Family medicine: a brief review of its history and concepts and its relevance to Pakistan.

Inmost countries of the world some form of family medicine is being practiced by members of the medical profession. In over fifty countries distinct practitioners of this form of medicine are recognized and in some countries formal designation as specialists is accorded to them. In certain countries the physicians are called family practitioners and in others they are called general practitioners. Both terms are correct as these physicians have broad-based clinical skills (generalists) and also take care of the families. In Pakistan health care is usually available only to those who can afford it. A large segment of population consists of people struggling to survive, who also carry a disproportionately heavy load of illness (L. Lee. Family Medicine; Some concepts, unpublished data, 1987). Furthermore, the health care system lacks a solid base of primary care physicians, both in number of practitioners in areas of greatest need and the quality of care provided. Competition in primary care private sector between family practitioners and specialists frequently leads to ineffective or inefficient utilization of scarce resources. Specialists with hospital based experience may tend to over-utilize the diagnostic and treatment modalities when dealing with first contact presentations, while general practitioners with inadequate training/experience are in general poorly prepared to provide scientific, comprehensive and flexible care to the community (B. Mi, R.W. Zuberi and B. Inam, unpublished data, 1990). The lack of referral facilities, in the case of the latter, compounds the issue. The broad-based training in family medicine, the high quality ambulatory clinical care and the strong community medicine base may fulfil many varied functions and meet the obvious deficiency in the health manpower training and development in Pakistan. It may also be a major solution to face the daunting challenge of health for all (A.H. Jiwani. The question of residency training in primary care unpublished data 1987).