|Year : 2012 | Volume
| Issue : 1 | Page : 59-61
Family medicine: A resident's perspective
Resident, DNB Family Medicine Program, Herbertpur Christian Hospital, Herbertpur, Dehradun, Uttarakhand, India
|Date of Web Publication||30-Mar-2012|
Family Medicine Resident, Herbertpur Christian Hospital, Herbertpur, Dehradun - 248 100, Uttarakhand
Source of Support: None, Conflict of Interest: None
Though family medicine has existed as a qualification for more than a decade in India, structured residency based training is a recent phenomenon. A growing number of young physicians are opting for this challenging and exciting new speciality as post graduate qualification through NBE (National Board of Examination) affiliated three year DNB (Diplomate of National Board) training program. MD family medicine is also in offing as Medical Council of India (MCI) has recently notified curriculum for this post graduate program. In this article, a resident shares his experience and excitement through the less travelled journey of family medicine residency training in India.
Keywords: DNB family medicine, primary care physicians, medical education, community based doctors, career in family medicine
|How to cite this article:|
Kumar B. Family medicine: A resident's perspective. J Family Med Prim Care 2012;1:59-61
| Definition|| |
The American Academy of Family Medicine defines family medicine as "Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. It is a specialty in breadth that integrates the biological, clinical, and behavioral sciences. The scope of family medicine encompasses all ages, both sexes, each organ system, and every disease entity". 
| My Background|| |
I was born in a village of Jharkhand (part of erstwhile Bihar). I grew up watching my mother suffering from asthma and struggling to breathe. I also remember doctors visiting during the middle of the night to give her some injections and other medicines for temporary relief. My village has a referral hospital (now known more for its non-functional state than for its glorious past) which used to have fresh medical graduates hired as medical officers. For the most part the hospital was a good place for the patients. Strategically, it is still at the outskirts of the expanding village and merging hamlets of the bigger village (which has now become a community development block). These doctors were MBBS as well as a few with MD degrees and provided primary care and some secondary level health care to the people in the community. Finding much relief from the prescriptions of these doctors, as common for many Indians, my parents wanted me to be a doctor! After passing my intermediate of science (called 10+2 by some), it took me 3 years of preparation to clear the entrance test to secure a position in a medical college. In retrospect, I believe that these 3 years were those becoming equivalent to the knowledge deficit of staying and learning at a rural school as the questions asked in Indian medical and post-graduate entrance tests are usually out of the context and not focused on what is relevant to medical care of the real patient but at molecular details. ,
| Medical College|| |
It was a great part of my life as it gave exposure to the world unknown to me so far. Meeting different people daily, running around to participate in lectures, going for practical experiences, and participating in traditional day to day life of a medical college. I also witnessed that many of my teachers were more involved their private clinics than being engaged in training future physicians! For the most part medical students were left by themselves to get perplexed which resulted in the fact that some of my colleagues had to appear for the final exams many times during the entire duration of the MBBS degree course. I would relate it more to the poor teaching-training standards than to the students' capabilities as majority came to study medicine after successfully passing a competitive entrance test at the state or national level.
| Career Plans and Executions|| |
Towards the end of medical school training, I started interacting with local officials within the National Polio Surveillance Project (NPSP)  -a project of the government of India in collaboration with the World Health Organization. Gradually, Public Health started fascinating me! While many of my peers started preparing for the post-graduate entrance tests I applied for the position of a Surveillance Medical Officer (SMO) with the NPSP and after a formal interview at the New Delhi office of NPSP, I became an SMO in March 2006 and was posted at various locations in Bihar, India. For a period of around 15 months with NPSP career, I garnered substantial public health skills by working towards global effort for polio eradication. Somehow, my parents and family members were not happy with my choice of becoming a public health professional and wanted to see me as a practicing clinician. I quit the NPSP job and came to Ranchi, India. Soon, I came to know that there is a vacancy for a medical doctor with the famous humanitarian organization Médecins Sans Frontières (MSF) or Doctors Without Borders. While working with the organization and working in the remotest areas of Chhattisgarh (central India), many of the realities of impoverished tribes in India, struck me. At times, it was interesting to find myself as the only doctor working for the rural masses of an entire community development block!
| Need Realization|| |
NPSP experience and my professional work in Bihar guided me how people survive perennial floods and poverty where as MSF and Chhattisgarh consolidated my belief that MAD MaMa (a pneumonic for malaria, acute respiratory infection, diarrhea, malaria and malnutrition) is a sad reality of India, that we cannot unfortunately get rid of, in spite of the inflated claims that we are finally developing as a nation at a rapid pace. During this time, I also realized that malnutrition is a major issue in India and in places, we have higher density of people below the poverty line even if compared with places in the African continent. , The head of India mission of MSF agreed that there is a growing amount of socio-economic inequality! The environment and experience with the MSF led me research my inner self as a physician (as opposed to an aspiring public health professional) to really what would my life be as a clinician and one fine day the goal to become a "family physician" a "general practitioner" grew in. The more I started pondering, the stronger it became!
| Residency|| |
February 2009, I joined my family medicine Diplomate of National Board (DNB) residency at Herbertpur Christian Hospital with one more resident in the same department and two others in Rural Surgery (an excellent concept, but not being taken up by many as they do not know the capabilities of the rural surgeons). Since then my work has been in a rural remote hospital working largely for the strata of the society that usually belongs to the lower end of the social spectrum. Since the beginning and till now, one third of my work involved working in the emergency room (ER), managing myocardial infarction and pulmonary edema, severe asthma/COPD as well as suturing lacerations, inserting chest tubes, doing emergency caesarean sections, and counseling hyperventilating patients were just a few of the "procedures" I performed. Herbertpur Christian Hospital (HCH) is one of the better places in India to undergo family medicine training. A community hospital teaches its resident about how diseases present in a community as opposed to the out-patient departments of medical colleges. An individual can go to village clinics to learn the life-style of "common Indian" and also gain insights about their routine problems. This training has been enabling its residents learn the tenets of family practice and gives an ability to manage a big number and variety of cases in the clinics. Having a small number of doctors gives you many opportunities to sharpen your clinical skills. This hospital also invites many foreign medical students and consultant doctors (physicians, surgeons, emergency physicians) who learn and teach medicine over here for variety of reasons (e.g. fulfilling requirements of electives). I shall be finishing my residency in February 2012. These 3 years have been crucial in my career as a family physician.
| The Future|| |
For the last few weeks, people have started asking me about what I intend to do once I have completed my training at Hebrertpur. It is indeed a complicated question to answer at this point of time! Though family medicine as a discipline has been in India for more than 2 decades; there are no positions in hospitals! One may work as a "physician" but mostly NOT as family physicians. It is only recently that the topmost medical institute, the All India Institute of Medical Sciences has been recommended  to have a course in family medicine although the Christian Medical College, Vellore, has been running a distance learning course as well as has a full-fledged department of family medicine.  The Christian Medical College family medicine experts run a Low Cost Effective Care Unit.  It is also anticipated that there are many other medical colleges that might be offering a post-graduate course in family medicine. But what about the fresh family doctors? Where do we go? What do we do? Starting a family practice is an option but who will provide the initial infrastructure and set-up? These are the questions which many family physicians have to find an answer for as in many hospitals they are told to work where there is less manpower and are shuttled between departments.It is good that debates on family medicine and its relevance to India have been taking place in the media. ,
| Some Suggestions|| |
The government of India and state governments should establish family medicine clinics attached to community health centers that cater to diverse needs of the community. Primary health centers may not be very effective at this stage for some of the family physicians as their clinical skills are wide ranging and can possibly best be used in community health centers. National Rural Health Mission should utilize the skills of family physicians as their experts. The corporate sectors can use family physicians to manage their primary care clinics. Brazil having many a similarities with India has been doing very well and reaching its poor since 1994 through family health units and it is being praised everywhere. , There are other areas of need in primary care like: provision of comprehensive Emergency Obstetric Care, Primary Care Cardiology, and Primary Care Psychiatry. Indians enjoy excellent banking services and the banks are present in majority of the remote corners of the country either as nationalized banks or in the form of postal banking services through the post offices. Banks of India provide excellent services at nominal costs to people. Let us make quality health care available to everyone as we made banking services almost everywhere.
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