Different roles and challenges of Family Physicians

Kwai-wing Wong 黃桂榮

HK Pract 2021;43:102-103

Family medicine is a distinct medical discipline which delivers primary, continuing, comprehensive and holistic care to the individual and the family in their community. Family physicians are the first point of contact, serving as a point-of-entry for patients into the health care system. Patients with different backgrounds will come to see their family physicians for various problems. Family physicians have to equip with different clinical and communication skills to deal with undifferentiated illnesses and a wide range of patients and conditions. In this issue of the Hong Kong Practitioner, we have several good articles which illustrate the different roles and challenges as family physicians.

Cervical cancer was the eighth commonest cancer as well as the eighth leading cause of cancer deaths among women in Hong Kong.¹ Although cervical cancer screening and treatment of precancerous lesions have been shown to reduce the incidence and mortality of cervical cancer² , not all women receive regular screening. In a local study³ , it was shown that 61.2% of ethnic minority women never had cervical smear and they had 6- to 11- fold increased risk of cervical smear abnormalities compared with the local Chinese population. In this issue, Fong et al⁴ examined the attitudes and barriers to cervical cancer screening in ethnic minority women in Hong Kong. Health illiteracy, restriction of the public system, language barrier, and practical and emotional issues were identified as the barriers to access the screening services. The study also found out that community-based education, multilingual and simplified booking system, and extension of affordable cervical cancer screening service to public holidays were the facilitators to cervical cancer screening. Hopefully, the research findings would inform the policymakers to further enhance the cervical cancer screening services for ethnic minority women in Hong Kong.

As the first point of contact, patients come to see their family physicians with a vast variety of presentations. Some of the presenting symptoms are common while some are very rare. Or and Chen⁵ reported a case of 89 years old lady presented with acute chorea in a general outpatient clinic. She was admitted to hospital and was later diagnosed with Chorea Hyperglycaemia Basal Ganglia Syndrome. The syndrome is a rare manifestation of poorly controlled diabetes. Since diabetes is one of the commonest chronic illnesses encountered in primary care, family physicians should have a high index of suspicion of the syndrome if they encounter patients presented with acute chorea and a background history of poorly controlled diabetes.

We may encounter medicolegal challenges in our daily practice. Mounsey⁶ presented a patient with persistent abdominal pain and she was eventually diagnosed with a small bowel tumor. The case report reminds us accurate documentation of patient’s symptoms is vital and can serve the purpose of providing medicolegal protection, in case the clinical decision is challenged at a later time. At times, telephone consultations may be utilised by family physicians as an alternative or supporting method of providing services. However, the need for a face-to-face consultation should never be replaced by a telephone consultation if the patient is a poor historian or there is doubt about the nature or severity of the symptoms. Also, it is important to reconsider the working diagnosis if the patient’s symptom is persistent, despite ongoing active treatment.