Family medicine as a challenging but rewarding career

Wai-man Yeung 楊偉民

HK Pract 2020;42:73-75

Family medicine is a specialty which adopts a holistic approach, considering patients’ physical, psychological and social well-beings. Apart from treating the physical body of patients, family physicians will also assess their mood, and look into relational issues such as patients’ families, work and social network. Family physicians are the first point of contact so that patients with different backgrounds can come to see them for whatever problems they need help. Family medicine also stresses on continual, comprehensive, coordinated and preventive care. Family physicians indeed have an important role in the healthcare system to combat the different healthcare problems nowadays such as the increasing aging population, chronic diseases, mental disorders, multi-morbidities, and the threat of infectious diseases especially the COVID-19 pandemic. In this issue of the Hong Kong Practitioner, we have several good articles which help us to reflect on our role as family physicians.

Dr Cheung’s case presentation¹ has illustrated an important role of family physicians. As first point of contact, patients come to see their primary care family physicians with a vast variety of presentations. Some are very common such as hip or knee pain. But some of these common presentations have underlying rare but sinister conditions such as hypertrophic pulmonary osteoathropathy - a paraneoplastic manifestation of lung cancer. Although it is sad to learn that the patient in this case presentation had unfortunately died of lung cancer one month later, Dr Cheung and his team had done an excellent job by being vigilant always to consider any serious underlying causes for the presenting problem, and to provide the possibly best care and management.

Dr Yu’s article² has pointed out that female urinary incontinence is a common problem. A previous survey showed that as many as over 75% of women had reported to have some kinds of urinary incontinence³ , the prevalence of which is believed to be even higher now, owing to an aging population. However, urinary incontinence is often been dismissed as being normal and neglected. This article reminds us that family physicians are in an advantageous position to adopt holistic care for their patients. In our training, we were taught to always put our patients at ease, be open and encouraging, so that our rapport can be easily established, and our patients will be able to tell us their real concerns, including those they find embarrassing to talk about such as the urinary incontinence problems. These problems may already be long-lasting, had tortured the patients for years, and not just affected them physically, but also the psychological stress and the social disabilities thus resulted. No matter how trivial their concerns may seem to us, their determination to voice out should always be appreciated. Having a similar experience of our patients can surely help us to understand their difficulties. Although it is true that we may not have all their same experiences, we can always be empathetic and let them feel the concern and support from their doctors. This should be the basis of the consultation on which a good holistic management plan can be formulated.

In our daily practice, we notice that some conditions are curable while some may not be. The latter may include serious life-threatening diseases, chronic diseases that patients must live with throughout their years, or the disabilities resulted from previous diseases or accidents. For all patients, we can always engage with them and tailor-make a management plan best suit for them, which may consist of physical, psychological, social or even spiritual level. In this way, many patients are still able to have a reasonable quality of life, and they can find their life happy and meaningful. In fact, with the advances of medicine, even cancer might not be an imminent early death sentence but could be a chronic condition.^4,5 Family physicians are very suitable to help all these patients to adapt to their new stages in life. In addition to the treatment specific to the disease by itself, symptom control and optimisation of patients’ physical capacity should always be considered. Professor Cindy Lam had also told us in the HKPCC 2020 that promoting mental health and wellness is also essential in primary care, and those patients with common mental health problems can be managed by several strategies such as psychoeducation, engagement and self-care, psychosocial interventions or pharmacological interventions.⁶ All these can be well done by family physicians after received appropriate training. The time when patients get a drastic change in life can also be a time for them to reflect on themselves, reconcile with people, and to find the meanings of their life, and the family physicians are also in a good position to walk with these patients and offer their support and concern.

On the other hand, family physicians must also prepare themselves to face life and death matters together with their patients. Some patients may be diagnosed to have a serious illness such as cancer, as in Dr Cheung’s case, and we may need to break bad news to them. This is indeed a very important moment for the patients and their relatives, and we need to ask ourselves what help we should offer apart from medical treatment. Different people may have their individual needs, but surely every one of them wants to feel from their family doctors that their problem is highly and seriously considered, and they are not alone to walk this difficult road. Your detailed explanations, your kind words are all treasured and highly valued by the patients and their loved ones. That is why some patients or their relatives would come back later to express their thanks, and this would be very rewarding to the family doctor.

Apart from the above, Drs Sung, Chu and Liang had made a study on multi-morbidity and its associations with healthcare service utilisation and glycaemic control in diabetic patients in a primary care clinic in Hong Kong.⁷ They observed that the vast majority of their patients had multi-morbidity. Their study has highlighted the importance of adopting a multidisciplinary and holistic-centred approach when managing these patients. Family physicians are never working alone. We treasure our special role as a coordinator in the healthcare system. No single specialty or discipline can stand alone by itself, each having their different strengths and limitations. By liaising with all colleagues in the health care system, we face together the ever increasing demand of health care needs in our community, and give our patients the best medical care we are able to offer.

Family physicians are also known as general practitioners in some other countries, and general practice has been considered the best job in the world, owing to its special relationship with the patients.⁸ I strongly agree with that. Family medicine is really a challenging but rewarding career which I would surely recommend to medical students when I teach them in my clinic.