Without the White Coat
By Dr. Florentino P. Alerta II

FAMILY MEDICINE… taking a stand from other specialties

I have tackled before what Family Medicine (Filipino Family Physician) is. Now let me reiterate that Family Medicine is a specialty , not a big threat to other specialties, but a member of the team of health care specialties that addresses the main problem of the patient and his family whose approach is thru the whole human being and not just a group of organ systems or tissue network. It is unfortunate, however, that people from other specialties view Family Medicine as a big threat to their thriving medical practice. (Some consultants are even bad-mouthing the specialty of Family Medicine as a “jack of all trades master of none” or merely as a “general practitioner” without any knowledge of practicing Medicine, the nerve to say that!) Again here is to enlighten those who were deceived and had believed in themselves deeply not knowing that most of their referrals come from Family Physicians who are practicing Family Medicine (what a big shame, and they call themselves diplomates and fellows of their specialty societies). Hopefully, the Iloilo Medical Society can discipline some “ignoramus” physicians having a primitive midbrain . For the facts , (again) a Filipino Family Physician is a medical doctor who is trained in the specialty of Family Medicine, like other specialties the Family Physician complete an extensive three year residency training program in their specialty after graduating from medical school.(This is the difference between a Family Physician and a General Practitioner.) There are four (4) criteria for considering Family Medicine as a specialty that differentiates it with a General Practitioner. (Prof Ian R. McWhinney) It has a distinguishable body of knowledge , it has a unique field of action , it has an active area of research , and lastly it involves intellectually vigorous training . In Family Medicine instead of specializing in only one medical area, the Family Physicians are trained in all major areas from PEDIATRICS (eat your heart out classmate) to INTERNAL MEDICINE to GYNECOLOGY, including prenatal and baby care. In actual practice the Family Physician refers patients to other specialists in 10 to 15% of the cases that they see. (Another shocking reality that “some” of us specialist forget) The Family Physician can save you money (hopefully all the layman out there just don't keep on asking what is your specialty?, it is time that we all answer them that “OUR SPECIALTY IS YOU.) Instead of paying for various specialties for each member of the family, the Family Physician will cut cost since he/she cares (always remember that a Family Physician don't promise any cure for the patient or disease, but there is one thing he/she can promise that patient, it is the “care” he/she will render the patient) for the whole family (perhaps, it is time that the general public wake up and be more practical in this times of our lives--the FAMILY PHYSICIAN IS UNIQUELY QUALIFIED ), in which, emphasis is given in the preventive aspect of medical care that can save the family lots of money and headache. Always remember that the Family Physician never define people by their disease, but as a total human being.

Presented here are facts (irrefutable) from a special article taken from the American Family Physician July 1999,Volume 60, Number 1 (if the great training programs in West Avenue would like a copy of the article, the newspaper would be glad to furnish you with a copy of the article just drop us a line.)” Compared with Family Practice residencies , Internal Medicine and Pediatrics programs tend to emphasize inpatient Medicine . They also tend to offer broader exposure to the “specialist aspects” of each specialty. They tend to place less emphasis on continuity of care in the outpatient setting. No evidence shows that the graduates of any combined programs are more effective in practice or obtain more privileges than those who graduate from a Family Practice residency program. In fact, evaluations of these programs often use Family Practice as the benchmark . Only about 68 percent of physicians trained in Internal Medicine and Pediatrics , for example, actually practice Primary Care Medicine and only 55 percent practice both Internal Medicine and Pediatrics. (Does these sound and look familiar in our set-up? -- yes your guess is good as mine.) In contrast, Family Medicine is practiced by more than 91 percent of the physicians who received training in a Family Practice residency during the first 25 years that the training was offered, and Family Medicine is practiced by more than 93 percent of current graduates of Family Practice residency programs.” (Remember that it was UPGH that started the program. In Iloilo we have three (3) existing programs in IMH , St. Paul's Hospital and WVMC , it is only in the hospital in West Avenue that we don't have the training program -- this may explain where the bulk of the criticisms comes from in which one statement was picked up “ then after Family Medicine training what will the graduate do? ” or just simply defining Family Medicine as a General Practitioner (GP) , or plainly placed- a Jack of all Trades , a Master of None .”- why bad-mouth other specialties in front of your residents and put down the Family Medicine training programs down? Is the competition so great? That you cannot take the heat, just remember most of the referrals that you get comes from your friendly Family Physician – a case in point, the child for tonsillectomy was referred to your service because he has pneumonia, considering that this was a simple case, but for delicadeza , I went ahead and refer the case to your specialty--fear of losing a patient? Hell no I was just simply helping and sharing my blessings and as part of the team I never entertained competition cuz I viewed it as being part of the team… that will always care for the patient, and never promises any cure. ) One question that is left hanging upon our heads (and will all this criticism and intrigues) “How satisfied will Family Physicians be in the FUTURE? -- it appears that the Family Physicians are faring better than most physicians in the evolving medical environment. Certainly the demand for Family Physicians has increased (in the Philippines and the US , remember a lot of physicians are leaving our country as nurses) dramatically because of the cost-effective care they deliver. Their ability to coordinate care, to take responsibility for patient care, to use resources wisely and to be efficient and comprehensive bodes well for the future.” As stated in Family Practice,1993:37:257-63 “Family Physicians report being extremely satisfied with their general professional life, intellectual stimulation, status within the community, clinical competence, and the long-term relationships with their patients.”