What is family medicine

F Y T Lau 劉鈺棠

Dear Editor

I read your editorial in volume 24 October, 2002 and the article entitled 'Does our discipline house a sharp and clear image?'. Both have interested me immensely. My conclusion after reading them was that both authors have no 'clear and sharp' definition of Family Medicine or what family physicians should do. Because of the lack of this definition, it is difficult to ascertain the scope of our expertise in respect to other specialties in medicine.

Dr Wun mentioned in his article that the scope of Family Medicine is defined more in breadth than in depth. Hence there are really no boundaries to it. I clearly remember Dr Stephen Foo's presidential address in August, 1997 and it has had a profound effect on my understanding of what Family Medicine is. So I would like to share some of my thoughts with you.

From my experience with numerous medical under-graduates, I have found that very few; if not, none of them have had a grasp of what Family Medicine is. I do not blame them because many family physicians themselves do not have the answer. Many of these candidates in training are provided with only an extension of their vocational training in hospitals. As a result, they lack the required insight into family medicine. They are not instructed to view a patient's problem in the context of the patients environment.

Dr Foo's definition of a Family Physician was 'a practitioner who provided whole person, comprehensive care for a patient in his/her environment'. This definition has helped me to define Family Medicine. It defined not the depth of our knowledge of the subject but on the methodology we use to delineate and solve a patient's problem. Some specialties are defined by the organs attended to; for example, dermatologist with the skin; nephrologist with the kidney; hepatologist with the liver etc. But some specialists are categorised by the way they operate; for example, surgeons use the scalpel.... . Therefore, family medicine can be defined according to our mode of operation.

We practise medicine by analysing the interaction between the patient and his/her living environment and the resulting illnesses that may occur. The aim of such an approach is to identify any causal factor(s) and to avoid a repetition of occurrence. In other words we actually practise preventive medicine.

I believe for every illness, there is a cause and it is our responsibility to identify this cause. An example I frequently use to illustrate our different approach to a problem is essential hypertension. Indeed it is hypertension by definition (WHO) but is it vital for a medical specialist to tell the patient he/she has hypertension and provide anti-hypertension drugs? This is merely a standard procedure and no effort has been made to identify the underlying cause. From my experience, I have often received an emotional response when I asked such patients whether there are problems or worries in their daily lives. Sometimes they are willing to share the information with me, other times they are not. But as the practitioner, I will then consider their personal problems whenever possible.

There are other common situations I have encountered. One of these is a patient presenting symptoms of gouty arthritis limited to only one foot. The explanation of this phenomenon lies in his environment. When the patient walks, his weight places unequal amounts of stress on each of his foot. This hypothesis can be then observed by the different extents of wear and tear on the soles and heels of his shoes.

If we, as family practitioners are to relate illnesses with the environment, we tend to look for a cause that is not exclusive to clinical pathology. In that sense, we practise what is in essence a form of preventive medicine. So, can one equate Family Medicine with this?

F Y T Lau, MBBS
Family Physician in Private Practice.