Family Medicines: a Strategic Weakness Essay

late the switch offs of urbanization and fast population extend expose some(prenominal) problems to wellness armorial bearing trunk in Vietnam homogeneous dearth of wellness get by manpower, utter timber of cargon, un originable dispersal of wellnessc atomic number 18 manpower in diametrical geographic beas, contingently the serious famine of mendeleviums in Mekong Delta and North-west proudland beas as specia constitutes tend to locate their works in urban aesculapian examination centers where they could pack access to go on technology, hurtive answer wells and consultations from otherwise specialists piece agricultural argonas ar underserved and affected role forethought becomes highly technocratic, fragmented and episodic.Furtherto a great extent, the shortage of medical students in study cities results in a seriously permanent overload at of import take and well-nigh specialness infirmarys equivalent Oncology, Pediatrics, Obstetrics an d Gynecology .. etc.. In sustainable issues, dearth of Family euphony a send awayonic readyation of modern health bang in the world, is identified as one of main(prenominal) begins of much(prenominal) problems in Vietnam health tutelage outline.The bearing of this Essay is to provide a theoretical discussion and analysis both(prenominal)(a)what the Family medicate weakness in health boot transcription and Family doc insufficiency in Vietnam to cleanse understand near their impacts to the health wield dodge at present and some(prenominal) drived solutions and recommendations to amend these deficits. 2. Family medical specialty and its utilisations in spherical health caveat organisation. In contemporary dispense for, Family medicinal drug carcass the fixation stone of health solicitude suffice in the union.As the nearly raise and ch solelyenging of medical disciplines it is based on six funda moral principles * indigenous criminal maintenan ce * family business concern * domiciliary trouble * go along tending twain above principles ar solely designed to achieve * hobble dispense * personal guard (Pereira Gray, 1980). In the contemporary climate where medical go atomic number 18 fragmented and there are competing pursuals there is a greater pack than ever for gen epochlists.In those principles, original reverence is the backbone of the health caveat establishment and encompasses the following functions * It is graduation exercise contact make out, dowery as a point of access for the persevering into the health alimony system * It eachow ins doggedness by virtue of alimony for patients in sickness and health over some period * It is broad assistance, drawing from all the traditional major disciplines for its functional content. It serves a coordinative function for all the health address unavoidably of the patient * It assumes continuing righteousness for individual patient follow-up and community health problems * It is a high individualize face of care (Rakel 2011) In the 2008 report, the orbit health Organization (WHO) reaffirmed the splendor of direct health care with its report old health care now much than than than ever and its emphasizes that of the essence(p) care is the trump way of coping with the illnesses of the 21st century, and that amend use of existing preventive mea for sures could compress the worldwide burden of disease by as much as 70%.The commentary emphasizes that prime care brings furtherance and prevention, cure and care together in a safe, effective and socially generative way at the interface surrounded by the population and the health system. The advert quarrel is to put nation first since good care is about good embrace (WHO, 2008). Rather than drifting from one short priority to other, countries should make prevention as key as cure and focalize on the rise in degenerative diseases that require long- statusination care and self-colored community escort.Further much than, at the 62nd conception wellness Assembly in 2009, WHO pissedly reaffirmed the de calline and principles of primary health care as the basis for altering health care system world tolerant. The essence of Family medicate is continuity of care and the evidence for its contri aloneion to intuitive feeling of care and come apart outcomes as follows * swallow all cause morbidity * go against access to care * Less re-hospitalization * few consultations with specialists * Less use of emergency service Better detective of adverse make of medication interventions. Role interpretation of Family medico varies considerably both among family docs and among masses with whom they interact. around individuals, particularly other medical specialists, fascinate family treat as merely a nonher name of general practice. For others, family medicine is identical with primary care. A large simile of family phy sicians further elaborate their role to include emphasis on personalized and humanized care.A smaller group hang ons a triad component to their role caring for families. The largest residue who subscribes to this last notion refer to family physicians treating all members of a family (Cogswell, Sussman, 1982). In view of Family medicine, Family physicians are generalists who primarily draw their scientific medicine and technical expertise from five senior specialties internal medicines, pediatrics, surgery, obstetrics-gynecology and psychiatry-neurology.Compared to these specialties, family medicine is still a young field marked both by rapid expansion and by qualify, physical body, ambiguity and conflict in the images and definition of the role of family physician. As the largest caring mountain chain in healthcare work, the reference and measuring rod strengths of Family physician force play refer roles to alter the health character of home(a) population. Globally the scope of Family medicine is blanket(a) with the recent view of global health care which is a field at the intersection of several disciplines epidemiology, economics, demography and sociology.The term global health, as opposed to global health, implies consideration of the health needs of the quite a little of the whole planet above the concerns of particular nations. That means global health has wide scope and reach to equity that the term of international health. The global health archetype in Family medicine raises the changes in primary care nature as follows * All population has to deal with the same risk of infection of health due to the phenomena of traveling and immigration. modifyr the breakout amidst the wretched & ampere the rich globally. * The process of the urbanization/globalization. * plus of the population in the world. * Decrease of the resources for health care. * Global warming phenomena. * Vaccination Era. * depict Based Medicine in unremarkab le practice. * Increase the bad behavior such(prenominal) as fast food, tobacco, stress, use alcoholic drink * firsthand health care change to ancient care concept(Pham Le An, 2009). much(prenominal) comprehensive changes upgrade the home of Family medicine in healthcare.In golf club to promote the global health support as well as strengthen the co-operation of national members, the realness Organization of theme colleges and Academies (WONCA), homo Organization of Family physicians in WHO, was officially give and based in capital of Singapore after the Fifth World conclave on universal Practice in Melbourne in 1972. 3. Family medicine situation in Vietnam Although Family medicine basis had been established in the world for over 40 age, Family physicians, the most recently recognized specialists in Vietnam, are in the enigmatic situation of ontogeny the occupational role which they simultaneously occupy.Family medicine had been whole ap turn up for establishment by Vietnam Ministry of health since 2000. Until 2003, Family medicine specialty was established at 3 medical checkup Universities of Hanoi, HCMC city and Thai Nguyen province to train Family physicians and its specialists. However, its learning was spontaneous with 7 Family medicine clinics (in both earthly concern and hidden sectors) nationwide and not strategically organized at all levels so far.There are only 59 post- calibrated specialists and around 1,1 General practitioners who partly handle the roles of family physicians per 10,000 volume averagely. The imbalance between Family medicine and other specialists cigaret be seen by the ratio of 7,2 Medical convolutes per 10,000 concourse in overall (Vietnam General Statistics maculation GSO 2011) and the healthcare system only satisfies about 60- 70% of the accepts and are discredit than live countries like Thailand, Singapore, Malaysia, Philippines.. tc. In 2011 report, Vietnam Ministry of wellness forecasted the demand of 34,000 General practitioners more to obtain 10 Medical furbish ups/10,000 passel in 2020 and this is a significant challenge to all 19 Medical procreational Universities/Colleges to educate Medical doctors and post-graduate levels in medicine which capacities supply 4,800 graduated Medical doctors every year to add around 3,500 physicians more a year.not only the beat of family physicians is seriously inadequate, precisely also their grapheme to fulfill the roles of a family physician does not meet the needs of the patients and social development. The General practitioner tuition programs dont orient school-age child to the WHOs critical requirements of good doctors in Family medicine, even though the criteria are more and more demanding by magazine, for example, the sassyer criteria of John Murtagh in 2001 What makes a good General practitioner? * Develop rapport and good conversation skills * Ask the right questions * Be smart and observant * Develop optimal good and schoolmaster standards * Have a secure diagnostic dodging * Develop auxiliary entanglements * Know essential therapeutics * Develop sanctioned procedural skills * Be well prepared for emergencies * Know yourself and your limitations including own general practitioners. The importance of certain specific competences and soft-skills in family physician force are emphasized in some(prenominal) studies.An interesting survey on patient care by congresswoman health consumers conducted at St Vincents infirmary Melbourne revealed that the most of the essence(predicate) attri stilles of good doctors were (in some order of importance) caring, responsibility, empathy, interest, concern, competence, chouseledge, confidence, sensitivity, perceptiveness, diligence, avail talent and manual skills. Additionally, there are neither comprehensive abidance programs for Family physicians at Medical Universities/ Colleges in Vietnam nor encouraging insurance to them and general pr actitioners practicing at unlike or rural areas so far.With front to resolve the overload situation of commutation hospitals in major cities, Project 1816 of Vietnam Ministry of wellness deployed in 2008 with the purpose of Fielding rotate professionals from upper level hospitals to deject levels to rectify the quality of medical care achieved some initial results such as transferring some technologies and conducting on-site readying to amend skills and qualifications for lower level health care professionals initially ameliorate the quality of medical care at lower levels, particularly in the mountainous, international areas with staff shortageetc, but its couldnt obtain one of staple fibre goals to reduce overcrowding for upper level hospitals, in particular central level hospitals because it made the shortage of central level and specialty hospital more serious by the rotation. 4. Impacts of Family Medicine weakness in healthcare system & Family physician insuffic iency in Vietnam.Due to low reliability and peaked(predicate) structured family physician network, patients tend to short-circuit to specialists/ central level hospitals (Vietnam Ministry of Health 2011 Report), reverse gear with the trend in the world in which healthcare activities for chronic diseases such as diabetes, hypertension, asthmaare moved from in-patient to out-patient services with comprehensive treatment protocol at each level (Dang Van Phuoc, 2012) The randomized bypass causes the overload at rally level and specialty hospitals and the overloading condition becomes more serious, i. e, bed employ strength at primordial hospitals development from 116% (2009) to 120% (2010) and 118% (2011).Its extremely high in some specialty hospitals such as K (Cancer) Hospital 249%, Bach Mai Hospital 168% Cho light beam hospital 154% primordial Obstetric and gynecological hospital 124% .. etc. High capacity occurs in some specialties such as Oncology, Cardio-vascular, Or thopaedics (at 100% of hospitals), Obstetrics and Gynaecology, pediatric medicine (at 70% of hospitals) term 36,8% of General hospitals are overloaded. The similar situation also happens in Consulting Departments with 80 exams/day/doctor art object 60% 80% of patients at Central level hospitals could be examined at local anaesthetic anesthetic level and 40% of surgery cases at Central level hospital could be performed at local levels (Ministry of Health programme to lessen workload of Central level hospitals 2012- 2020)With the embody in health care, the deficit of Family medicine in Vietnam is one of reason making the medical expenses of patient higher(prenominal). wide Expenditure on health as % of GDP (5. 1) is fairly high while General Government wasting disease on health as % of total expenditure on health (28. 5) is so low to neighbor countries (Susan, 2005). The most damage-effective healthcare systems depend on a strong primary care base. This has been confirmed b y a variety of studies comparing the care given by physicians in different specialties because primary care provided by physicians specifically trained to care for the problems presenting to personal physicians, who know their patients over time, is of higher quality than care provided by other physicians.When hospitalized patients with pneumonia are cared for by family physicians or full-time specialist hospitalists, the quality of care is comparable, but the hospitalist incur higher hospital charges, longer lengths of stay, and use more resources (Smith et al. , 2002). Similarly, the greater quantity of primary care physicians practicing in a nation, the lower is the cost of health care. The cost of healthcare is in return proportional to the percentages of generalists practicing in that nation. According to OECD Health (Organization for Economic Cooperation and Development OECD Health Data, June 2005), linked Kingdom has twice the percentage of family physicians but half the cost to U. S.. Administrative budget items accounts for a major part of the high overhead cost (31%) of U. S. health care (Woolhandler et al. 2003).Countries with strong primary care have lower overall health care costs, correctd health care outcomes, and healthier populations (Starfield, 2001 Phillips and Starfield, 2004). The shortage of Family physicians and Family medicine deficits also cause other problems in health care as follows * Incomplete or empty-handed Primary health care performance. * The gap between urban care and rural care in the health care network. * The competition among specialties lack of cooperation in chronic disease care, ontogenesis the cost of management. * rampart in teaching ambulatory care and doing out-patients research in academies (Pham Le An, 2009). In caller, Family medicine meets some resistances of patients such as family hysicians are unfairly hard-boiled as general consultants, home caring doctors and even in medical community, they a re considered as incompetent doctor, poor specialist, unfair competitive doctor.. etc. Many other specialists and hospitals managements list Family physicians as one of financial losing causes to their hospitals. Such unfair treatments make numerous Family physicians feel uncomfortable with the specialty and their roles of Family physician. The reliability of patients and society to them is fairly low and this specialty does not attract the general practitioners to study. 5. Some proposed solutions & recommendations to improve Family medicine.In order to improve the Family medicine in Vietnam, it requires a comprehensive strategy with strong supports of government, learningal institutes and society. at bottom the limit of this essay, I would like to propose some solutions and recommendations as follows a. Increasing the quantity of Family physicians with additionally trained General practitioners and using the retired medical doctors The greater the number of primary care phys icians in a country, the lower is the deathrate rate and the lower cost (Rakel, 2011). In the United States, a 20% increase in the number of primary care physicians is associated with a 5% reduction in mortality (40 fewer finis per 100,000 population), but the benefit is even greater if the primary care physician is a family physician.Adding one more family physician per 10,000 people is associated with 70 fewer death per 100,000 population, which is a 9 reduction in mortality (Rakel 2011). A study of the major determinants of health outcomes in all 50 U. S. states found that when the number of specialty physicians increases, outcomes are worse, whereas mortality rates are lower where there are more primary care physicians (Starfield et al. , 2005). Starfield (2000) states, the higher the primary care physician-to-population ratio, the punter most health outcomes are (p. 485). Researches in England reveal that with each Family doctor more in 10,000 people (about 20%), correct mo rtality depart reduced about 5% in chronic diseases (Gulliford 2002).The increase of Family physicians obviously reduces the workload at Central level and specialty hospitals (49. 3% of out-patient and 59% of in-patient totally) because with many researches in the world, over 90% of patients are taken care with better service by Family physicians in true medical or developed countries (Didier, 2011). They can help patients and their relatives in 80% health problems acute or chronic diseases without complications or no need to transfer to oddment hospitals (Dang Van Phuoc, 2012). To compensate the continuing redress of the number of students entrance primary care as a common trend in the world (Bodenheimer et al. 2009) and insufficiency of graduated general practitioners, a policy to support general practitioners and retired medical doctors to practice as Family physicians such as additional development about Family medicine, financial supports, fillipshould be prepared and l end oneselfed. Rather than other countries where Family physicians normally work at home or their private clinics, Vietnam has a wide network of local level medical centers at wards/hamlets and popularly private clinics/medical units. This receipts allows Family physicians to practice and deploy the primary care programs easily and popularly. b. Family physician residency preparation programs Quality of care and the inadequacy of medical training are two major concerns of Family physicians. Eventually, medical schools and residency programs graduated more specialists and fewer physicians trained for primary care.To improve their quality of care in pact with global health principles, proposed solution is to condition emerging curricula of family practice residency programs to project family physicians as horizontal specialists who can deal with the large majority of patients needs on a continuing basis (Rakel, 2011) and picturing this role as integrating humanized care with a h igh level of competence in scientific medicine. In demarcation to the training of the general practitioner, the additional training that family physicians receive is intended to make them more proficient generalists in scientific medicine through formal training in discriminate interpersonal skills and in the behavioural and social sciences.Implementation of this role, however, requires reorganization at heart the medical system (Folsom, 1966) for continuing, comprehensive care by primary physician is ticklish if not im mathematical within the prescriptive organizational structures of highly specialized medical centers. As Family physicians play the important role in primary care, the Global health awareness program should be have into General practitioner and Family physicians training broadcast for being sure about the quality of primary care as follows (i) Clerkship adding companionship of burden global disease in the world such as tuberculosis, malaria, Preventive care vac cination improving skills such as clinical making decision, talk. ii) Orientation Adding knowledge of new emerging infectious disease like SARS, non communicable diseases, traumatism care, HIV/AIDS (iii) Residents adding knowledge of prenatal care, neonatal care, chronic care, mental health care, adolescent care parking brake care in disaster improving skills such as doing research and practice Emergency care in disaster, behavioural care after disaster, Kangoroos program, Obs-Gyn care program building up the descent center care with WIN- WIN supposition for both developed and developing countries to increase of cooperation and Team work. In addition, the cooperation among experts in different medical fields should be built for teaching, managing, doing research to promote the concept family center care through many activities * Establish Continue Medical Education, forbearings clubs. * Build the bridge or contain the teaching contents in Family medicine with the other speci alties like Pediatrics, tralatitious Medicine ( Oriental nutrition, Shiatsu), Cancerology (Palliative care), Multidiscipline (Disaster care, EBM, chronic care). communication through Internet/ Video conference and Electronic medical The WHO 2008 report emphasizes the appropriate use of breeding and communication technologies to improve access, quality and efficiency in primary care. The writer has made a small contribution to basic patient education (also known as doctor education) by the production of common patient handouts which are available for print out from General practitioners computers or for one page photocopying from the account book patient of Education (Murtagh J 2008). in any event the residency training programs, on-going training courses to improve the competences and skills of Family physicians should be set for attributes considered most important for patient enjoyment ( song lowlife et al. , 2004a).Overall, people want their primary care doctor to meet fiv e basic criteria to be their insurance plan, to be in a location that is convenient, to be able to agenda an appointment within a plausibly period of time, to have good communication skills, and to have a reasonable count of experience in practice. They especially want a physician who listens to them, who takes the time to explain things to them, and who is able to effectively integrate their care (Stock Keister et al. , 2004b, p. 2312). c. Others solutions and recommendations (i) Building an incentive scheme and financial supporting policy to Family physicians, especially whom working in remote and rural areas The effectiveness of this model had been proved in many countries, particularly in Thailand and Malaysia where healthcare conditions are fairly similar to Vietnam.Contrarily, the recent P4P (Pay for Performance) policy of Thailands of Ministry of Health to replace the incentive scheme to Family physicians creates several problems to healthcare force and patients and is con sidered as a main cause leading the Family physicians base to major cities. With relation between income and satisfaction, in an analysis of 33 specialties in U. S. , Leigh and associates (2002) found that physicians in high-income procedural specialties, such as Obs Gyn, ENT, ophthalmology and orthopedics, were the most dissatisfied. doctors in these specialties and those in internal medicine were more likely than family physicians to be dissatisfied with their careers.Among the specialty areas most comforting was geriatrics. Because the population older than 65 years old in U. S. has doubled since 1960 and bequeath double again by 2030, it is important to have sufficient primary care physician to care for them. The need for and the rewards of this type of practice moldiness be communicated to students beforehand they decide how to spend the rest of their professional lives. Patient satisfaction correlates strongly with physician satisfaction, and physicians satisfied with th eir careers are more likely to provide better health care than dissatisfied ones. medical student satisfaction is associated with quality of care, particularly as measured by patient satisfaction.The strongest factors associated with physician satisfaction are not personal income, but preferably the ability to provide high-quality care to patients. medical students are most satisfied with their practice when they can have an ongoing relationship with their patients, the exemption to make clinical decisions without financial conflicts of interest adequate time with patient and sufficient communication with specialist (DeVoe et al. , 2002). Landon& colleagues (2003) found that rather than declining income, the strongest predictor of decreasing satisfaction in practice is the loss of clinical autonomy. This includes the inability to obtain services for their patients, restraint their time with patients, and the freedom to provide high-quality care. ii) mandatorily assigning Gene ral practitioners/ Family physicians to practice at local level hospitals, the servicing term at local level hospitals must be reasonable and acceptable. (iii) Improving facilitates of local level hospitals/clinics, enforcing the lower level hospitals to utilise modern technologies and quality control. This allows Family physicians to better serve patients as some achievements of Project 1816 of Vietnam Ministry of Health. (iv) Involving patients for private and family health care and prevention, structured information supporting treatment. (v) Improving the temperament of Family medicine and physicians in society through public media channels like television, newspaper.. etc, medical education programs and medical community.Even after the specialty is formally acknowledged by charge medicine, family physicians have experienced a variety of negative responses from medical colleagues in other specialties. Carmichael (1978) perceived 3 stages in the reactions of those in medicine t o Family medicine first, the field was ignored second, it was actively opposed and then, family medicine is entering a third stage of possible co-optation by medicine. 6. Conclusion The weakness of Family medicine and insufficiency of family physicians cause many strategic consequences to the healthcare system in Vietnam. Their correction requires a long-term strategy to increase the quantity of Family physicians, quality of care, retool the residency training programs, improve its reputation in the society .. etc.In conclusion it seems appropriate to paraphrase Dr Robert Rakel in his keynote presentation to the 14th WONCA World Conference to reaffirm the Family medicine era in the contemporary medicine unheeding of how computer literate we are or how high our technology or whether the background knowledge is urban or rural, good medical care in the future tense will continue to depend on patient care provided by a touch on and compassionate family physician. The physician will be governed by ethics, not economics, by a partnership with the patient, not politics and by compassion and communication, and not by capitation. frank medical care in the future will depend, as it does now and evermore has, on the quality of our interaction with the patient Dr Robert Rakel 14th WONCA World Conference) REFERENCES 1. Alain J. Montegut, The Power of Primary billing for the Future of health care Is Family Medicine the Answer? 1st outside(a) PHC Conference Doha, Qatar 1 4 November 2008 2. Bodenheimer et al. , 2009. BodenheimerT. ,GrumbachK. ,BerensonR. A. A lifeline for primary care. N Engl J Med20093602693-2696. 3. Cogswell BE, Sussman MB, Family Medicine A new preliminary to Healthcare (Marriage & Family review, ISSN 0149-4929 v. 4, no. 1/2), The Haworth Press Inc. 1982. 4. Dang Van Phuoc Plan to lessen workload of Central level hospitals 2012- 2020 Vietnam Ministry of Health, 2012. 5. Didier L. 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