Family medicine

By Dra Maria Alice [email protected]

Dr Maria Alice is a consultant in General and Family Medicine and is director of Luzdoc International Medical Service in Praia da Luz, Lagos.

Family medicine is the natural evolution of historical medical practice as the first physicians were generalists who, for thousands of years, provided all of the medical care available.

With World War II, the age of specialisation began to flourish. In the two decades following the war, the number of specialists and subspecialists increased at a phenomenal rate, while the number of generalists declined dramatically with fragmentation of care and the shortage of personal physicians who could provide initial, continuing and comprehensive care.

The concept of the generalist was reborn with the reorientation of medicine back to personal, primary care and the establishment of family medicine as a specialty.

Family medicine is a three-dimensional specialty, incorporating knowledge, skill and a unique process, centered in the patient-physician relationship with the patient viewed in the context of the family.

It is the extent to which this relationship is valued, developed, nurtured and maintained that distinguishes family medicine from all other specialties.

I hope you enjoy, as much as I did, the thoughts of Dr Joanna Karamon, a brilliant and dedicated family doctor.

The 10 Commandments of a Family Doctor

It took me 10 years to realise that I actually enjoyed being a GP, or rather I finally recognised myself as having become a true family doctor. It was not easy, believe me.

It took a long time to get over the “inferiority complex” of having all of your medical school friends getting their specialisation in orthopedics, anesthetics, cardiovascular surgery etc, and here I was, a GP … just a GP.

I’m not even sure what triggered that light bulb moment but suddenly I realised that, over the years, I have created so many fantastic patient-doctor relationships that I would not want to trade in those experiences for just another diploma on my wall.

So I tried to analyse exactly what makes just a GP become a true family doctor … all the highs and lows, all the good parts and the not so good parts, and came up with my own 10 Commandments of a Family Doctor:

The patient is thy God, and thou shalt not have any other patients but them: be focused and take the time to really listen to your patients, as if they were your only patient. Respect them and their symptoms and treat them all like the fellow humans that they are.

Thou shalt not speak of your patient or their situation: keeping the Hippocratic Oath can sometimes be difficult, but respecting your patient’s privacy (even to members of their own family) is an important element of building that trust between patient and doctor.

Thou shalt be available to your patients: even if they phone you at 3am on a Sunday because of an itchy rash they had for the last four days … You can still scream, cry, vent and call them names, but in the privacy of your car as you’re driving out for the house call!

Thou shalt honour your teachers and stay up-to-date in your field of expertise: you need to stay on top of your game always, especially when your patient has already self-diagnosed himself online, or comes for a consultation with a lengthy print-out of the latest internet “cures”

Thou shalt not kill: rather self-explanatory that one I think … always remember your Oath: “ … first do no harm…”

Thou shalt not cheat: whether you’re cheating them out of options or hope or guidance … never give up on your patients, educate them to the best of your ability on their disease, its impact on their lives, and encourage them at all stages of their illness and healing.

Thou shalt not steal your patients’ time: do not send them for unnecessary tests and examinations just because you’re not 100% sure what the matter is with them

Thou shalt not lie: even if you don’t want to tell the hard truth, honesty IS the best policy. Do not be afraid to say “I don’t know what’s wrong with you”, but explain to them HOW you intend to get to the answer; this will make for a healthy give-and-take relationship.

Thou shalt not covet your patients: any good physician knows their limitations and timely referral to the correct specialists is sometimes necessary and sometimes even lifesaving.

Thou shalt not covet your patient’s wife: spouse, partner, cousin, pet … no matter … learn to be their empathetic friend but never cross that “professionally detached line”. It is important to care for your patients but you must learn to “compartmentalise” your own feelings, otherwise you will end up pretty much an emotional wreck each time you have to tell one of your patients some bad news or, even worse, have to see them pass on.

I’m not sure what Moses would make of all these ramblings, but for me at least, these basic rules have helped to keep me on track with what being a family doctor is all about!

Dr Joanna Karamon

General Practitioner

Assistant Director – Luzdoc IMS