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In many parts of
the world, this case scenario is repeated daily, however in over 51
countries there has been developed a specialist called the family doctor
1 who can help patients with a different approach to medical care. The
family doctor is a “physician who is a specialist trained to provide
health care services for all individuals regardless of age, sex or type
of health problem; provides primary and continuing care for entire
families within their communities; address physical, psychological and
social problems; coordinates comprehensive health care services with
other specialists as needed.” 2
The family doctor has a very unique set of attributes that differentiate
him from other specialist physicians. It is these attributes that lay
the foundation for the function of the family doctor in his role as a
primary health care physician in any health care delivery model.
First the family doctor is a generalist. He must be able to address all
of the health problems that present to him from the entire population
he serves. He must be able to render care to all patients no matter
their age, sex, social class, religion or their health problem. The
family doctor must be able to provide continuous and comprehensive
medical care. The patient and her physician must be able to develop a
long-standing and personal relationship. This relationship must allow
the patient to obtain his care in a longitudinal fashion over time and
not limit this interaction to just a brief illness.
The specialty of Family Medicine goes far beyond simply providing
curative care it offers its patients a more comprehensive approach to
medical care. The family physician also provides his patients with a
full breadth of knowledge that includes health promotion, disease
prevention, psychological support, and social support. This physician
also assists his patients in coordinating their care. He can be the
first contact physician, but when necessary he can make the appropriate
referral to a needed specialist. He can then advise his patient about
the advice given by the specialist.
The family physician is by definition family-oriented. He knows the
individuals through their context in their families. Since he takes
care of these patients over time, he also learns about their
relationships within the community, their work and their friendships.
Finally, the family physician is always concerned about his community.
The patients’ health and medical problems is looked at through the
contest of the community and how he lives there. The family doctor
needs to be aware of the health needs of the people living in the
community. He should strive to improve the health of the community
working with all health agencies and community groups.
So the family doctor then is a physician who is an effective clinician.
This doctor enjoys and supports his relationship with his patients over
time. The family physician is based in the community and works
collaboratively with the resources of the local community and the
greater medical community to render health care to the defined
population.
From 1995 until 2000, the Ministry of Health, Vietnam underwent a very
careful analysis of its primary care education and delivery system. It
decided to base it health care system on a specialty trained primary
care doctor and chose Family Medicine as the specialty for this new kind
of general doctor.
In 2001, the Ministry of Health, Vietnam created the new specialty of
Family Medicine. In doing so it authorized the establishment of First
Degree Specialty training programs for this new field. The development
of Family Medicine in Vietnam began with the implementation of the
Vietnam Family Medicine Project. This was a six year collaborative
project with the Maine Medical Center, Portland, Maine, USA and newly
created academic Family Medicine Centers within each of three academic
stakeholders, the Hanoi Medical University, the Ho Chi Minh University
of Medicine and Pharmacology (HCMCUMP) and the Thai Nguyen Medical
College. 14
The UMP set a goal to be the first school of medicine to receive
permission from the MOH to train First Degree Specialists in Family
Medicine. The process was difficult and several steps were needed to
achieve this goal. These included 1) Setting a University agenda for the
new specialty training development , 2) Maneuvering the agenda through
the political process of the University, 3) Creating a new
infrastructure within the university, 5) Developing a new curriculum
acceptable to the University and the MOH, 6) Recruiting trainees through
the national postgraduate entrance examination process, and 7) Training
program implementation.
The leadership of the Family Medicine Center of the UMP was successful
in its organization and development of the new training program. It
worked diligently on designing the outcomes of the First Degree
Specialty training in Family Medicine. These included:
1-Care and strengthen both comprehensively, and continuously the health
for individuals, members of families, not differentiated by age and
gender.
2- Manage effectively the common health problems across the human life
cycle and the family life cycle.
3- Provide health education counseling for individuals and families, to
promote motivation towards health improvement.
4- Provide preventive health screen for the detection of the diseases in
the early stage.
5- Coordinate western modern medicine and Traditional Medicine in
managing health problems.
6- Develop sound relationships with patients, members of their families
and the community.
7- Encourage other resources from within a Family and community to care
for and promote the health for all.
8- Be a self-learner, recognizing personal educational needs, selecting
appropriate learning resources, and evaluating one’s progress.
The training program was then designed to achieve these outcomes and was
successfully implemented in June of 2002. The curriculum developed at
the UMP, was then adopted as the national Family Medicine curriculum.
The other two academic partners in the Vietnam Family Medicine
Development Project implemented their training programs later in that
same year. Since 2002, the HCMC Family Medicine Center has graduated 45
physicians as Family Medicine First Degree Specialists. In addition,
there have been nine faculty trained in Family Medicine faculty
development in the US for short courses, and there have been two trained
at the University of the Philippines, Manila in the Masters in Family
Medicine. The Family Medicine Center has a strong core of trainers both
within the Center and in the many specialty areas where the CK-1
students train.
Study material has been difficult to access for faculty and trainees.
There has been a need for a reference for learners consistent with the
curriculum in Vietnam. Translations of textbooks from the US have been
completed, but they of course have not been entirely relevant to the
Vietnamese medial situation. Here for the first time in Vietnam is a
textbook, written by the medical educators who have been teaching this
new specialty. They have gained the knowledge over the past eight years
about this new discipline; they have acquired the skills to teach it and
the attitudes inherent in the use of the biopsychosocial model of
Family Medicine. This textbook, which has been lacking up until this
time in Family Medicine education is now present and will have a major
impact on the future generation of specialty trained family doctors in
Vietnam.
Alain J. Montegut, MD, FAAFP
Associate Professor
Director of WONCA North Americain region
Director, Global Health Primary Care Initiative
Department of Family Medicine
Boston University
August 1, 2008
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