|Year : 2004 | Volume
| Issue : 2 | Page : 41-42
Efficiency versus effectiveness of the Saudi family doctor
Nabil Y Al Kurashi
President, Saudi Society of Family & Community Medicine Associate Professor of Family Medicine, College of Medicine, King Faisal University; Member, Scientific Council, Arab Board for Medical Specialties, Saudi Arabia
|Date of Web Publication||30-Jun-2012|
Nabil Y Al Kurashi
President, Saudi Society of Family & Community Medicine Associate Professor of Family Medicine, College of Medicine, King Faisal University; Member, Scientific Council, Arab Board for Medical Specialties
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Al Kurashi NY. Efficiency versus effectiveness of the Saudi family doctor. J Fam Community Med 2004;11:41-2
The Family Physician may be defined as a highly competent specialist capable of providing comprehensive, personalized and continuous care for all family members as well as others, regardless of the sex, age or the kind of illness presented. Whatever the problem is, whether social, physical, psychological or spiritual, the Family Physician endeavors to keep the families on his list in good health.
The nature of this journal demands that this topic be treated scientifically rather than philosophically. The thrust of this article is that there is an urgent need to foster and encourage the work of the family physician in the Arab world, to make them more effective.
I propose to deal with this issue in the Kingdom of Saudi Arabia rather than generalize. In this article, reference to a Doctor in a certain specialty means medical practice in that specialty.
The competence of a skillful cardiac surgeon can only be proved in the operating theater when he performs open-heart surgery. His skills are useless without adequate facilities such as equipment, tools, technology, and the supporting medical, technical and nursing staff. These factors enable the competent specialist doctor to do all that is necessary for the recovery and the improvement of the patient's heart condition.
I use the cardiac surgeon as an example. The efficiency and effectiveness of this surgeon, is dependent on the resources available and the support team.
Family Medicine developed with the advancement of modern medicine. Family Physicians have become more creative, skillful and competent in their field of speciality. Now, many practise family medicine and have special interests as well. For example, one Family Physician may be particularly interested in the management of psychiatric cases, whereas another might be interested in the management of pediatric cases, rheumatic diseases, or prefer geriatric medicine.
Moreover, the family physician may now use medical equipment and technology and practice surgery in areas which were previously not permitted in general practice. The family physician in America for example is privileged to perform cesarean sections on his patients or an endoscopy for upper or lower GI or colposcopy, etc., when necessary.
Day Surgeries have become normal practice for family physicians. A long list of curative and surgical procedures are permitted in the practice of the family physician. Family physicians' clinics in various countries of the world which have won approbation in the area of practice of family medicine and care, are well-designed, have good equipment and efficient staff but are inexpensive. There are people whose job is to assess the cost effectiveness of a practice and its benefit to the family, community and the state, in the short and long terms.
There are very good academic programs for the family physicians in Saudi Arabia. The training of these physicians is not much different from the programs offered in the West: in the USA, Canada, Europe or Australia. This is an interesting specialty, the importance of which has not been recognized by the medical community and the general public. Consequently, the prospective family physician still undergoes a cycle of four years of training for the Family Medicine Fellowship. After graduation, faces daunting problems in practising his specialty. Unless officials take immediate bold steps to address the problem of the plight of the family physician, there will be an exodus into other jobs. They may continue to practice medicine but not diligently and with much devotion as recent studies have shown.
It is obvious that all Family Medicine fellowship programs produce physicians capable of practising family medicine effectively in the right environment. For example, the family physician is unable to carry out his duties properly if he doesn't know the people for whom he should provide medical care. He neither has the list of families under his care nor a well-equipped clinic. Because of the restrictive rules and regulations that govern the prescription of certain drugs and the performance of minor surgeries, he cannot practise the way he should. The Primary Health Centers are neither properly designed nor adequately equipped, and there are not enough health educators to give advice to patients.
A review of the health team necessary for the work of the family physician reveals a lack of vital professionals such as a social worker, a psychologist, a counselor, homecare team and a qualified secretary. Sometimes, there is not even a nurse, a key member of the health team. The physician is therefore, put in the awkward situation of being unable to give necessary help to the patient. The patient, consequently, goes elsewhere (a private clinic or hospital) for help. Needless to say, this situation completely negates the idea of family medicine and continuous care for the patient. Consequently, the family physician is ineffective although qualified and competent. Under similar circumstances the cardiac surgeon would not be able to perform any heart surgery.
For any positive change to occur, there should be the awareness of the limitations in the practice of family and community medicine. International standards of the practice of family and community medicine should be studied and considered for local implementation.
As a first step, there should be a system of assigning family physicians to each family in the Kingdom of Saudi Arabia. The Ministry of Health and other government health services may consider utilizing the services of the family physician on a contractual basis rather than full time to provide health care for the family members. This system may be very useful to the health insurance system in the Kingdom. The family physician is the gateway to health care. The government as well as the health insurance companies should ensure the provision of high quality of health care for the family members and the community, the reduction of wastage in the health services and ensure continuous care for each individual on the list of the family physician.
A direct contract with the family physician would make it possible for him to view himself as a novel specialist capable of giving a great deal to all family members. He will find it satisfying and rewarding to provide his patients total care including health education and counseling. He is the leader of the medical or health team, responsible for their financial and other rights. Awareness that hard work and greater effectiveness have better financial rewards will speer him on to give his best to his patients and staff.
This issue needs urgent consideration for immediate implementation. "Think big, start small but act now".