees the person first and not the disease, conceptualising the symptoms and behaviours in their social and psychological context and responding with compassion to the patient's experience and concerns
  2. A physician tries to understand the multiple biopsychosocial variables related to the disease and communicates this effectively to the patient
  3. He/she coordinates care from other specialities in the hospital so that specialist time could be saved
  4. He/she considers patients' social and economic needs and discusses with the management accordingly
  5. He/she contributes significant time to the patient's disease-specific education
  6. He/she maintains a consistent visit of patient and record keeping for proper follow-up
  7. He/she makes appropriate referral with basic history and examination and presents to the referred consultant through FM interns.

  Family Medicine: A Unique Approach Towards Patient Care Top
FM at the tertiary care institute of AIIMS Rishikesh is striving to bridge this gap between primary and tertiary care with the principle of FM, that is comprehensive, coordinated and continuum of care to patients. FM is a person-centric clinical discipline based on knowledge, process and skills from public health and behavioural sciences including psychology and anthropology.[7] It is a unique amalgamation with individual, family and community in a clinical setting. From February 2019 to February 2020, the total number of cases seen in FM OPD is 36,601. On an average, 3000 patients attended FM OPD per month. Almost 70% of the cases were treated in the FM OPD and the remaining 30% were referred to the respective departments, mostly cardiology and neurology. Patients with hypertension, diabetes mellitus, upper respiratory tract infection, anaemia, Vitamin D deficiency and musculoskeletal pain were more commonly evaluated, counselled and treated in the FM OPD. The demand for family physicians among patient community continues to exist through there is decline in the available services. Patients often present to their family physicians with vague and undistinguishable symptoms. Therefore, multiple domains of illness have to be explored and a red flag sign should always be kept in mind. Patients are well bounded to the family physicians, and they easily express their emotions, anger and concerns in front of their doctor. The maintenance of health records of all patients presenting to the OPD is also very important and useful for patient follow-up.
  Family Medicine and Family Health Top
As a speciality, FM is concerned with the health of the family as the basic social unit of the society. The entire family is viewed as 'the patient'. At a family level, their socioeconomic status, family composition, psychosocial problems, housing and environment conditions, acceptance by the community, etc., will be considered. Family Medicine focus to recognise the impact of family factors on the patient's health and making way in preventive and curative measures.[8]
  Services of Family Physician Top
The family practitioner will give care in various fields such as maternal and child health; adult ambulatory care; adolescent health; geriatrics; palliative care; occupational health; school health services; clinical prevention; mental health, diet and weight and obesity management and vaccinations.[6] The provision of comprehensive family-level care reduces morbidity and mortality at much lower costs and significantly reduces the disease burden. The team-based approach and the availability of a large number of services enable a more improved patient–provider relationship, and the establishment of trust in the public health system.
  Conclusion Top
Comprehensive, coordinated and continuum of care is being provided to all patients attending to the FM OPD at AIIMS Rishikesh. Apart from therapeutic care, FM is also bridging the gap between community and tertiary care by conducting awareness camps and ensuring their participation in various health and wellness programmes organised by the community and FM department. The services of FM should be further planned to be extended in terms of counselling in maternal and child health, adolescent-friendly health clinic and preventive and promotive clinic in NCDs. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

 
  References Top

1.
Hellenberg D, Williams FR, Kubendra M, Kaimal RS. Strengths and limitations of a family physician. J Family Med Prim Care 2018;7:284-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Pandve HT. Quaternary prevention: Need of the hour. J Family Med Prim Care 2014;3:309-10.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
World Health Organization. The Rising Importance of Family Medicine. World Health Organization. Available from: https://www.who.int/dg/speeches/2013/family_medicine_20130626/en/. [Last accessed on 2020 Jun 01].  Back to cited text no. 3
    
4.
World Health Organization. NCD Mortality and Morbidity. World Health Organization; 2020. Available from: https://www.who.int/gho/ncd/mortality_morbidity/en/. [Last accessed on 2020 May 31].  Back to cited text no. 4
    
5.
Wade DT, Halligan PW. The biopsychosocial model of illness: A model whose time has come. Clin Rehabil 2017;31:995-1004.  Back to cited text no. 5
    
6.
Raman K. Role of Family Physicians in Healthcare System; 2013.  Back to cited text no. 6
    
7.
Rakel R, David P. Psychological influence on health. In: Textbook of Family Medicine. 8th ed., Ch. 3. Philadelphia: John Casey; 2007. p. 24-6.  Back to cited text no. 7
    
8.
Block SD, Clark-Chiarelli N, Peter AS, Singer JD. Academia's chilly climate for primary care. JAMA 1996;276:677-82.  Back to cited text no. 8
    




 

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Introduction
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